As you mentioned, Takayasu arteritis is an autoimmune disease that causes progressive inflammation and obstruction of blood vessels throughout the body. The echocardiographic findings that you mention, tricuspid, aortic, and pulmonic valve regurgitation, are difficult for me to evaluate without seeing your daughter’s echocardiogram. Typically, we characterize these leaks as trivial, mild, moderate, and severe. You say that these are “small”, which suggests that, at most, they are mild. All of the valves of the heart can have at least trivial regurgitation, which is a normal finding and is not associated with any disease. It is unclear to me whether your daughter’s findings are any worse than this. I will say that a valve leak does not cause pulmonary hypertension; it is actually the other way around. Pulmonary hypertension is elevated blood pressure across the lungs. This pressure can push back to the right side of the heart and lead to pulmonic and tricuspid valve regurgitation. One of the helpful things that echocardiography has given us is the ability to noninvasively measure the pressures in certain chambers of the heart. Specifically, with tricuspid valve regurgitation, we can estimate the peak pressure across the lungs. Therefore, what would be more important here is not how much leak there is at the tricuspid valve, but what is the estimated right ventricular pressure. If this is normal, there is no evidence of pulmonary hypertension. Your cardiologist should be able to give you this information. Sadly, pulmonary hypertension has been reported in conjunction with Takayasu’s.
Of note, a pulmonary specialist will not be able to assist with pulmonary hypertension, if she does, in fact, have it. It would be better treated by a cardiologist who specializes in the management of pulmonary hypertension, who may use medications to help to lower the pulmonary pressure. As well, as you likely know, catheter interventions with balloon angioplasty and stent placement for the arterial obstruction in Takayasu arteritis have also been intermittently successful in improving blood flow to the lungs.