tricuspid valve disease
DESCRIPTION
a transcription regarding tricuspid regurgitation and stenosisTRANSCRIPT
Tricuspid Valve DiseaseTricuspid Valve Disease
Bernardo D. Morantte Jr. M.D.Bernardo D. Morantte Jr. M.D.Dept. of MedicineDept. of Medicine
College of MedicineCollege of MedicinePamantasan Ng Lungsod Ng MaynilaPamantasan Ng Lungsod Ng Maynila
Tricuspid Valve DiseaseTricuspid Valve Disease
• Tricuspid regurgitation is the back flow of blood from RV to RA during systole.
• Tricuspid stenosis is the narrowing of the valve orifice with obstruction in the diastolic blood flow from RA to RV.
Pathophysiology of Tricuspid Pathophysiology of Tricuspid RegurgitationRegurgitation
• Progressive RV dilatation causes the TV annulus to dilate. The valve leaflets do not coaptate completely with development of regurgitant blood flow to the RA
• Progressive RA dilatation occurs
Etiology of Tricuspid RegurgitationEtiology of Tricuspid Regurgitation
• Most commonly secondary to pulmonary hypertension of whatever etiology such as COPD, pulmonary emboli, left sided valvular disease_ MS, MR, AS, AR
• Dilated and restrictive cardiomyopathy• Bacterial endocarditis• Congenital Pulmonic stenosis Eibstein anomaly Arrythmogenic right ventricular dysplasia• RV infarction• Trauma• Functional Congenital or artificial AV fistulas (dialysis patients) Pacemakers
SymptomsSymptoms
• RUQ tenderness due to hepatomegaly• Abdominal swelling• Peripheral edema
• Symptoms related to chronic lung disease and other associated valvular disease:
• dyspnea , orthopnea / PND• cough and wheezing• easifatigability• syncope due to malignant ventricular • arrhythmias in arrythmogenic RV dysplasia
Physical ExaminationPhysical Examination
• Key Findings: Gr II-IV blowing systolic murmur at the lower sternal region which increases on inspiration
• S1 , S2 , right sided S3, S4• Sternal lifting or substernal pulsation• Jugular venous distention with large V waves• Pulsatile enlarge liver• Ascites• Peripheral edema
DiagnosticsDiagnostics
• EKG _ RAH and RVH• giant P waves suggest Eibstein anomaly Ventricular tachycardia (VT) in RV dysplasia• Holter monitoring if recurrent syncope is occurring • Chest x-ray Prominent right heart border Obliteration of retrosternal space in the left lateral view
EchocardiographyEchocardiography
• Key Finding: the presence of regurgitant • jet in the RA by doppler and • elevated RA pressures.• RV and RA dilatation• Prolapse of the tricuspid valve• Bacterial vegetations• Giant anterior leaflet and ventricularization of the
RA confirms the diagnosis of Eibstein anomaly
Medical therapyMedical therapy
• Treat the underlying cause• RX• Diuretics• Digoxin• Control of cardiac arrhythmias• SBE prophylaxis*• * Not required if TR is functional in nature
SurgerySurgery
• Indication
For severe tricuspid regurgitation not
improved with medical therapy
• Annuloplasty and implantation of Carpentier ring
Tricuspid StenosisTricuspid Stenosis
• Pathophysiology of Tricuspid Stenosis
The tricuspid valve obstruction causes an increase in RA pressures with progressive RA dilatation
Pathophysiology of TricuspidPathophysiology of TricuspidStenosisStenosis
Right HeartRA
RV
PA
Tricuspid valve
Pulmonic valve
Etiology of Tricuspid stenosisEtiology of Tricuspid stenosis
• Part of a multivalvular involvement in rheumatic heart disease
• Carcinoid syndrome• Congenital _ Eibstein anomaly• Connective tissue disease such as SLE• Methysergide therapy• Antiphospholid syndrome• Others:• Whipples disease• Fabry’s disease• Endocardial fibroelastosis
SymptomsSymptoms
• Easifatigability
• Abdominal swelling
• Peripheral edema
• Exertional syncope
• Other symptoms are related to the associated diseases and anomalies
Physical ExaminationPhysical Examination
• Key finding: the presence of long • diastolic murmur in the lower sternal • or subxyphoid region which increases on inspiration. Right sided opening snap (OS) may be present. There is presystolic accentuation if the rhythm is sinus.• S1 is increased • Signs of right heart failure• jugular venous distention with A wave• hepatomegaly• peripheral edema
DiagnosticsDiagnostics
• EKG _ RA hypertrophy
• giant P waves suggest Eibstein
anomaly
• Chest x-ray
• Prominent right heart border
EchocardiograpyEchocardiograpy
• Key finding: Stiff and deformed tricuspid
leaflets with increased diastolic
velocities across the tricuspid
valve and turbulence in the
doppler flow signal
• Giant anterior leaflet of the tricuspid valve and ventricularization of RA suggest Eibstein anomaly
Medical therapyMedical therapy
• RX • Duiretics• Digoxin for control of A-fib• Rheumatic fever prophylaxis• SBE prophylaxis
• Invasive Balloon valvulotomy
Indication for invasive interventionIndication for invasive intervention
• Persistent symptoms despite medical therapy in a patient with valve area of
1.5 cm2 or less
SurgerySurgery
• Open commisurotomy
• Tricuspid valve replacement
• Prognosis: Depends on underlying cause and other associated pathologies