From the Guidelines
The pulmonic valve is normal, with no evidence of stenosis or regurgitation, and therefore requires no intervention. The peak velocity of 1.0 m/s and peak gradient of 4 mmHg are within normal limits, as are the mean velocity of 0.8 m/s and mean gradient of 2 mmHg, indicating normal blood flow from the right ventricle to the pulmonary artery without obstruction or backward leakage 1. According to the European Association of Cardiovascular Imaging, the assessment of prosthetic heart valves, including the pulmonic valve, should include peak velocity, peak and mean pressure gradient, and presence, location, and severity of regurgitation 1. In this case, the hemodynamic parameters are within normal limits, and there is no evidence of pulmonic stenosis or regurgitation. The pulmonic valve typically has the lowest pressure gradients among the four cardiac valves due to the lower pressure system of the pulmonary circulation compared to the systemic circulation. Regular cardiac follow-up can continue as previously scheduled, with periodic clinical follow-up recommended for all patients with congenital heart disease, including those with normal pulmonic valves, to monitor for any potential hemodynamic abnormalities 1. Key points to consider in the follow-up of patients with normal pulmonic valves include:
- Monitoring for signs of pulmonary regurgitation, such as a soft and short murmur, or minimal turbulence on echocardiography 1
- Assessing RV pressure, size, and function, as well as TR, to determine the frequency of follow-up 1
- Considering the potential need for pulmonary valve replacement in patients with severe RV enlargement or dysfunction, or those with deteriorating exercise capacity or onset of atrial or ventricular arrhythmias 1.
From the Research
Pulmonic Valve Structure and Function
- The pulmonary valve consists of 3 leaflets and is similar in anatomy to the aortic valve 2
- It is the least likely to be affected by acquired disease, and thus, most disorders affecting it are congenital 2
Pulmonic Stenosis
- The most common hemodynamic abnormality of the pulmonary valve is the congenitally narrowed domed valve of pulmonic stenosis 2
- Pulmonary stenosis is usually well tolerated in its mild and moderate forms 2
- Congenital causes of pulmonic stenosis constitute well over 95% of these conditions, including acommissural dome-shaped, dysplastic, and bicuspid types 3
- Rare acquired causes of pulmonic stenosis include carcinoid, rheumatic, and infective endocarditis 3
Pulmonic Regurgitation
- Pulmonary regurgitation (PR) is common in patients with congenital heart defects (CHD) and contributes to morbidity and mortality in the long-term 4
- Causes of pure pulmonic regurgitation include conditions associated with anatomically abnormal valve cusps (congenital, rheumatic, carcinoid, trauma, and infective endocarditis) and conditions associated with anatomically normal cusps (elevated pulmonary artery systolic pressures, idiopathic dilated pulmonary trunk, and Marfan's syndrome) 3
- Echocardiographic assessment of PR is feasible, and parameters such as pressure half time (PHT) and slope can be used to predict the indication for pulmonary valve replacement (PVR) 4
Diagnosis and Treatment
- Echocardiography is a useful tool for diagnosing and assessing the severity of pulmonic stenosis and regurgitation 4, 5
- Cardiac magnetic resonance imaging (CMR) can also be used to assess the severity of pulmonic regurgitation and predict the need for pulmonary valve replacement 4, 6
- Natural language processing (NLP) algorithms can be used to identify patients with pulmonic valve stenosis and regurgitation from transthoracic echocardiography (TTE) reports 5