Tricuspid regurgitation
Introduction
Introduction to tricuspid regurgitation Tricuspid regurgitation is caused by congenital or acquired factors leading to tricuspid valve disease or tricuspid annulus dilatation, which causes the tricuspid valve to be completely closed during systole. The disease is functional and organic. The former is often secondary to lesions leading to right ventricular dilatation. The incidence is quite high, such as primary pulmonary hypertension, mitral valve disease, pulmonary valve or funnel stenosis, right ventricle. Myocardial infarction, etc. The latter may be a congenital anomaly such as Ebstein malformation and common atrioventricular pathway, or may be acquired lesions such as rheumatic inflammation, coronary artery disease caused by tricuspid papillary muscle dysfunction, trauma and infective endocarditis, etc. The prognosis of the disease depends on the nature of the primary disease and the severity of heart failure. The prognosis of patients with primary pulmonary hypertension and chronic pulmonary heart disease is often worse than those caused by mitral valve disease or atrial septal defect. Medical treatment can relieve symptoms and can be cured by surgery. basic knowledge The proportion of illness: 0.013% Susceptible people: no specific population Mode of infection: non-infectious Complications: Liver enlargement Ascites
Cause
Tricuspid regurgitation
Pulmonary hypertension (35%)
Common in mitral valve disease and chronic pulmonary heart disease, involving the inferior myocardial infarction of the right ventricle, rheumatic or congenital heart disease, pulmonary hypertension caused by late heart failure, ischemic heart disease, cardiomyopathy.
Tricuspid annulus dilatation (30%)
Tricuspid annulus dilatation leads to tricuspid regurgitation, multiple secondary to various cardiac and pulmonary vascular diseases, such as common mitral valve disease and chronic pulmonary heart disease, involving the inferior myocardial infarction of the right ventricle.
Other factors (15%)
For example, trauma and carcinoid plaque often sink on the ventricular surface of the tricuspid valve, and the tip of the valve adheres to the right ventricular wall, causing tricuspid regurgitation.
Prevention
Tricuspid regurgitation prevention
For certain diseases such as primary pulmonary hypertension, mitral valve disease, pulmonary valve or funnel stenosis, right ventricular myocardial infarction, etc. or should always be alert and prevent functional tricuspid regurgitation; and in other diseases such as Ebstein malformations and common atrioventricular pathways in congenital anomalies, and some acquired lesions such as rheumatic inflammation, tricuspid papillary muscle dysfunction caused by coronary lesions, trauma and infective endocarditis, etc. The appearance of tricuspid regurgitation occurs.
Complication
Tricuspid regurgitation Complications
In rheumatic valvular heart disease, tricuspid valve disease usually coincides with left heart valve disease, and simple involvement of tricuspid valve is rare. This indicates that combined valve disease is one of its characteristics. Such patients not only have pulmonary blood vessels. Increased resistance, secondary respiratory damage, and increased systemic venous pressure, gastrointestinal bleeding, digestive dysfunction.
Rheumatic valvular disease with tricuspid valve disease, the main cause of poor recovery or death of heart function at the end of surgery is concurrent right heart failure and elevated venous pressure. The main clinical manifestations are jugular vein engorgement, hepatomegaly, ascites, low protein blood. Symptoms, drug treatment can only be relieved in a short period of time, and the mortality rate of reoperation is extremely high.
Symptom
Tricuspid regurgitation symptoms Common symptoms Jugular vein systolic murmur heart valve disease Tricuspid valve prolapse Right heart failure Neck beats palpation No pulmonary artery closure ventricular hypertrophy fatigue pain
First, the symptoms
In severe cases, there are fatigue, abdominal distension and other symptoms of right heart failure. Complications include atrial fibrillation and pulmonary embolism.
Second, physical signs
(a) blood vessels and heart
1 jugular vein engorgement with obvious systolic pulsation, enhanced inspiratory, severe reflux with venous systolic murmur and tremor.
2 right ventricular beats showed a high dynamic impact.
