Tricuspid Regurgitation

Question 1

What are the causes of tricuspid regurgitation

Answer 1

Due to dilatation of the tricuspid annulus resulting from dilatation of the right ventricle

• Right ventricular failure
• Pulmonary hypertension

More rarely:

• Infective endocarditis (IVDU)
• Congenital malformations (eg. Ebstein anomaly)
• Carcinoid syndrome

Question 2

What is Ebstein anomaly

Answer 2

Congenital malformation

Caused by downward displacement of the tricuspid valve into the body of the right ventricle

Valve is regurgitant and malformed

*Associated with othe structural cardiac abnormalities

*High incidence of SVT and VT

Question 3

What are the clinical features of tricuspid regurgitation

Answer 3

Prominent v wave in the JVP

Pansystolic murmur at left lower sternal edge

Loud p2 if there is pulmonary hypertension (pulmonary component of second heart sound)

Pulsatile hepatomegaly

Ascites

Peripheral oedema

*Signs of underlying cause of right heart failure (eg. mitral valve disease or pulmonary disease)

Question 4

How do you manage tricuspid regurgitation

Answer 4

Treat underlying cause

Heart failure management

Risk factor modification

*Tricuspid valve replacement considered in very severe cases