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

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 less than 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 less than 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.