Approach

TR is most often found secondary to, or in association with, left-sided cardiac pathology in the form of advanced mitral, aortic, or left ventricular myocardial disorders.[1] The most commonly associated conditions include ischaemic or degenerative mitral regurgitation. Other associated factors include a history of rheumatic heart disease, constrictive pericarditis, and permanent pacemaker placement. TR may be a consequence of endocarditis or carcinoid syndrome. Rarely, TR presents as an isolated disease process.

The pathological consequences of advanced TR are related to a reduced cardiac output and right atrial hypertension. The clinical sequelae include atrial fibrillation, findings of advanced liver disease from chronic congestion or fibrosis (cardiac cirrhosis), and findings of congestive heart failure.[6][13]com.bmj.content.model.Caption@3d0f96bd[Figure caption and citation for the preceding image starts]: Tricuspid valve entrapped with a pacemaker leadFrom the collection of Dr Thoraf M. Sundt III [Citation ends].com.bmj.content.model.Caption@6426a8a1[Figure caption and citation for the preceding image starts]: Two patients referred for severe tricuspid regurgitation after pacemaker implantation. A, C. Apical 4 chamber views (Mayo Clinic display format with right ventricle on the right) showing impingement of tricuspid leaflets by pacemaker leads (arrows). Note presence of two right ventricular leads in the first patient (panel A; one active, one abandoned lead). B, D. Corresponding Colour Doppler images demonstrating severe tricuspid regurgitation due to lead impingement.From the collection of Sorin V. Pislaru, Mayo Clinic [Citation ends].com.bmj.content.model.Caption@72844a6a[Figure caption and citation for the preceding image starts]: Severe tricuspid regurgitation due to carcinoid valvular disease. A. Systolic frame from mid-oesophageal 4 chamber view. Note thickened tricuspid leaflets, but also retracted and thickened chordae, typical of advanced carcinoid valvular disease (arrows). The right ventricle and right atrium are enlarged. The atrial septum is deviated to the left, demonstrating right atrial pressure is higher than left atrial pressure (asterisk). B. Colour Doppler demonstrating severe tricuspid regurgitation. Vena contracta measured 1.2 cm, consistent with the coaptation gap on 2D images and virtually free flow between the right ventricle and right atrium.From the collection of Sorin V. Pislaru, Mayo Clinic [Citation ends].

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