Highlights & Basics
- 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.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Severe tricuspid regurgitation due to annular enlargement. A. Systolic frame from apical 4 chamber view (Mayo Clinic display format with right ventricle on the right). Note tricuspid annular enlargement measuring 4.2 cm and tethering of the tricuspid leaflets leading to failure of coaptation of the tricuspid valve. B. Massive tricuspid regurgitation on Color Doppler. C. Continuous Wave Doppler through the tricuspid valve. Note the dagger-shaped tricuspid regurgitant signal (arrows), consistent with rapid equalization of pressures between right ventricle and right atrium, typical of massive tricuspid regurgitation. D. Pulsed Wave Doppler of the hepatic veins demonstrates late systolic flow reversals consistent with severe tricuspid regurgitation.
Severe tricuspid regurgitation due to carcinoid valvular disease. A. Systolic frame from mid-esophageal 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. Color 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.
Tricuspid valve entrapped with a pacemaker lead
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 Color Doppler images demonstrating severe tricuspid regurgitation due to lead impingement.
Citations
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Abbas M, Hamilton M, Yahya M, et al. Pulsating varicose veins!! The diagnosis lies in the heart. ANZ J Surg. 2006 Apr;76(4):264-6.[Abstract]
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