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Pulmonary Valve Regurgitation
Children’s heart conditions can’t be prevented, but a lot can be done to improve and often completely repair their hearts at any age. Thanks to advanced technology and the pediatric heart experts at the Nemours Cardiac Center (based at Nemours/Alfred I. duPont Hospital for Children), most children born with a heart problem — even newborns only hours or days old — can be quickly diagnosed and treated right when it matters the most. At the Cardiac Center, we specialize in early detection and repair of congenital heart defects (also often called, “congenital heart disease”).
If your child’s been diagnosed with pulmonary valve regurgitation (also called “pulmonary insufficiency”), we’re here to ease your concerns, answer your questions, and give your child the best possible chance for a healthy future.
Pulmonary valve regurgitation refers to leakage of the pulmonary valve, which is the valve separating the right ventricle (the lower right chamber of the heart that receives oxygen-poor blue blood from the right atrium) from the pulmonary arteries (the arteries that deliver blood to the lungs).
Normally, in between heartbeats, the pulmonary valve closes and prevents blood from flowing backward back into the heart. With pulmonary insufficiency, the right ventricle must pump more blood than usual because some of the blood it pumps out with each beat flows back and must be pumped out again. Over time, this causes enlargement of the right ventricle (“dilatation”) to help the ventricle pump more blood. Eventually, the enlargement becomes inefficient and children may develop heart failure.
How Does the Heart Normally Work?
When your child has a congenital heart defect, there’s usually something wrong with the structure of the heart. In order to understand your child’s condition, it can help to know how the heart should work normally.
Learn More About Normal Cardiac Anatomy »
Nemours’ experts at KidsHealth.org also offer these helpful resources to help both you and your child understand how the heart works:
Pulmonary valve regurgitation rarely occurs on its own. Most commonly, it’s the result of repairing other congenital heart defects that include an abnormal or small pulmonary valve (such as pulmonary stenosis, or tetralogy of Fallot (see Tetralogy of Fallot).
As part of treating those conditions, the pulmonary valve is often opened up and leaks. Although in some children, the heart tolerates that regurgitation for the rest of their lives, many will eventually develop right ventricular enlargement. This is usually diagnosed when children develop fatigue or other signs of heart failure, although it may also be identified during routine follow-up after earlier operations. Diagnostic tests to evaluate the valve and heart function might include cardiac MRI or an echocardiogram (“echo”).
Because pulmonary valve regurgitation may not cause any problems until a child is well into adulthood or beyond, the amount of leakage at the valve doesn’t tell us whether or not a child needs surgery. Instead, we focus on the size of the right ventricle and whether a child has symptoms. Our Nemours Cardiac Center heart surgeons may recommend valve repair or replacement in order to prevent the enlargement of the right ventricle from becoming irreversible and to treat symptoms. In most children, treatment involves a valve replacement.
Valve replacement involves using an artificial valve, or a valve from a different person or animal to replace the child’s nonfunctioning valve. There are multiple options for different types of valve replacement that your heart surgeon will discuss with you.
Most children will get either:
- valve made of animal tissue (called a “bioprosthetic” or “tissue” valve)
- donated human valves (called “homografts”)
Depending on the child’s age and size, and which other operations the child has had before, certain children may be able to have a valve placed through a catheter (a tube inserted into a vein in the leg), rather than having to get surgery.
Sometimes, children with pulmonary valve regurgitation don’t need a valve replacement and live into adulthood without symptoms. When a valve replacement is required, most children’s symptoms will significantly improve. The valve replacement itself isn’t a reason to limit physical activity, although each child and family should discuss exercise limitations with their cardiologist. Artificial valves don’t last forever, but in most cases we expect the valve to last between 10 and 15 years — at which point another operation (or a catheter inserted valve) may be required.
If your child has pulmonary valve regurgitation, know that at the Nemours Cardiac Center we’re here to give your child the very best, most comprehensive and compassionate care. Our goal is to guide your family, from start to finish, through your child’s heart disease journey — and to help your child live the healthiest, most fulfilling life possible.
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Information for Patients
Outpatient Services and Inpatient Units: (302) 651-6660
After 5 p.m. and Weekends:
Cardiac Intensive Care Unit: (302) 651-6644
General Inpatient Unit, 2B: (302) 651-6690