Isolated Pulmonary Regurgitation without Right Heart Remodeling or Pulmonary Hypertension

BACKGROUND Isolated pulmonary regurgitation (PR) without right heart remodeling or pulmonary hypertension is a rare clinical entity, poorly characterized in the literature. Typically associated with conditions like pulmonary hypertension or congenital heart disease, moderate PR in their absence poses diagnostic and management challenges. This case report describes a rare presentation of isolated moderate PR, highlighting the clinical approach, diagnostic evaluation, and importance of long-term monitoring. CASE REPORT A 71-year-old woman with a history of paroxysmal supraventricular tachycardia, multiple myeloma, hypertension, and dyslipidemia presented with palpitations and a syncopal episode. Echocardiography revealed moderate pulmonary regurgitation, mild tricuspid regurgitation, normal right ventricular size and function, and a normal pulmonary artery diameter. No acute intervention was required, and management focused on arrhythmia control and blood pressure optimization. Follow-up included serial echocardiography planned at 6-month intervals to monitor pulmonary regurgitation progression and right ventricular function. CONCLUSIONS This case underscores the rarity of isolated moderate PR without right heart remodeling and the need for careful evaluation using advanced imaging, such as echocardiography and potential cardiac MRI. Long-term monitoring is critical to detect progression to RV dysfunction, which may necessitate interventions like pulmonary valve replacement. Clinicians should consider primary valvular degeneration or arrhythmia-related strain as potential etiologies, with follow-up guided by symptom onset and imaging findings. This case contributes to the limited literature on isolated PR.