Overview
Tricuspid valve diseases happen when the normal function of the tricuspid valve isn't achieved. In a normal state, the tricuspid valve opens and closes to ensure that blood flows in one direction from the right atrium to the right ventricle to the lungs. Sometimes this valve cannot open and close properly, resulting in blood backflow from the right ventricle to the right atrium: Tricuspid valve regurgitation (TR), other times the valve might become narrowed, not allowing the blood to flow from the right atrium to the left ventricle: Tricuspid valve stenosis (TS)
Etiology
Tricuspid valve regurgitation might be primary or secondary. Primary TR is less common and has many causes: Endovascular pacemaker defibrillator, chest wall or deceleration injury trauma, infective endocarditis, Ebstein anomaly, rheumatic valve disease, carcinoid syndrome, ischemic heart disease affecting the right valve with rupture or papillary muscle dysfunction, myxomatous degeneration associated with tricuspid valve prolapse, connective tissue disorders, Marantic endocarditis with SLE and RA, Drug-induced (Fenfluramine, Phentermine, Pergolide), whereas secondary TR is more common and defined as regurgitation with no anatomical defects, it happens due to any condition that elevates the right ventricular pressure or pulmonary hypertension that leads to dilation in the right atrium, right ventricle, and tricuspid annulus.
Tricuspid valve stenosis is commonly of rheumatic origin, and it often occurs with tricuspid valve regurgitation.
Pathophysiology
TR happens when blood backflows from the right ventricle to the right atrium due to its inability to open and close adequately. In mild-moderate cases, this does not lead to any hemodynamic consequences, but in severe cases where this backflow results in an increase in right atrial and venous pressure, patients will develop heart failure signs and symptoms.
The narrowing or stiffness of the tricuspid valve results in a persistent diastolic pressure gradient between the right atrium and ventricle that increases with exercise and inspiration and, in significant cases, might lead to venous congestion features: jugular venous distention, ascites, and peripheral edema.
Clinical Manifestations
Symptoms: usually no symptoms in mild-moderate cases, but in severe cases, there might be a pulsatile sensation in the neck and right-heart failure symptoms: eg: ascites. (2) Sometimes symptoms arise from the underlying cause.
Physical examination: with severe right-sided heart failure, patients appear: cachectic, chronically ill, cyanotic, and sometimes jaundiced.
Jugular vein:
Palpation:
Edema
Hepatomegaly
Cardiac Auscultation
Symptoms
Physical examination
Labs:
Mild elevation in serum bilirubin; ALT and AST are normal or mildly increased; albumin is normal or mildly depressed.
Chest radiograph:
It is not necessary unless the patient has dyspnea.
ECG:
This is not indicated unless the patient has other valvular heart disease (AFIB).
Treatment:
References
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