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Pulmonic regurgitation
- Authors
- Alexander C Egbe, MD, MPH
Alexander C Egbe, MD, MPH
- Assistant Professor of Medicine
- Division of Cardiovascular Diseases
- Mayo Clinic
- Heidi M Connolly, MD, FASE
Heidi M Connolly, MD, FASE
- Section Editor — Congenital Heart Disease
- Professor of Medicine
- Mayo Medical School
- Section Editor
- William A Zoghbi, MD, FASE, FAHA, MACC
William A Zoghbi, MD, FASE, FAHA, MACC
- Section Editor — Valve Disease
- Professor and Chairman
- Department of Cardiology
- Elkins Family Distinguished Chair in Cardiac Health
- Houston Methodist DeBakey Heart & Vascular Center
- Houston Methodist Hospital
- Deputy Editor
- Susan B Yeon, MD, JD, FACC
Susan B Yeon, MD, JD, FACC
- Deputy Editor — Cardiovascular Medicine
Physiologic trace to mild pulmonic valve regurgitation (also known as pulmonic regurgitation or PR) commonly occurs in normal individuals. Greater degrees of PR are caused by various disorders and can lead to right ventricular volume overload and right heart failure.
The causes, clinical manifestations, diagnosis, and treatment of PR are discussed here. Echocardiography of the pulmonic valve is discussed separately. (See "Echocardiographic evaluation of the pulmonic valve and pulmonary artery".)
The etiologies of pulmonic regurgitation (PR) can be classified into physiologic, primary, and secondary causes. Primary causes include iatrogenic, infectious (infective endocarditis), immune-mediated (rheumatic heart disease), systemic (carcinoid disease), and congenital [1-3]. Secondary or functional PR occurs in patients with morphologically normal pulmonic valve who have pulmonary artery dilatation and/or severe pulmonary arterial hypertension [4,5]. (See "Classification and prognosis of pulmonary hypertension in adults" and "Clinical features and diagnosis of pulmonary hypertension in adults".)
Physiologic trivial or mild PR is a common finding on color Doppler echocardiography of normal hearts [6-8].
The most common cause of severe PR is iatrogenic, due to surgical valvotomy/valvectomy or balloon pulmonary valvuloplasty performed for right ventricular outflow tract obstruction as a component of Tetralogy of Fallot (or other conotruncal abnormality) repair [9-12]. Other causes of severe PR include endocarditis and carcinoid. (See "Pathophysiology, clinical features, and diagnosis of tetralogy of Fallot" and "Management and outcome of tetralogy of Fallot" and "Clinical manifestations and evaluation of adults with suspected native valve endocarditis" and "Clinical features of the carcinoid syndrome".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
Subscribers log in hereLiterature review current through: Oct 2017. | This topic last updated: Jul 25, 2017.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References
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- Symptoms and signs
- Test findings
- - Electrocardiogram
- - Chest radiograph
- Approach to diagnosis and evaluation
- Echocardiogram
- Cardiovascular magnetic resonance
- Computed tomography
- Exercise testing
- Cardiac catheterization
- Monitoring
- Medical therapy
- Intervention
- - Surgical
- Indications
- Valve choice
- - Percutaneous
- Follow-up


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State Sen. Brian Nieves, who represents this area, voted against the incentive package the state will offer Boeing to locate facilities here to build its new 777X commercial airliner.
The state Senate approved the incentive program, proposed by Gov. Jay Nixon, Wednesday by a vote of 23-8. Nieves, a Republican, was one of eight GOP senators who voted against the proposal.
The House was expected to approve the proposal Friday.
Nieves did not respond to a call by The Missourian prior to the Senate vote to determine his position on the issue.
The issue is of major importance to this area since companies here do work for Boeing, and if its new facilities are located in the St. Louis area, it is expected to create new jobs in this immediate area.
Darren Lamb, Washington's economic director, briefed the 353 Redevelopment Corporation Thursday on the Boeing matter. He gave board members a copy of an email sent to this area's elected representatives in Jefferson City Tuesday, informing them of the importance of the Boeing project to the Washington area.
In the letter, it was pointed out that plants here now manufacture parts for Boeing, and that tool and die companies also do work for Boeing. This area is home to more than a dozen tool and die businesses that employ 500 or more workers in total. The letter mentioned two companies in particular that do work for the aerospace industry — Valent and RTI Tradco. The two Washington companies employ more than 370 full-time workers.
"This contract would have a positive effect on over 700 suppliers within Missouri, including the two industries mentioned — Valent and RTI Tradco," the letter stated. "For example, RTI Tradco has noted that with the phasing out of the C-17 program and the F-15 production uncertain, the new program to build the 777X will be critical to continued job growth at the Washington facility. With regard to Valent, it currently has over 250 orders for parts specific to the 777. It is poised to expand if the 777X is to be manufactured within the St. Louis region."
The Washington industrial corporations urged the area lawmakers to consider "a responsible, yet competitive incentive package for Boeing." The letter was signed by the president of the two industrial corporations, Bill Miller, Sr. The two corporations are the 353 Redevelopment Corporation and the Civic Industrial Corporation.
In the Senate Wednesday on the $1.7 billion incentive package over two decades, 15 Republicans voted for the package, along with eight Democrats. As mentioned, eight Republicans voted "no," and one Republican and two Democrats did not vote.
The house approved the measure Friday.

