Tricuspid regurgitation

tricuspid-regurgitation-01 tricuspid-regurgitation

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.


[A] Primary:

  • Rheumatic heart disease.
  • Endocarditis, particularly in intravenous drug-users.
  • Ebstein’s congenital anomaly.

[B] Secondary:

  • Right ventricular dilatation due to chronic LHF.
  • Right ventricular infraction.
  • Pulmonary hypertension (e.g. co pulmonary)

Clinical features:

Symptoms: Symptoms are usually non-specific and related to reduced forward flow (tiredness) & venous congestion (oedema, hepatic enlargement)


  1. Raised JVP.
  2. Large systolic wave in JVP ( CV wave replaces the x descent)
  3. Systolic pulsation over the liver.
  4. Pansystolic murmur (at left sterna edge): Louder on inspiration.


  1. Chest X-ray: Dilated right atrium & right ventricle.
  2. Echo:
  • 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.


  1. Davidson’s Principles and practice of Medicine, 21st edition.
  2. Wikipedia the free encyclopedia.

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