Tricuspid Regurgitation
Definition
Backflow of blood from the right ventricle into the right atrium during systole - may be acute or chronic.
Etiology
- Functional
- Pulmonary hypertension (e. g., mitral stenosis etc.)
- Right ventricular infarction
- Annular dilatation
- Anatomic (organic)
- Rheumatic heart disease
- Infective endocarditis
- Tricuspid valve prolapse
- Ruptured chordae tendineae
- Papillary muscle dysfunction
- Carcinoid syndrome
- Ebstein's anomaly
- Pacemaker wire
Signs and Symptoms
- Usually well tolerated
- Weakness, Fatigue
- Jugular venous distention
- Hepatomegaly, Peripheral edema, Ascites
Complications
- Severe right-sided failure
- Renal failure when severe congestion is present
Cardiac Auscultation
- A holosystolic. high-pitched blowing sound heard best in the tricuspid area along the left sternal border over the right ventricular apex
- The murmur of tricuspid regurgitation may be accentuated with inspiration; this is known as Rivero-Carvallo's sign
- Right-sided S3 which may be accentuated with inspiration
Electrocardiogram
- Right atrial enlargement
- Incomplete right bundle branch block
- Atrial fibrillation
Chest X-ray
- Right atrial enlargement
- Right ventricular enlargement
Treatment
- None (tricuspid regurgitation may be well tolerated for years)
- Annuloplasty (Carpentier ring, Kay ring, Duran ring)
- Tricuspid valve replacement (usually with a tissue valve to reduce the risk of thrombus formation)
M-Mode
- Right ventricular-volume overload pattern (right ventricular enlargement with paradoxical septal motion)
- B "bump" or "notch'' indicates increased right ventricular end diastolic pressure (≥ 9 mm Hg)
2-D
- Right atrial enlargement
- Right ventricular enlargement
- Right ventricular volume overload pattern (right ventricular enlargement with paradoxical septal motion)
- Dilated tricuspid valve annulus (> 3. 4 cm) indicates severe tricuspid regurgitation
- Dilated inferior vena cava (normal: 1. 2 to 2. 3 cm)
- Dilated hepatic veins (normal: 0. 5 to 1. 1 cm)
- Persistent contrast echo indicates significant tricuspid regurgitation
- Systolic reflux of contrast into the inferior vena cava and hepatic veins may also indicate significant tricuspid regurgitation (may also be visualized by color flow Doppler)
PW Doppler
- Up to 93% of normal patients appear to have tricuspid regurgitation; calculate the duration and length of the regurgitant jet to differentiate between true and physiologic tricuspid regurgitation
- Determine tricuspid regurgitation by using the mapping technique
- Systolic flow reversal in the hepatic veins indicates severe tricuspid regurgitation (may also be detected by color flow Doppler)
- Laminar tricuspid regurgitation flow may denote significant tricuspid regurgitation
CW Doppler
- Compare the regurgitant Doppler spectral display with the tricuspid inflow Doppler spectral display
- Determine systolic pulmonary artery pressure by the tricuspid regurgitation method.
Color Flow Doppler
- Determine regurgitant jet area/right atrial area (see table), using the formula for mitral regurgitation
- Proximal acceleration (flow convergence) may indicate 3+ or 4+ regurgitation.
- Systolic flow reversal in the hepatic veins indicates severe tricuspid regurgitation.