Tricuspid insufficiency (TI), a valvular heart disease also called tricuspid regurgitation (TR), refers to the failure of the heart’s tricuspid valve to close properly during systole. As a result, with each heart beat some blood passes from the right ventricle to the right atrium, the opposite of the normal direction. Tricuspid regurgitation occurs in roughly less than 1% of people and is usually asymptomatic.
- Rheumatic heart disease.
- Endocarditis, particularly in intravenous drug-users.
- Ebstein’s congenital anomaly.
- Right ventricular dilatation due to chronic LHF.
- Right ventricular infraction.
- Pulmonary hypertension (e.g. co pulmonary)
Symptoms: Symptoms are usually non-specific and related to reduced forward flow (tiredness) & venous congestion (oedema, hepatic enlargement)
- Raised JVP.
- Large systolic wave in JVP ( CV wave replaces the x descent)
- Systolic pulsation over the liver.
- Pansystolic murmur (at left sterna edge): Louder on inspiration.
- Chest X-ray: Dilated right atrium & right ventricle.
- Right ventricular dilatation.
- Tricuspid valve may be structurally abnormal (Rh disease)
- Estimate PA pressure from Doppler.
Diagnosis: Diagnosis is usually made by echocardiography identifying tricuspid prolapse or flail. The finding of a pulsatile liver and/or the presence of prominent CV waves in the jugular pulse is also essentially diagnostic.
Electrocardiography assists in the diagnosis, indicating enlargement of right ventricle and atrium.
[A] TR due to right ventricular dilatation:
- Diuretics and vasodilators or
- Mitral valve replacement.
[B] Sever organic tricuspid valve damage & elevated pulmonary artery pressure require tricuspid valve repair (annuloplasty or placation) & very occasionally tricuspid valve replacement may be necessary.
- Davidson’s Principles and practice of Medicine, 21st edition.
- Wikipedia the free encyclopedia.