Tricuspid Regurgitation

  • Tricuspid regurgitation
    • Etiology
      • Increased pulmonary artery pressure (MCQ)
        • from left-sided failure or mitral regurgitation/stenosis
      • Right ventricular dilation stretching the outflow (MCQ)
        • fromright heart failure, infarction, or tricuspid regurgitation itself
      • Right papillary muscle rupture from infarction(MCQ)
      • Tricuspid valvular lesions(MCQ)
        • fromrheumatic heart disease or bacterial endocarditis
    • Signs and symptoms
      • Signs of right heart failure: Prominent JVD, pulsatile liver
    • Diagnosis
      • Holosystolic, blowing, medium-pitched murmur(MCQ)
        • heard best along the left sternal border in the 5th interspace,
        • accentuated with inspiration
      • ECG shows right ventricular enlargement.(MCQ)
      • Atrial fibrillation is common.
      • Echocardiography demonstrates diseased valve.
    • Treatment
      • Treat left heart failure, if applicable.
      • Diuresis to reduce volume load(MCQ)
      • Surgical repair and endocarditis prophylaxis if valve defective
    • Clinical pearls:
      • Right-sided bacterial endocarditis is most frequently associated with nonsterile technique in IV drug abuser(MCQ)
      • A holosystolic murmur can be due to mitral regurgitation, tricuspid regurgitation, or ventricular septal defect.(MCQ)
      • Systolic c-v wave in jugular venous pulsations.(MCQ)
      • Tricuspid valve apparatusversus Mitral valve apparatus.
        • Besides having three leaflets rather than two, the tricuspid valve has many chordae that attach to the RV endocardium rather than to discrete papillary muscles, and chordal attachments to the RV septum
      • Tricuspid valvular incompetence often occurs whenever there is RV dilation from any cause.(MCQ)
      • The RV dilation is often secondary to left heart failure(MCQ)
      • The JVP waveform
        • Normally ,itshould decline during ventricular systole (the x descent).
        • The timing of this decline can be observed by palpating the opposite carotid artery.
        • As tricuspid regurgitation worsens, more and more of this valley in the JVP is filled with the regurgitant wave until all of the x descent is obliterated and a positive systolic waveform will be noted in the JVP(MCQ)
      • Cyanosis may be present if
        • the increased RA pressure stretches the atrial septum and opens a PFO
        • there is a true ASD (eg, in about 50% of patients with Ebstein anomaly).(MCQ)
      • If the PA or RV systolic pressure is < 40 mm Hg, primary tricuspid regurgitation should be suspected.(MCQ)

Severe Tricuspid Regurgitation – Transthoracic Echocardiogram (TTE)
This is an echocardiography collection about Severe Tricuspid Regurgitation.
Giant C-V Waves of Tricuspid Regurgitation
giant systolic pulsations, known as C-V waves, were noticeable during jugular venous examination of a 33-year-old woman who had tricuspid-valve endocarditis. In video 2, transthoracic echocardiography revealed severe tricuspid regurgitation.
Mild tricuspid regurgitation with borderline pulmonary hypertension
Mild TR and borderline pulmonary hypertension.
Interesting Cases: Tricuspid Valve Repair: Severe Tricuspid Regurgitation
Watch an in-depth discussion of a tricuspid valve repair on a 68-year-old male who was experiencing severe symptomatic tricuspid regurgitation related to a right ventricular contusion and an implantable cardioverter defibrillator (ICD) for ventricular tachycardia. Piedmont cardiac surgeon Dr. Fred Milla and cardiologist Dr. Randy Martin review intraoperative images and echocardiography and discuss the interesting aspects of this complex case, including a recent publication on the effect of ICDs and pacemakers on the tricuspid valve.
Repair of functional Tricuspid Valve Regurgitation
TV repair with the Medtronic Contour 3-D annuloplasty ring.
What is Tricuspid Valve Disease
Tricuspid Valve Disease: This video highlight questions and answers about the symptoms, diagnosis and treatments of Tricuspid Valve Disease.
Tricuspid Regurgitation Health Byte
Tricuspid regurgitation is a heart condition wherein the tricuspid valve fails in systole
Congenital Tricuspid Regurgitation
Aberrant papillary muscle in the right ventricle,Aberrant tendinous chord originating from the iv septum and attached to the septal leaflet of the tricuspid valve,causing a lack of coaptation of the tricuspid leaflets with tethering of the septal leaflet and severe tricuspid regurgitation with laminar flow : Elevation of the right atrial pressure and RA and RV dilatation.TTE parasternal long axis and RV inflow views and apical view.
HeartWorks RV Dysfunction with Tricuspid regurgitation