TRICUSPID REGURGITATION

Tricuspid regurgitation is leakage of blood backwards through the tricuspid valve each time the right ventricle contracts.

Tricuspid valvular regurgitation often occurs whenever there is RV dilation from any cause. As tricuspid regurgita­tion increases, the RV size increases further pulling the valve open due to chordal and papillary muscle displacement. This, in turn, worsens the severity of the tricuspid regurgita­tion. In most cases, the cause of the tricuspid regurgitation is the RV geometry (functional) and not primary tricuspid valve disease.

An enlarged, dilated RV may be present if there is RV systolic hypertension from valvular or subvalvu­lar pulmonary valve stenosis, pulmonary hypertension for any reason, in severe pulmonary valve regurgitation, or in cardiomyopathy. The RV may also be injured from myocar­dial infarction or may be inherently dilated due to infiltrative diseases (RV dysplasia or sarcoidosis).

RV dilation often occurs secondary to left heart failure. Inherent abnormalities of the tricuspid valve include Ebstein anomaly (displace­ment of the septal and posterior, but not the anterior, leaflets into the RV), tricuspid valve prolapse, carcinoid plaque for­mation, collagen disease inflammation, valvular tumors, or tricuspid endocarditis. In addition, pacemaker lead valvular injury is becoming an increasingly frequent iatrogenic cause.

Symptoms

Tricuspid valve regurgitation often doesn’t cause signs or symptoms until the condition is severe. The condition may be discovered when tests are done for other reasons.

Signs and symptoms of tricuspid valve regurgitation may include:

• Fatigue
• Heart rhythm problems (arrhythmias)
• Pulsing in the neck
• Shortness of breath with activity
• Swelling in the belly area (abdomen), legs or neck veins

Diagnosis

The ECG is usually nonspecific, though atrial flutter or atrial fibrillation is common. The chest radiograph may reveal evidence of an enlarged RA or dilated azygous vein and pleural effusion. The echocardiogram helps assess severity of tricuspid regurgitation (The AHA/ACC valvular heart disease guidelines for definitions). In addition, echocardiography/Doppler provides RV systolic pressure as well as RV size and function. A paradoxically moving inter­ventricular septum may be present due to the volume over­load on the RV. Catheterization confirms the presence of the regurgitant wave in the RA and elevated RA pressures. If the PA or RV systolic pressure is less than 40 mm Hg, primary valvular tricuspid regurgitation should be suspected.

Treatment

Treatment may not be needed if there are few or no symptoms. You may need to go to the hospital to diagnose and treat severe symptoms.

Swelling and other symptoms of heart failure may be managed with medicines that help remove fluids from the body (diuretics).

Some people may be able to have surgery to repair or replace the tricuspid valve. Surgery is most often done as part of another procedure.

Treatment of certain conditions may correct this disorder. These include:

• High blood pressure in the lungs
• Swelling of the right lower heart chamber

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