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Tricuspid Valve Insufficiency

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Tricuspid valve regurgitation and TR

  • The tricuspid valve is one of four one-way valves that control blood flow through the heart's four chambers.  Normally, oxygen-poor blood (venous) enters the right side of the heart on its return from the rest of the body. It flows from the upper chamber, the right atrium, through the tricuspid valve to the right ventricle below.  The blood then leaves the right ventricle through the pulmonary valve, and goes into the pulmonary artery, which carries the blood to the lungs to pick up oxygen.
  • Some disorders affect the valve by preventing it from closing properly, resulting in regurgitation of pumped blood from the lungs back into the right ventricle.
  • TR is usually secondary to a combination of dilation (or enlargement of the chamber) of the right ventricle and high pressure due to increased blood pressure in the lungs (pulmonary hypertension) or obstruction of blood flow from the right ventricle (e.g., pulmonary stenosis).
  • Infective endocarditis (especially in IV drug addicts), rheumatic heart disease, Myocardial Infarction (heart attack) affecting the right ventricle, cor pulmonale, or the use of the diet drug fenfluramine are other causes of secondary TR.
  • Primary causes of tricuspid regurgitation are endocardial cushion defects, blunt trauma or after mitral valve surgery, Ebstein's anomaly (i.e., downward displacement of a distorted tricuspid cusp into the right ventricle), and carcinoid syndrome.

  • Fatigue, shortness of breath, edema (fluid build up in lower extremity), and sensation of pulsations in the neck.
  • Right upper quadrant abdominal fullness or discomfort due to (backing of fluids) liver congestion.

  • Some patients (as with intravenous drug abusers) are able to live years with TR, requiring treatment only in the event of complications due to conditions resistant to medical therapy, such as severe Heart Failure, arrhythmias, Pulmonary Emboli, repeated blood infections from endocarditis, and pulmonary Hypertension.
  • Surgical treatment includes valve repair and replacement.

  • Depending on the severity of TR and the pressure on the right ventricle and degree of right ventricular failure the tests will show:
    1. ECG may show various degrees of RV overload.
    2. Chest X-Rays may show enlarged right atrium and right ventricle enlargement. With the enlargement of atrium, arrhythmias (atrial flutter and fibrillation) may be evident on the ECG tracing.
    3. Echocardiography shows an increased right atrial and right ventricle enlargement, and in endocarditis, bacterial vegetations on the valve.
    4. Doppler and two-dimensional echocardiography will show the degree of regurgitation across the valve.
    5. Cardiac catheterization and Angiography can confirm the diagnosis of TR and assess severity and cause.

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