What is the significance of mild pulmonic regurgitation and right ventricular systolic pressure (RVSP) of less than 30mmHg in a 26-year-old with minimal symptoms?

From the Guidelines

Mild pulmonic regurgitation with an RVSP less than 30mmHg in a 26-year-old with minimal symptoms is generally considered a benign finding that requires no specific treatment. This condition can be monitored with routine follow-up every 5 years with a clinical examination and Doppler echocardiogram, as suggested by the guidelines 1. The normal RVSP (below 30mmHg) indicates the absence of pulmonary hypertension, which is reassuring. Pulmonic regurgitation is often well-tolerated by the right ventricle for many years or even decades before causing any significant symptoms or cardiac remodeling.

According to the 2018 AHA/ACC guideline for the management of adults with congenital heart disease 1, mild PR and RV enlargement can be managed with interval follow-up, and pulmonary valve replacement is considered for those with progressive RV dilation and/or RV dysfunction and/or progressive decrease in exercise capacity. However, in this case, the patient has minimal symptoms and an RVSP less than 30mmHg, which suggests that the condition is not severe and does not require immediate intervention.

The patient should maintain a healthy lifestyle with regular exercise and a heart-healthy diet, but no activity restrictions are necessary. This condition represents a normal variant in many young adults, as the pulmonic valve often has a small amount of physiologic regurgitation that does not impact cardiac function or long-term health outcomes. The minimal symptoms reported are likely unrelated to this cardiac finding and may be addressed separately based on their specific nature.

Key points to consider in the management of this patient include:

• Routine follow-up every 5 years with a clinical examination and Doppler echocardiogram 1
• Maintenance of a healthy lifestyle with regular exercise and a heart-healthy diet
• No activity restrictions are necessary
• Monitoring for any changes in symptoms or cardiac function, and addressing any new symptoms separately based on their specific nature.

From the Research

Significance of Mild Pulmonic Regurgitation

• Mild pulmonic regurgitation is a condition where the pulmonary valve does not close properly, allowing blood to flow back into the right ventricle 2.
• In a 26-year-old with minimal symptoms, mild pulmonic regurgitation may not be immediately concerning, but it can still have long-term implications for cardiac health 3, 4.
• The right ventricular systolic pressure (RVSP) of less than 30mmHg is within normal limits, which suggests that the right ventricle is not experiencing excessive pressure or strain 5.

Impact on Exercise Capacity and Ventricular Function

• Studies have shown that pulmonary regurgitation can limit exercise capacity in patients with repaired tetralogy of Fallot, particularly those with moderate to severe regurgitation 6.
• However, in patients with mild pulmonic regurgitation and normal RVSP, exercise capacity may not be significantly impaired 3, 6.
• The relationship between pulmonic regurgitation and ventricular function is complex, and further studies are needed to fully understand the implications of mild regurgitation on long-term cardiac health 3, 2.

Diagnostic and Prognostic Considerations

• Echocardiography and magnetic resonance imaging (MRI) are useful tools for assessing the severity of pulmonic regurgitation and monitoring cardiac function over time 2.
• The tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) are non-invasive indices that can provide complementary prognostic data in the management of chronic pulmonary regurgitation 3.
• Regular monitoring and follow-up with a cardiologist are essential to assess the progression of pulmonic regurgitation and adjust treatment plans as needed 4, 5.