Clinical recognition of congenital pulmonary valve insufficiency.

Abstract Four patients with congenital pulmonary valve insufficiency were given a correct diagnosis on the basis of clinical evaluation. With one exception, all patients were completely free of toms, tolerated their lesions well, and none showed evidence of pulmonary hypertension. The diagnosis of pulmonary valve insufficiency was first suspected in each instance because of a diastolic murmur in the pulmonary area radiating downward along the left sternal border. The murmur was low-frequency in type, occurring in early diastole in three patients and during mid-diastole in the fourth. Of specific interest was the observation that this murmur increased in intensity during inspiration. The hearts were not enlarged, but the pulmonary arterial segment was quite prominent in 3, 1 of whom had idiopathic dilatation of the pulmonary artery. In this patient a pulmonary ejection sound was also present. The electrocardiograms were normal in 3 patients and indicative of right ventricular hypertrophy in the fourth. The diagnosis of isolated pulmonary valve insufficiency was supported by the data obtained at cardiac catheterization in each instance. No definite treatment was considered necessary except that all patients were instructed to undertake antibiotic prophylaxis against bacterial endocarditis.