Tricuspid Regurgitation

Tricuspid regurgitation may occur in a variety of situations other than disease of the tricuspid valve itself. The most common is right ventricular overload resulting from left ventricular failure due to any cause. Tricuspid regurgitation occurs in association with right ventricular and inferior Myocardial Infarction (MI). Tricuspid valve endocarditis and resulting regurgitation are common in intravenous drug users. Other causes include the carcinoid syndrome, lupus erythematosus, and myxomatous degeneration of the valve (associated with mitral valve prolapse). Ebstein's anomaly, a congenital defect of the tricuspid valve, often presents in adults as massive right-sided cardiomegaly due to tricuspid regurgitation.

The symptoms and signs of tricuspid regurgitation are identical to those resulting from right ventricular failure due to any cause. In the presence of mitral valve disease, the tricuspid valvular lesion can be suspected on the basis of early onset of right heart failure and a harsh systolic murmur along the lower left sternal border which is separate from the mitral murmur and which often increases in intensity during and just after inspiration.

Hemodynamically, tricuspid regurgitation is characterized by a prominent regurgitant systolic v wave in the right atrium and jugular venous pulse, with a rapid y descent and a small or absent x descent. The regurgitant wave, like the systolic murmur, is increased with inspiration, and its size depends upon the size of the right atrium. In tricuspid regurgitation, especially with right ventricular failure, an inspiratory S3 may be present.

Tricuspid regurgitation secondary to severe mitral valve disease or other left-sided lesions may regress when the underlying disease is corrected. When surgery is required, valve repair or valvuloplasty of the tricuspid ring is often preferable to valve replacement. Replacement of the tricuspid valve is infrequently done now.