Primary and secondary forms
Doctors share two fundamentally different scenarios. In the primary form, the valve itself is damaged: it is changed after infective endocarditis, rheumatism, trauma, with congenital Ebstein anomaly, or touched by a pacemaker electrode. In the secondary, more common form, the leaflets are normal, but the valve ring is stretched and the right ventricle is enlarged due to pressure or volume overload. This happens with pulmonary hypertension, mitral valve disease, heart failure and prolonged atrial fibrillation.
- Primary - damage to the valves and chords
- Secondary - expansion of the fibrous ring
- Degrees: trace, light, moderate, severe
- Separately, regurgitation associated with the pacemaker electrode is distinguished
- Ebstein's congenital anomaly
Causes and risk factors
Most often, tricuspid insufficiency is not an independent disease, but a reflection of a problem in another part of the heart or in the lungs. Chronic obstructive pulmonary disease, pulmonary embolism, and pulmonary hypertension increase pressure in the right ventricle and distend the valve. Mitral valve defects and left heart failure act in the same way. Atrial fibrillation has been dilating the right atrium for years. Infective endocarditis of the tricuspid valve occurs with intravenous drug use and long-term venous catheters.
- Pulmonary hypertension of any nature
- Mitral and aortic valve diseases
- Chronic heart failure
- Prolonged atrial fibrillation
- Infective endocarditis
- Pacemaker electrode
- Past rheumatic fever
Symptoms
Mild regurgitation does not give any sensation and is detected by chance. With severe insufficiency, blood stagnates in the systemic circulation, and complaints are associated precisely with stagnation: in the evening the legs swell, the liver enlarges, heaviness and distension appear in the right hypochondrium, the abdomen enlarges due to fluid. A person gets tired quickly, tolerates stress less well, and notices the pulsation of the veins in the neck. Shortness of breath is more often associated with an underlying heart or lung disease.
- Swelling of the legs and feet, worsening in the evening
- Heaviness and pain in the right hypochondrium
- Abdominal enlargement, bloating, loss of appetite
- Swelling and pulsation of the neck veins
- Weakness and decreased exercise tolerance
- Heart palpitations and interruptions
Diagnostics
The diagnosis is made by echocardiography: it shows the degree of reverse flow, the size of the right chambers, the diameter of the valve ring, the estimated pressure in the pulmonary artery and the condition of other valves. The doctor always looks for the cause: evaluates the left side of the heart, the condition of the lungs, and the rhythm. An ECG reveals atrial fibrillation and overload of the right sections. A chest x-ray helps evaluate the lungs and heart size. The tests look at the function of the liver and kidneys, because with prolonged stagnation they suffer. In difficult cases, cardiac MRI or transesophageal echocardiography is performed.
- Echocardiography with assessment of the degree of regurgitation
- ECG
- Chest x-ray
- Blood biochemistry with liver and kidney parameters
- Transesophageal echocardiography when planning surgery
- MRI of the heart in difficult cases
Treatment
Mild and moderate asymptomatic regurgitation does not require treatment - observation and control of the underlying disease are needed. In case of stagnation, diuretics are prescribed, which reduce swelling and heaviness in the hypochondrium, treat atrial fibrillation and heart failure, and reduce pressure in the pulmonary artery, if possible. Surgical treatment is discussed in cases of severe failure with symptoms or dilatation of the right ventricle, and also when another valve is being operated on: then tricuspid repair is performed simultaneously. Options include plastic surgery with a support ring, prosthetics, and in some cases transcatheter techniques.
- Observation for mild cases
- Diuretics and salt restriction during stagnation
- Treatment of heart failure and arrhythmia
- Treatment of pulmonary hypertension according to indications
- Valve plastic with support ring
- Prosthetics or transcatheter intervention
