0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Pulmonic Valve Insufficiency: A Common Cause of Transient Diastolic Murmurs in Renal Failure

JULIO E. PÉREZ, M.D.; CAROL A. SMITH; and VICTOR N. MELTZER, M.D.
[+] Article and Author Information

Grant support: in part by grant HL 17646 from the National Institutes of Health; a Specialized Center of Research (SCOR) grant in Ischemic Heart Disease; and by a Squibb Cardiovascular Research Fellowship (Dr. Pérez).

▸Requests for reprints should be addressed to Julio E. Pérez, M.D.; Box 8086, Cardiovascular Division, Washington University School of Medicine, 660 S. Euclid Avenue; St. Louis, MO 63110.


St. Louis, Missouri


© 1985 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1985;103(4):497-502. doi:10.7326/0003-4819-103-4-497
Text Size: A A A

To study the transient diastolic murmur associated with renal failure, we used Doppler echocardiography to characterize flow across the semilunar valves in 10 patients on chronic hemodialysis with a diastolic murmur (group A), 26 patients on chronic hemodialysis without murmurs (group B), and 15 healthy persons (group C). Nine patients in group A had pulmonic valve insufficiency that encompassed 77 ± 21% (SD) of diastole with peak regurgitant flow velocities of 1.7 ± 0.3 m/s. Doppler-calculated mean pulmonary artery pressure in 8 of them was 43 ± 7 mm Hg before dialysis and 20 ± 12 mm Hg afterward (p < 0.001). Dialysis reduced the duration of pulmonic insufficiency to 10 ± 16% of diastole and lowered peak regurgitant flow velocities to 0.2 ± 0.2 m/s (p < 0.001 for each). Three patients in group B had aortic valve insufficiency and 3 had pulmonic valve insufficiency like that in group A. Three persons in group C had mild pulmonic valve insufficiency. Thus, transient diastolic murmurs associated with pulmonic valve insufficiency are not uncommon in patients with renal failure; they are related to fluid overload, are diminished by extracellular fluid removal, and reflect correctable pulmonary hypertension.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)