Tricuspid Insufficiency

What is Tricuspid Insufficiency?

In tricuspid insufficiency, also known as tricuspid regurgitation, an incompetent tricuspid valve allows blood to flow back into the right atrium during systole, decreasing blood flow to the lungs and left side of the heart. Cardiac output also decreases.

Causes of Tricuspid Insufficiency

Tricuspid insufficiency results from marked dilatioc of the right ventricle and tricuspid valve ring. It most commonly occurs in the late stages of heart failure because of rheumatic or congenital heart disease.

Less commonly, it results from congenitally deformed tricuspid valves, atrioventricular canal defeas. or Ebstein's malformation of the tricuspid valve. Other causes include infarction of the right ventricular papillary muscles, tricuspid valve prolapse, carcinoid heart disease, endomyocardial fibrosis, infective endocarditis, and trauma.

Signs & Symptoms of Tricuspid Insufficiency

There may be no symptoms of tricuspid regurgitation. However, because tricuspid regurgitation often exists with mitral stenosis, symptoms may develop. Symptoms that do occur usually begin many years after the bout with rheumatic fever and are associated with symptoms of heart failure. Swelling in the legs or abdomen (causing tenderness in the liver) or difficulty with breathing, especially when you are lying down, may occur. Other symptoms include irregular heartbeat, coughing up blood, or chest pain

Diagnostic Tests

Cardiac catheterization demonstrates markedly decreased cardiac output. The right atrial pressure pulse may exhibit no x descent during early systole, but instead a prominent c-v wave with a rapid y descent. The mean right atrial and right ventricular end-diastolic pressures typically are elevated.

Chest X-rays show right atrial and ventricular enlargement.

Echocardiography reveals right ventricular dilation and prolapse or flailing of the tricuspid leaflets.

Treatment

A sodium-restricted diet and diuretics help reduce hepatic congestion before surgery. When rheumatic fever has deformed the tricuspid valve and resulted in severe insufficiency, the patient usually needs open-heart surgery for tricuspid annuloplasty or tricuspid valve replacement.

Prevention Tips

Discuss any history of heart valve disease or any family history of congenital heart diseases before treatment by a health care provider or dentist. Any dental work, including cleaning, and any invasive procedure can introduce bacteria into the bloodstream. This bacteria can infect a weakened valve causing endocarditis.

Obtain prompt treatment for conditions that may cause valve disease. Treat strep infections promptly to prevent rheumatic fever.