subset: commoncrawl


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Read more about Machu Picchu – The Lost City of the Incas – located 50 miles northwest of Cusco (Cuzco) above the Urabamba Valley in Peru.
Nestled in the mountain ridge above the Urabamba Valley in Peru lies one of the Wonders of the World, a UNESCO World Heritage Site, and a Peruvian Historical Sanctuary. The Lost City of the Incas, known as Machu Picchu in Quechua, is a historical jewel visited by hundreds of thousands of people each year.
Located only 50 mi (80 km) northwest of Cuzco and 7,970 ft (2,430 m) above sea level, Machu Picchu is one of the most important icons of the Inca world. The Incas built Machu Picchu around 1450 but abandoned it only a century later, in 1572, during the Spanish conquest. The site is particularly important because it one of the few Inca remnants that was not found and plundered by the Spanish. Machu Picchu is one of the most important archeological sites in South America and one of the most visited tourist sites in Latin America.
The Machu Picchu ruins feature 140 structures including temples, sanctuaries, parks and residences with thatched roofs. The unlevel land also required more than one hundred sets of stone steps that were often carved from a single block of granite rock. Water fountains and interconnected channels with water drains were used to irrigate and some evidence shows that holy water was carried via the irrigation system to the houses. The ruins of Machu Picchu are divided into to main sections: the city, or urban section, and the agricultural sector. The city is then subdivided into three districts: the Sacred District, the Popular District, and the Priests and Nobility District.
The Incas were master stone masons and implemented a technique, called ashlar, in which stones were perfectly cut to fit together so tightly that no mortar was needed. This classical Inca architectural style is present in the central buildings of Machu Picchu and also protected the buildings against damage from earthquakes.
It is commonly believed that Machu Picchu was the estate of Pachacuti, an Inca Emperor, and that the location was selected due to its position and alignment with important astronomical events. Other theories include that Machu Picchu was built to: control the economy of conquered regions, use as an Inca prison, test different agricultural techniques, for the Gods to live in, or for special events such as the crowning of kings.
Machu Picchu was brought to international attention in 1911 by Hiram Bingham, Yale lecturer and American historian, who was led to the site by a Quechua boy. He made several trips and conducted excavations which yielded various artifacts that he took back to Yale with him. He coined the name "The Lost City of the Incas" with his first book publication. In 1913, the popular National Geographic Society magazine devoted an entire issue to Machu Picchu and sealed the site's fame. In 2007, Peru and Yale University reached an agreement to share rights over the artifacts that were taken to Yale by Hiram Bingham.
The area around Machu Picchu is spectacular and rich with flora and fauna. In 1981 Peru declared an area of 125 mi2 (325 km2) surrounding the site as a Historical Sanctuary. Despite this, the impact of tourism and uncontrolled development in the region has landed Machu Picchu on World Monument Fund's list of Endangered Sites.
Machu Picchu, an amazing tribute to the Inca culture located in a breathtaking region, is not to be missed on your next visit to Cuzco, Peru.


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By Graeme Bailey
Last Updated: 01/01/70 1:00am
The 32-year-old Salako and Watson go straight into The Royals' squad for their game against Northampton on Saturday as Reading bolster their ranks in a bid to rekindle their floundering promotion campaign.
Manager Alan Pardew was delighted to have got Salako, his former team-mate at Crystal Palace, saying: "I don't want to go overboard on him, I know what he can do and I feel it is a coup for us.
"Any First Division clubs would shake their heads in disbelief that they missed this one.
"As manager of this club I'm desperate to get it right, I haven't sat on my hands, I've acted and I have brought in two players who I feel can help us out.
"I've been after John for 14 months, I always felt he was the one player missing that could take us to another level," he told the Reading Evening Post.
"He can play in three positions, either as a striker, left midfield or left back, which he played in the Cup Final when he was just 21-years-old.
"Both he and Kevin will join for a month and then we'll see how it goes."
Meanwhile, Reading have confirmed the departure of assistant manager Martin Allen, who was dismissed by the club on Thursday.


