What is tricuspid regurgitation?

The tricuspid valve is an important component of the heart's blood circulation, controlling the direction of blood flow to the right ventricle. If the tricuspid valve does not close completely, tricuspid regurgitation will occur, causing the blood flowing out of the right ventricle to flow back into the right ventricle, which will lead to right ventricular dilatation and severe pulmonary hypertension, which is very harmful. So, what does tricuspid regurgitation mean? Let’s take a closer look at this disease.

Blood flows backward from the right ventricle into the right atrium through a regurgitant tricuspid valve. Tricuspid regurgitation (TR) is usually secondary to right ventricular dilatation and right ventricular hypertension due to severe pulmonary hypertension or right ventricular outflow tract obstruction. Single dilatation (such as large atrial septal defect) or single hypertension (such as severe pulmonary stenosis) does not produce TR. More rarely.

It may be secondary to infective endocarditis, particularly from IV drug use, papillary muscle insufficiency in right ventricular infarction, or use of fenfluramine. TR is occasionally primary, due to tricuspid valve dehiscence (i.e., defect in the endocardial cushions), blunt trauma, Ebstein anomaly (i.e., a deformed tricuspid valve that moves downward into the right ventricle), or carcinoid tumors in which the valve may be fixed in a semiopen position. More rarely, TR is due to myxoid degeneration, causing prolapse, often with mitral valve prolapse. Moderate to severe tricuspid regurgitation may occur in patients with no or mild tricuspid regurgitation after successful mitral valve replacement, and increased mitral blood flow exposes the underlying tricuspid regurgitation.

Symptoms, Signs, and Diagnosis

Aside from symptoms of low output such as fatigue, cool skin, dyspnea, and edema, the only specific symptom of severe TR is a pulsating sensation in the neck due to high jugular venous regurgitation waves transmitted from right ventricular pressure. Discomfort in the right upper abdomen may occur due to liver congestion. As the right atrium enlarges, atrial fibrillation and atrial flutter are common, which further reduce cardiac output and can suddenly induce severe heart failure.

The jugular venous wave may have varying degrees of V wave or Y tilt, depending on the degree of TR. Synchronous with the V wave, the liver has varying degrees of systolic pulsation.

When TR is significant, there is often a systolic murmur and thrill in the right jugular vein. If TR is mild, secondary to pulmonary hypertension, a high-pitched TR murmur can be heard during full systole. If TR is significant and primary, the murmur frequency is medium. The murmur increases during inspiration (Carvallo sign). It is usually clearest in the 4th and 5th intercostal spaces near the sternum or in the upper abdomen. However, if the right ventricle encroaches on the original apex, the murmur is loudest at the apex. If TR is secondary to cor pulmonale caused by emphysema, the murmur can be heard on the free edge of the liver.

The ECG may show varying degrees of RV overload, depending on the severity of TR and whether it is secondary to pulmonary hypertension. There may be tall, peaked P waves and a QR pattern in lead V1. This is typical of right atrial enlargement and RV hypertrophy.

X-rays show widening of the superior vena cava, right atrium enlargement (causing the heart shadow to enlarge to the right) and right ventricle enlargement (causing the heart shadow to enlarge to the left). Lateral chest radiographs may also show right ventricular enlargement.

Echocardiography shows enlarged right atrium and right ventricular diameter. Doppler and two-dimensional echocardiography can confirm this diagnosis. Cardiac catheterization and angiography can directly confirm TR and measure right ventricular pressure, which can determine whether TR is primary or secondary.

treat

Even patients with severe TR can still tolerate it for many years. In heroin addicts, tricuspid valve resection is often required due to infective endocarditis. If TR is due to heart failure, internal and external treatment of the cause of heart failure can reduce the amount of regurgitation. If TR is secondary to pulmonary hypertension and right ventricular hypertension caused by left heart valve disease (such as MS), it can be improved by surgical treatment of left heart valve disease. During mitral valve surgery, annuloplasty can be used to correct TR at the same time to prevent death from low cardiac output after surgery.