3 In severe reflux, the third lower heart of the sternum has a third heart sound, which is enhanced when inhaling.
4 The tricuspid regurgitation is high-pitched, with a squeaky and full systolic period. It is the loudest in the lower left rim or xiphoid area of the sternum. When the right ventricle is significantly enlarged to occupy the apical area, it is most obvious in the apical area, and the murmur is enhanced by inhalation. When the right heart fails and the stroke volume cannot be further increased, this phenomenon disappears.
5 In severe reflux, the tricuspid blood flow increased, and there was a short diastolic rumbling murmur after the third heart sound on the lower left sternal border.
6 tricuspid valve prolapse has a systolic click.
7 can see the systolic pulsation of the liver.
(two) systemic congestion
Symptoms and signs of tricuspid regurgitation are related to the degree of valvular insufficiency. Mild regurgitation is not clinically detectable. In severe cases, fatigue may be present, poor appetite, pain in the liver area, abdominal distension, and lower extremity edema.
Examine
Tricuspid regurgitation
(1) X-ray examination shows the right ventricle, the right atrium is enlarged, the right atrial pressure is increased, and the azygous vein dilatation and pleural effusion can be seen; if there is ascites, the sacral sac is lifted up, and the right atrial systolic pulsation can be seen in perspective. .
(B) ECG examination can show right ventricular hypertrophy strain, right atrial hypertrophy; and often have right bundle branch block.
(3) Echocardiography can be seen in the right ventricle, the right atrium is enlarged, the superior and inferior vena cava is widened and pulsating; even the tricuspid valve, two-dimensional echocardiography can confirm the reflux, Doppler ultrasonography can judge the opposite The degree of flow and pulmonary hypertension.
Diagnosis
Diagnosis of tricuspid regurgitation
diagnosis
X-ray photographs show hypertrophy of the right atrium and right ventricle, with the right edge of the heart protruding and half of the changes caused by other valvular lesions.
ECG shows atrial hypertrophy, P wave height and width; and right bundle branch block or right ventricular hypertrophy, and even myocardial strain, often atrial fibrillation.
Echocardiography and Doppler examination: Facet ultrasound can detect the size of the tricuspid annulus, understand the thickening of the valve, help to distinguish between relative and organic lesions, tricuspid regurgitation, contrast-enhanced ultrasound Visible microbubbles to and from the tricuspid valve; Doppler can directly detect abnormal signals from the right ventricle to the right atrium, and can estimate the degree of reflux.
Cardiac catheterization showed V-wave protrusion of the right atrial pressure waveform, y descending branch became steeper, more obvious during inhalation, right atrial pressure waveform was similar to right ventricular pressure waveform, only small amplitude, called right ventricular Right atrial pressure is a manifestation of severe tricuspid regurgitation.
Cardioangiography: Right ventricular angiography, right anterior oblique film photography can show tricuspid regurgitation and its extent, but there is a potential false positive due to the cardiac catheter crossing the tricuspid valve.
The diagnosis of tricuspid regurgitation should include an understanding of the degree of incomplete closure. Typical clinical signs have a value in the diagnosis of severe tricuspid regurgitation. In the past, right ventricular angiography was used as a means of diagnosing suspicious cases and estimating the degree of reflux. In recent years, ultrasound and Doppler examinations have gradually replaced traumatic examinations.
Differential diagnosis
Mitral regurgitation: typical ventricular systolic murmur in the apical region and enlargement of the left atrium and left ventricle.
Tricuspid regurgitation: the lower end of the left sternal border and the limited contraction of the localized squeaky squeak. When inhaling, the murmur is enhanced by the increase of blood volume, and the exhalation is weakened. When the pulmonary hypertension is high, the second heart sound of the pulmonary valve is hyperthyroidism. The v-wave of the jugular vein is enlarged, there may be liver pulsation, swelling, right ventricular hypertrophy can be seen by electrocardiogram and X-ray examination, and echocardiography can confirm the diagnosis.