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National plans cell phone chips to compete with TI, Motorola, Lucent
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SANTA CLARA, Calif. ( ChipWire) -- National Semiconductor Corp. here disclosed plans to build a front-to-back chip set for cellular telephony. Based on a new architecture, the chip set would put National in competition with cell phone IC suppliers like Texas Instruments, Motorola and Lucent Technologies.
National made the disclosure during its technology demonstrations here, which emphasized its strength in market-focused processors and analog components. The company used the demos to take the lid off its wireless WebPAD devices, motor controllers, thin-client terminals, DVDs and audio players. The showings were also intended to show strength in mixed-signal communications and interface ICs, as well as National's own tweaks to the x86 processor architecture.
National's plans to build a complete chip solution for cellular phones, however, were among its most revealing plans. The company had already told financial analysts earlier this month that revenue for the previous quarter was considerably elevated by RF and wireless components.
At the demonstration, National's director for set-top box platforms, David Pederson, said the company was staking claims in Bluetooth -- while exploring HomeRF and IEEE 802.11 wireless LANs -- as well as building GSM and CDMA phones.
At the end of February, National revealed an integrated radio transceiver for GSM cellular phones the CeBit 2000 exhibition in Germany. At that time the company clearly indicated its interest in portable wireless applications.
Targeting cost and power consumption, National is perhaps 12 to 18 months away from rolling out a new DSP architecture that would be part of its offering for the booming cellular handset market. That offering will include a small DSP core that might be developed by National or sourced from outside, as well as a number of coprocessors and a "library of DSP building block functions," integrated on the same die, said William T. Stacy, vice president of wireless communications at National.
National would object to paying big royalties for the use of a less-than-optimal DSP core, though some intellectual-property providers will provide near-term support, Stacy said. National is currently a licensee of the TeakDSPCore from the DSP Group in Santa Clara, Calif., Stacy confirmed, but refused to comment on whether that architecture will be modified or displaced going forward. "The issue for us is getting out the lowest-cost, lowest-power solution," Stacy said.
National's DSP bid in cellular is fueled by algorithmic work at Algorex Inc. in San Francisco, a DSP and wireless design company National acquired last December for $21 million. The group's work in DSPs will be wrapped together with new and existing analog and RF parts into a multichip, system-level offering.
Power management -- a National strength -- will be a continuing concern with 3G phones, Stacy said. "A new solution is needed for low-power wireless handsets," he said. "It's clear as you get to third-generation cellular that power consumption is a real problem."
Dennis Monticelli, vice president of National's Power Management Division, said today's cell phones are typically built around four major parts: a digital baseband, an analog baseband, a power-management chip and RF. In the future that could be collapsed to a digital baseband running a software radio and a single analog chip.
Stacy said National intends to roll out a cell phone chip set supporting the GSM air interface and GPRS data overlay this year. A chip set for the CDMA air interface will follow early next year. A new architecture would help the company compete with other cell phone IC suppliers whose forte was DSP, he said.
The first-generation Bluetooth module demonstrated this week in Santa Clara (and with NEC at CeBit 2000) utilizes the National LMX3162 radio transceiver and LMX5001 link controller/DSP link manager. It also uses an Analog Devices ADSP218X as the host DSP. It currently fits on a 17 x 17-mm LTCC module, with firmware -- the Bluetooth protocol stack -- supplied by DigiOn.
The next-generation Bluetooth module will reduce the radio transceiver to one chip, and replace the DSP with a dedicated baseband engine, said James Benefer, product marketing manager in the company's Wireless Communications Division.
Meanwhile, National's Information Appliance Division demonstrated the Geode SP2GX00 in WebPADs and thin-client terminals. The company expects to roll out a family of Geode devices that targets specific markets starting this summer.
In the background, the company is also developing its next-generation X86 core. Code-named Red Cloud, the CPU will be a Pentium III-class device with completely redesigned floating-point and integer units, said Jean-Louis Bories, executive vice president and general manager of the Information Appliances Group. The part is expected to tape out in October and become a core in future commercially available Geode integrated parts early next year.


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