Tricuspid regurgitation

Question 1

Definition?

Answer 1

Blood flows backwards through the tricuspid valve.

Question 2

RF?

Answer 2

• Left sided HF
• Dilated tricuspid annulus
• Rheumatic heart disease
• Permanent pacemaker
• Endocarditis
• Carcinoid heart disease

Question 3

aetiology?

Answer 3

• RV dilatation
• Infective endocarditis
• Rheumatic fever
CT tissue diseases

Question 4

CP?

Answer 4

• RFs
• Fatigue and effort intolerance
• Dyspnoea
• Palpitations
• Jugular venous abnormality
• Irregular heart rhythm
• Parasternal systolic murmur
• Increased holosystolic murmur on inspiration (Carvallo’s sign)
• Peripheral oedema

Question 5

pathophysiology?

Answer 5

• Closed in systole to allow blood flow through the aorta, open in diastole to allow ventricles to fill
• In systole, it doesn’t close completely and blood leaks backwards
• Pulmonary HT-increased RV pressure causing dilation of the valve
• Rheumatic disease-inflammation of valave causing leaflet fibrosis-no seal-leak through
• MI-damages papillary muscles, not allowing full closure of valve
• Ebstein anomaly-leaflets too low-harder to form tight seal
• Holosystolic murmur-throughout systole
• Carvallo’s sign-louder with inspiration-neg pressure-more blood back up into the heart so kore turbulence
Extra blood drained into ventricle into diastole increases preload-RV hypertrophy-sarcomeres added in series-stretches annulus more-worsens-can lead to RHF

Question 6

investigations?

Answer 6

• Transthoracic or transoesophageal echo-
• EF valve structure and function, pericardial disease, constriction/restriction, wall abnormalities
• ECG-AF, previous MI
• LFT’s-cardiac cirrhosis
• Serum urea and creatinine-renal abnormality
• FBC-renal/liver abnormality
CXR-HF

Question 7

management primary-mild?

Answer 7

• Treatment of underlying cause and follow up

HF managment and risk factor for CVS modification

Question 8

management severe primary?

Answer 8

• Treat underlying cause
• Congenital or trauma, autoimmune toxin/radiotherapy exposure
• Tricuspid valve replacement or annuloplasty
• If RHF, AF, RV dysfunction
• replacement is indicated in cases of severe sub-valvular disease affecting leaflet mobility, severe annular dilation, right ventricular dysfunction, or pulmonary hypertension.
• Repair-pericardial patch repair of perforation, artificial chordae and annuloplasty
• Temporary pacing leads also used in operation
• HF managment and RF modification
• ACEi, BB, Diuretics and treatment of AF -aspirin, warfarin, or a direct oral anticoagulant
Also lifestyle modifications

Question 9

management secondary mild?

Answer 9

• Treatment of underlying cause
• Left sided heart pathologies
• Tricuspid valve repair with annuloplasty
• If pulmonary HT or tricuspid annular dilation
• Temporary ventricular pacing is also used
• HF managment and RF modification
• ACEi, BB, Diuretics and treatment of AF -aspirin, warfarin, or a direct oral anticoagulant
Also lifestyle modifications

Question 10

management secondary severe?

Answer 10

• Treatment of underlying cause
	• left-sided cardiac pathology in the form of advanced mitral, aortic, and left ventricular myocardial disorders.
• HF managment and RF modification
	• ACEi, BB, Diuretics and treatment of AF -aspirin, warfarin, or a direct oral anticoagulant
	• Also lifestyle modifications
• Tricuspid valve repair
	• If mitral valave disease
Temporary pacing given

Question 11

complications?

Answer 11

• AF
• Advanced liver disease
• AV block
• MI
Valve thrombosis/endocarditis

Question 12

prognosis?

Answer 12

• High rate of mortality after valve replacement
• Outcomes of surgery depend on cardiac co-morbidities
• Repair has a better outcome than replacement
• Reoperation has more risks associated with it
• Failure-increased RV pressure, Left EF and TR