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    Tricuspid Valve Disease

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    sarguss14
    This document discusses tricuspid valve disease, including tricuspid regurgitation and stenosis. It covers etiology, pathophysiology, symptoms, physical exam findings, diagnostics including echocardiography, and treatment options like medications, balloon valvuloplasty, surgery. Tricuspid regurgitation is caused by things like pulmonary hypertension and dilated cardiomyopathy and is assessed by Doppler echo. Treatment involves managing the underlying condition and possibly surgery like annuloplasty. Tricuspid stenosis is often part of rheumatic heart disease and is evaluated by echo showing stiff leaflets; it may require balloon valvuloplasty or valve replacement.

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    Tricuspid Valve Disease

    Uploaded by

    sarguss14
    567 views20 pages
    This document discusses tricuspid valve disease, including tricuspid regurgitation and stenosis. It covers etiology, pathophysiology, symptoms, physical exam findings, diagnostics including echocardiography, and treatment options like medications, balloon valvuloplasty, surgery. Tricuspid regurgitation is caused by things like pulmonary hypertension and dilated cardiomyopathy and is assessed by Doppler echo. Treatment involves managing the underlying condition and possibly surgery like annuloplasty. Tricuspid stenosis is often part of rheumatic heart disease and is evaluated by echo showing stiff leaflets; it may require balloon valvuloplasty or valve replacement.

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    a transcription regarding tricuspid regurgitation and stenosis

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    This document discusses tricuspid valve disease, including tricuspid regurgitation and stenosis. It covers etiology, pathophysiology, symptoms, physical exam findings, diagnostics including echocardiography, and treatment options like medications, balloon valvuloplasty, surgery. Tricuspid regurgitation is caused by things like pulmonary hypertension and dilated cardiomyopathy and is assessed by Doppler echo. Treatment involves managing the underlying condition and possibly surgery like annuloplasty. Tricuspid stenosis is often part of rheumatic heart disease and is evaluated by echo showing stiff leaflets; it may require balloon valvuloplasty or valve replacement.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    567 views20 pages

    Tricuspid Valve Disease

    Uploaded by

    sarguss14
    This document discusses tricuspid valve disease, including tricuspid regurgitation and stenosis. It covers etiology, pathophysiology, symptoms, physical exam findings, diagnostics including echocardiography, and treatment options like medications, balloon valvuloplasty, surgery. Tricuspid regurgitation is caused by things like pulmonary hypertension and dilated cardiomyopathy and is assessed by Doppler echo. Treatment involves managing the underlying condition and possibly surgery like annuloplasty. Tricuspid stenosis is often part of rheumatic heart disease and is evaluated by echo showing stiff leaflets; it may require balloon valvuloplasty or valve replacement.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 20

    Tricuspid Valve Disease

    Bernardo D. Morantte Jr. M.D.


    Dept. of Medicine
    College of Medicine
    Pamantasan Ng Lungsod Ng Maynila
    Tricuspid 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
    Regurgitation
    • 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 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
    Symptoms
    • 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 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
    Diagnostics
    • 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
    Echocardiography
    • 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 therapy
    • Treat the underlying cause
    • RX
    • Diuretics
    • Digoxin
    • Control of cardiac arrhythmias
    • SBE prophylaxis*
    • * Not required if TR is functional in nature
    Surgery
    • Indication
    For severe tricuspid regurgitation not
    improved with medical therapy

    • Annuloplasty and implantation of


    Carpentier ring
    Tricuspid Stenosis
    • Pathophysiology of Tricuspid Stenosis

    The tricuspid valve obstruction causes an


    increase in RA pressures with progressive
    RA dilatation
    Pathophysiology of Tricuspid
    Stenosis
    Right Heart
    RA

    PA
    Pulmonic
    valve

    Tricuspid valve
    RV
    Etiology 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
    Symptoms
    • Easifatigability
    • Abdominal swelling
    • Peripheral edema
    • Exertional syncope
    • Other symptoms are related to the
    associated diseases and anomalies
    Physical 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
    Diagnostics
    • EKG _ RA hypertrophy
    • giant P waves suggest Eibstein
    anomaly
    • Chest x-ray
    • Prominent right heart border
    Echocardiograpy
    • 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 therapy
    • RX
    • Duiretics
    • Digoxin for control of A-fib
    • Rheumatic fever prophylaxis
    • SBE prophylaxis

    • Invasive
    Balloon valvulotomy
    Indication for invasive intervention

    • Persistent symptoms despite medical


    therapy in a patient with valve area of
    1.5 cm2 or less
    Surgery
    • Open commisurotomy

    • Tricuspid valve replacement

    • Prognosis: Depends on underlying cause


    and other associated pathologies

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