Tricuspid Regurgitation

Tricuspid regurgitation (TR) results from a failure of the tricuspid valve to close completely during systole, causing regurgitation of blood into the RA. It is estimated that up to 70% of normal adults have mild, physiologic TR as seen on high-resolution echocardiography. A much smaller percentage of people are actually symptomatic. It occurs in 90% of people with anatomically normal valve leaflets and chords.

Causes of Tricuspid regurgitation

  1. TR is usually secondary to RV dilation. Any cause of RV dilation can result in the enlargement of the tricuspid orifice. The most common cause is LV Failure, RV Infarction, Inferior wall MI and cor pulmonale.
  2. Tricuspid endocarditis— commonly seen in IVDU
  3. It may be secondary to RHD; usually accompanied by mitral and aortic valve disease.
  4. Ebstein anomaly—congenital malformation of tricuspid valve in which there is a downward displacement of the valve into the RV.
  5. Carcinoid syndrome, SLE, and myxomatous valve degeneration.

Clinical Features

  1. The patient is usually asymptomatic unless the patient develops symptoms of RHF/pulmonary HTN
  2. Signs and symptoms of Right Ventricular Failure (ascites, hepatomegaly, edema, JVD, Pulsatile liver)
  3. Prominent V waves in jugular venous pulse with rapid y descent
  4. Inspiratory S3 along LLSB may be present
  5. Tricuspid regurgitation murmur is blowing holosystolic murmur at Left lower sternal border, which increases with inspiration and reduced during expiration and Valsalva maneuver.
  6. Right ventricular pulsation along left lower sternal border
  7. AFib can be present with severe right atrial dilation

Tricuspid regurgitation murmur

Tricuspid regurgitation murmur

Diagnosis

  1. Echocardiogram
    • Quantifies amount of TR
    • Identifies prolapse/flail of tricuspid valve leaflets
  2. ECG: RV and RA enlargement

Good to Know

Mild or less severe Tricuspid regurgitation is common, can be easily identified by echo, is physiologically normal, and does not require any treatment.

Treatment

  • Treat any underlying causes of symptomatic Tricuspid regurgitation
  • Diuretics for volume overload and venous congestion/edema
  • Treat left-sided heart failure, endocarditis, or pulmonary HTN
  • Severe regurgitation may be surgically corrected if pulmonary HTN is not present
    • Native valve repair surgery
    • Valvuloplasty of the tricuspid ring
    • Valve replacement surgery: Rarely performed

References

  1. https://emedicine.medscape.com/article/158484-clinical
  2. https://pubmed.ncbi.nlm.nih.gov/19470900

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