tricuspid regurgitation (TR)
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Etiology
- dilatation of right ventricle resulting from
- mitral valve disease
- biventricular infarction
- pulmonary hypertension
- congenital heart disease
- permanent pacemaker or implantable cardioverter-defibrillator leads[4]
- tricuspid valve prolapse
- trauma
- endocarditis
- fungal
- Staphylococcal in drug addicts
- pulmonary hypertension can cause regurgitation of a structurally normal tricuspid valve[2]
- carcinoid syndrome
- pharmaceutical agents: fen-phen
Clinical manifestations
- jugular venous distention:
- merged & prominent v wave & c wave (Lancisi sign)
- increases with Valsalva, then decreases within 2-3 seconds
- prominent right ventricular impulse below sternum
- pansystolic murmur at the left lower sternal border
- murmur increases during inspiration
- right-sided 3rd heart sound may be heard
- peripheral edema
- hepatomegaly, pusatile, enlarged liver
- ascites possible
Management
- difficult to treat
- loop diuretics & aldosterone antagonists[2]
- surgery
- does not improve survival in isolated tricuspid regurgitation[5]
- procedures
- tricuspid valve repair if anatomy is favorable
- tricuspid valve replacement
- bioprosthetic or mechanical valve
- bioprosthetic valve preferred[2]
- bioprosthetic tricuspid valves do not degenerate as fast as left-sided valves
- tricuspid valve removal (endocarditis)
- percutaneous transcatheter-based repair[6][7]
- indications
- pulmonary hypertension (not mentioned in MKSAP17)
- severe tricuspid regurgitation with symptoms & evidence of right ventricular enlargement or right heart failure[2]
- severe tricuspid regurgitation at the time of surgery for left sided valve
- endocarditis
- tricuspid valve removal
- patients may tolerate complete valve removal for years
- often performed in conjunction with other cardiac surgery[2]
More general terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 45
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2022.
- ↑ Bruce CJ, Connolly HM. Right-sided valve disease deserves a little more respect. Circulation. 2009 May 26;119(20):2726-34 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19470901
- ↑ 4.0 4.1 Lin G, Nishimura RA, Connolly HM et al Severe symptomatic tricuspid valve regurgitation due to permanent pacemaker or implantable cardioverter-defibrillator leads. J Am Coll Cardiol. 2005 May 17;45(10):1672-5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15893186 Free Article
- ↑ 5.0 5.1 Axtell AL, Bhambhani V, Moonsamy P et al. Surgery does not improve survival in patients with isolated severe tricuspid regurgitation. J Am Coll Cardiol 2019 Aug 13; 74:715-725. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31071413
O'Gara PT Gillinov M, Rodes-Cabau J. Surgery for isolated tricuspid regurgitation: Limitations of observational analyses. J Am Coll Cardiol 2019 Aug 13; 74:726-728 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31395121 - ↑ 6.0 6.1 Nickenig G et al. Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study. Lancet 2019 Nov 30; 394:2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31708188 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32600-5/fulltext
- ↑ 7.0 7.1 Taramasso M, Benfari G, van der Bijl P et al. Transcatheter versus medical treatment of patients with symptomatic severe tricuspid regurgitation. J Am Coll Cardiol 2019 Dec 17; 74:2998 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31568868 https://www.sciencedirect.com/science/article/pii/S0735109719377393
- ↑ Ali MA, Colquhoun M Lancisi sign: Gian C-V Waves in Tricuspid Regurgitation. Mayo Clin Proc 2020 95(12):2592-93 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33276831 https://www.mayoclinicproceedings.org/article/S0025-6196(20)30992-7/fulltext