Tricuspid regurgitation Flashcards
(39 cards)
Define tricuspid regurgitation
TR is abnormal retrograde flow of blood from the right ventricle to the right atrium during systole
Explain the epidemiology of TR
- 4% of people >75% have clinically relevant TR
- 3yr survival is 58%
- 95% of TR are secondary and the leading cause is left heart disease
- more common in women
How is functional TR caused?
Functional TR is secondary to conditions that lead to dilation of the tricuspid annulus or right ventricle enlargement
How is primary TR caused?
Primary TR is caused by conditions that directly affect the tricuspid valve apparatus
What conditions cause primary TR?
- rheumatic heart disease
- congenital heart disease
- endocarditis
- trauma
What are 2 main causes of RV dilation?
- RV dysfunction
- pulmonary hypertension
How does RV dilation cause primary TR?
- Leaflet tethering
- Annular dilation
What conditions cause functional TR?
- pulmonary hypertension
- left sided heart failure
- Dilated cardiomyopathy
- right ventricular infarction
- Mitral stenosis or regurgitation
Explain 2 pathophysiological pathways of secondary tricuspid regurgitation
- Left heart disease causes increased LA pressure and LA dilation - atrial fibrillation that causes tricuspid annular dilation
- Lung disease that causes pulmonary hypertension leads to RV dysfunction/dilation
What are the symptoms of tricuspid regurgitation?
symptoms of right heart failure
- abdominal discomfort and bloating - ascites
- Swelling - peripheral edema
- RUQ pain (hepatomegaly)
- neck pulsations
- fatigue
- weight loss
What are the signs of tricuspid regurgitation
- jugular venous distension with a prominent V wave as blood is regurgitated into the RA during systole or systolic CW wave
- Pansystolic/holosystolic murmur heard along the left sternal border that increases with respiration helps distinguish with mitral regurgitation
- Pulsatile liver due to hepatic vein regurgitation
- Hepatomegaly
- Loud P2 if pulmonary hypertension
- Parasternal lift
- edema
What would the ECG of TR show?
- Right atrial enlargement - tall P wave in lead I (P pulmonale)
- Right ventricular hypertrophy - right axis deviation and a dominant R wave in V1
- Atrial fibrillation
What would the chest Xray of TR show?
- Cardiomegaly with right atrial and ventricular enlargement
- Evidence of pulmonary pathology such as pleural effusion and prominent pulmonary arteries
What would the echocardiogram of TR show?
- right ventricular and atrial enlargement
- leaflet abnormalities look for thickening, flail or prolapse
- Colour doppler to determine the severity of regurgitation from the jet
- continuous wave doppler to determine velocity of regurgitant jet
- Peak regurgitant flow velocity across the tricuspid valve.
What would cardiac catheterisation of TR show?
Elevated right atrial EDP with large v waves
- pulmonary artery pressure can be measured
What is another test performed in TR?
Serum chemistry that shows abnormal liver function test - hyperbilirubinemia secondary to hepatic congestion.
How is mild to moderate TR managed?
Diuretics to manage fluid retention and reduce edema and ascites
- regular ECHO and rhythm control for AF
How is severe TR managed?
Transcatheter tricuspid repair with percutaneous Mitraclip or Triclip
If other cardiac open surgery is occurring = annuloplasty or tricuspid valve repair
TV surgery is strongly suggest with severe TR at the time of left-sided valve surgery but rarely suggested in isolation
How would you treat secondary TR?
Treat underlying cause
- If LV failure, improve LV function
- If pulmonary disease improve lung function
What are the indications for surgery?
Severe symptomatic TR
or if TR is contributing to right heart failure
- if left sided heart surgery is occurring
What is tricuspid regurgitation (TR)?
An abnormal retrograde flow of blood from the right ventricle to the right atrium.
Also known as tricuspid insufficiency or tricuspid incompetence.
What percentage of people over 75 years old have clinically relevant TR?
More than 4%.
What percentage of older individuals in the UK have moderate to severe TR?
2.7%.
What is the 3-year survival rate for patients with TR?
About 58%.
