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Friday, February 18, 2011

TRICUSPID REGURGITATION

Tricuspid regurgitation is common. The most frequent causes are:
  • Right ventricular dilatation secondary to pulmonary hypertension
  • Rheumatic heart disease
  • Endocarditis, particularly in intravenous drug abusers
  • Right ventricular infarction
Clinical features
Symptoms are usually non-specific. The most prominent clinical feature is a large systolic wave in the jugular venous pulse. Systolic hepatic pulsation may also be present. There is a pansystolic murmur, similar to that of mitral regurgitation but best heard at the lower left or right sternal edge. The murmur gets louder in inspiration.

Management
Tricuspid regurgitation, which is due to right ventricular dilatation, gets better when the cause of right ventricular overload is corrected, for example by mitral valve replacement or by diuretic and vasodilator treatment of left ventricular failure.
patients with a normal pulmonary artery pressure tolerate isolated tricuspid reflux without ill effects, and valves damaged by endocarditis do not always need to be replaced.
A few patients with organic tricuspid valve damage and elevated pulmonary artery pressure may need tricuspid valve application or replacement.

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