Tricuspid Valve Regurgitation

Overview
  • Tricuspid Valve Regurgitation refers to inappropriate retrograde movement of blood from the right ventricle to the right atrium during systole.
Etiologies
  • Overview
    • In most cases tricuspid regurgitation is due to a functional defect in tricuspid valve closure, secondary to dilation of the tricuspid annulus, rather than a structural derangement of the valve leaflets themselves. Consequently, processes which result in right ventricular eccentric hypertrophy can give rise to tricuspid regurgitation.
  • Functional Tricuspid Regurgitation
    • In general, any pathophysiological process that leads to severe pulmonary hypertension will result in right ventricular hypertrophy which in its end-stage takes a eccentric pattern, enlarging the tricuspid annulus, and thus potentially leading to Tricuspid Regurgitation. In many cases, pulmonary hypertension arises in contexts of left heart failure which are frequently secondary to myocardial infarction or mitral stenosis. Less commonly, right ventricular dilation secondary to dilated cardiomyopathy or direct right ventricular myocardial infarction can also be a culprit.
  • Structural Tricuspid Regurgitation
    • Structural defects of the tricuspid valve are much rarer causes of tricuspid regurgitation. These include infective endocarditis affecting the tricuspid valve, usually observed in IV drug abusers. Patients with carcinoid syndrome develop plaques affecting the tricuspid valve possibly caused by high levels of circulating serotonin metabolites released by the tumor. These plaques structurally derange the Tricuspid leaflets and can lead to regurgitation.
Clinical Consequences
  • Tricuspid Valve Regurgitation results in retrograde transmission of systolic ventricular pressures into the systemic veins. This results in substantial peripheral edema and ascites along with hepatomegaly and in some cases visible systolic pulsation of the liver. In addition, there is an exaggeration of the right atrial V wave as blood is forced into the right atrium during right ventricular systole.