Tricuspid regurgitation usually presents with fatigue, dyspnea, and lower extremity edema. Additional complaints may include abdominal distension and early satiety.
Mild or moderate tricuspid regurgitation without abnormal valve anatomy, ventricular function, or pulmonary artery pressure is not necessarily abnormal but is estimated to be present in over 50% of asymptomatic young adults.
The clinically most important form is secondary to left-sided cardiac disease, with tricuspid annular dilation.
The affected valve may be repaired or replaced; similar to mitral surgery, surgical repair is preferred over replacement.
Operative risk for tricuspid valve surgery depends on the extent of right ventricular dysfunction and concomitant disease. Reoperation for severe tricuspid regurgitation after left-sided valve surgery carries a high risk. Therefore, correction of tricuspid regurgitation should be considered at the time of initial surgery.
The disease has largely been undertreated and its impact is under appreciated.
Tricuspid regurgitation (TR) occurs when blood flows backwards through the tricuspid valve. In the vast majority of patients, this occurs during systole, but severely elevated right ventricular filling pressure can be associated with diastolic TR. TR can be primary (abnormal valve morphology) or secondary (normal valve morphology). Some degree of valvular regurgitation is a relatively common incidental finding in color Doppler imaging. In fact, two-dimensional echocardiography has demonstrated that 50% to 60% of asymptomatic young adults exhibit mild tricuspid regurgitation. A smaller proportion, up to 15%, have moderate tricuspid regurgitation.
History and exam
- left-sided heart failure
- dilated tricuspid annulus
- rheumatic heart disease
- permanent pacemaker
- carcinoid heart disease
- pacemaker lead entrapment
- ischemic cardiomyopathy
- constrictive pericarditis
- congenital heart disease
- rheumatoid arthritis
- radiation therapy
- Marfan syndrome
- tricuspid valve prolapse
Shahab A. Akhter, MD
Professor of Cardiothoracic Surgery
Division of Cardiac Surgery
Department of Cardiovascular Sciences
Brody School of Medicine
East Carolina University
SAA declares that he has no competing interests.
Paul Tang, MD, PhD
Department of Cardiac Surgery
University of Michigan
PT declares that he has no competing interests.
Dr Shahab A. Akhter and Dr Paul Tang would like to gratefully acknowledge Dr Kevin L. Greason, Dr Sorin V. Pislaru, and Prof. Thoraf M. Sundt III, previous contributors to this topic.
KLG, SVP, and TMS declare that they have no competing interests.
Larry A. Weinrauch, MD
Assistant Professor of Medicine
Harvard Medical School
LAW declares that he has no competing interests.
Prakash P. Punjabi, MB BS
Consultant Cardiothoracic Surgeon
Imperial College Healthcare NHS Trust
PPP declares that he has no competing interests.
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