Pulmonary insufficiency (or incompetence, or regurgitation) is a condition where the pulmonary valve is incompetent and allows backflow to the right ventricle of the heart during diastole. While a small amount of pulmonary regurgitation may occur in healthy individuals, it is usually detectable only by an echocardiogram and is harmless. More pronounced regurgitation that is noticed through a routine physical examination is a medical sign of disease and warrants further investigation.
If it is secondary to pulmonary hypertension it is referred to as a Graham Steell murmur.The three primary pathological mechanisms causing pulmonary insufficiency, are dilatation of the pulmonic valve ring, acquired alteration of pulmonic valve leaflet morphology, or congenital absence or malformation of the valve.
Mild cases are usually asymptomatic. Because pulmonic regurgitation is the result of other factors in the body, any noticeable symptoms are ultimately caused by an underlying medical condition rather than the regurgitation itself. However, more severe regurgitation may contribute to right ventricular enlargement by dilation , and in later stages, right heart failure.
A decrescendo murmur can sometimes be identified early in diastole, heard best over the left lower sternal border.
Tetralogy of Fallot, a malformation of the heart characterized by four co-occurring defects: a ventricular septal defect, a misplaced origin of the aorta causing it to override the septal defect, narrowing of the pulmonary artery, and enlargement of the right ventricle.
Iatrogenic (post surgical repair for congenital heart disease)