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

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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
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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.





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