Wednesday, April 20, 2011

Tricuspid Regurgitation

Also known as tricuspid insufficiency, tricuspid regurgitation is a heart condition in which the tricuspid valve does not close properly during systole (heart contraction), causing blood to flow backward (leak) into the right atrium when the right ventricle contracts. The tricuspid valve connects these two chambers of the heart (upper and lower), allowing deoxygenated blood to flow from right atrium to the right ventricle. In most cases tricuspid regurgitation are caused by dilation of the right ventricle. Such dilation leads to derangement of the normal anatomy and mechanics of the tricuspid valve and the muscles governing its proper function. The result is incompetence of the tricuspid valve. Left ventricular failure is, in turn, the most common cause of right ventricular dilation. Other common causes of right ventricular dilation include right ventricular infarction, inferior myocardial infarction and cor pulmonale. Rheumatic fever can also affect the tricuspid valve.

Tricuspid regurgitation may not cause any symptoms if the patient does not have pulmonary hypertension. If pulmonary hypertension and moderate to severe tricuspid regurgitation exist together, the following symptoms may result: fatigue and tiredness, active pulsing in the neck veins, general swelling, decreased urine output, swelling of the abdomen, etc. Diagnosis is usually made by echocardiography identifying tricuspid prolapse. Electrocardiography assists in the diagnosis, indicating enlargement of right ventricle and atrium. The main therapy is treatment of underlying cause. In most cases, surgery is not indicated since the root problem lies with a dilated or damaged right ventricle. Medical therapy with diuretics is the mainstay of treatment. Unfortunately, this can lead to volume depletion and decreased cardiac output. Indeed, one must often accept a certain degree of symptomatic tricuspid insufficiency in order to prevent a decrease in cardiac output. Treatment with medicines to reduce cardiac afterload may also be of benefit but a similar risk of depressed cardiac output applies.