The tricuspid valve insufficiency (TI) is the final failure of the tricuspid valve and leading to the blood flow from the RV to the RA during systole. The most common cause is the dilatation of the RV. Symptoms usually missing, but a severe TI can cause pulsations in the neck, a holosystolic noise and RV-induced heart failure or atrial fibrillation. The diagnosis is made because of the physical examination and echocardiography. The TI is usually benign and does not require treatment, but some patients need an annuloplasty, valve repair, or replacement.

The tricuspid valve insufficiency (TI) is the final failure of the tricuspid valve and leading to the blood flow from the RV to the RA during systole. The most common cause is the dilatation of the RV. Symptoms usually missing, but a severe TI can cause pulsations in the neck, a holosystolic noise and RV-induced heart failure or atrial fibrillation. The diagnosis is made because of the physical examination and echocardiography. The TI is usually benign and does not require treatment, but some patients need an annuloplasty, valve repair, or replacement.

(See also Overview of the heart valve diseases.) The tricuspid insufficiency (TI) is the final failure of the tricuspid valve and leads to blood flow from the RV to the RA during systole. The most common cause is the dilatation of the RV. Symptoms usually missing, but a severe TI can cause pulsations in the neck, a holosystolic noise and RV-induced heart failure or atrial fibrillation. The diagnosis is made because of the physical examination and echocardiography. The TI is usually benign and does not require treatment, but some patients need an annuloplasty, valve repair, or replacement. Etiology tricuspid regurgitation may be primary secondary (most common) tricuspid regurgitation is frequent. It can by changes in the valves due to infectious endocarditis in i.v. Drug abuse, by carcinoid syndrome, blunt injury in the chest, rheumatic fever, idiopathic myxomatous degeneration, congenital defects (z. B. cleaved tricuspid Endokardkissendefekt), Ebstein’s anomaly (downward displacement of a congenitally deformed Trikuspidalklappensegels in the RV), Marfan’s syndrome and the ingestion certain medications (eg. ergotamine, fenfluramine, phentermine). Among the iatrogenic causes include pacing leads, which go beyond the tricuspid valve, and valve damages suffered during an RV endomyocardial biopsy. A secondary tricuspid regurgitation occurs most frequently by a dilatation of the RV with paint functions of a normal flap as used in the pulmonary arterial hypertension induced by RV dysfunction and heart failure in pulmonary outflow tract obstruction. A long-standing severe TI can lead to by RV dysfunction induced heart failure and atrial fibrillation. Symptoms and complaints The tricuspid regurgitation usually causes no symptoms, but some patients experience pulsations in the neck due to the increased Jugularvenendruckes. Symptoms of severe TI include fatigue, bloating of the abdomen and anorexia. Patients can also symptoms of atrial fibrillation and flutter develop. To the signs of moderate or severe tricuspid regurgitation include the expansion of the jugular veins with a prominent fused c-v-shaft and a steep drop-y, and sometimes an enlarged liver and peripheral edema. In severe TI a rechtsjugul√§res venous thrill may be palpable, as was systolic hepatic pulsation and an RV pulse to the lower left Sternumgrenze. On auscultation the first heart sound auscultation (S1) can be heard normally or hardly, if a Trikuspidalregurgitationsger√§usch exists; the second heart sound (S2) can be cleaved (with a loud pulmonary component [P2] in pulmonary hypertension) or singular because of a prompt Pulmonalklappenschlusses with fusion of P2 and the aortic component (A2) .p.p1 {margin: 0.0 0.0px px 0.0px 0.0px; font: Arial 16.0px; color: # 424240; -webkit-text-stroke: # 424240; background-color: #ffffff} span.s1 {font-kerning: none} A right third heart sound (S3) may be heard near the sternum with RV dysfunction-induced heart failure. The sound of the TI is often not heard. If present, it is a holosystolic sound that is best left of center or listen to the lower Sternumgrenze or epigastric with the bell of the stethoscope when the patient is sitting up or standing. The noise may be high frequency, when the TI is light and is due to pulmonalerteriellen hypertension, or it may be mittelfrequent when the TI is heavy and has other causes. If the noise is not present, the diagnosis is best made by the appearance of a jugular vein wave pattern and the presence of systolic pulsations of the liver. The sound varies with breathing and we with the inspiration louder (Rivero-Carvalho characters). Diagnostic echocardiography A slight TI is most often discovered during echocardiography, which is performed for other reasons. Moderate or severe TI may be suspected by the history and physical examination. The diagnosis is confirmed by echocardiography. The heavy TI shows echocardiography by at least one of the following features: Two-dimensional failure of coaptation or “flail” Big insufficiency beam in the colored Doppler Large flow convergence zone proximal to the flap width of the vena contracta> 7 mm systolic flow reversal in the hepatic veins Transtrikuspidale E-wave dominant> 1 cm / s poet, triangular, early peak Direction, continuous wave Doppler of the TI-beam at moderate or severe TI underestimated the tip speed of the regurgitation pulmonary pressure. The two-dimensional echocardiography detected structural changes in the primary TI. Cardiac MRI is now the preferred method to estimate the size and function of the RV and typically should be performed when the image quality of echocardiography is inadequate. An EKG and a chest X-ray absorption are often performed. The ECG is usually normal, but in advanced cases, it may exhibit high P-waves, which are caused by the increase of the RA, and a high R or a QR-wave in V1, which are characteristic of the RV hypertrophy, or atrial fibrillation. The chest x-ray recording is usually normal, in advanced cases with RV hypertrophy or RV dysfunction induced heart failure it may be an enlarged superior vena cava, a right-or right-enlarged silhouette (behind the upper sternum in the lateral projection), or a pleural effusion show. Laboratory tests are not required, but to show if they are carried out, hepatic dysfunction in patients with severe TI. A cardiac catheterization is indicated for the accurate measurement of pulmonary pressure when the TI is difficult, and the assessment of coronary anatomy if a surgical procedure is planned. The findings of catheterization include a prominent c-v-pressure wave in the right atrium during ventricular systole. The forecast severe tricuspid regurgitation ultimately a poor prognosis, even if you first years may well live with it. As with the left-sided valvular regurgitation, the volume-overloaded ventricle eventually decompensated irreversible. Treatment Treating the cause Sometimes annuloplasty or valve repair or replacement Very light TI is a normal finding and makes no intervention required. Drug treatment of the causes (eg. As heart failure, endocarditis) is indicated. Patients with severe tricuspid regurgitation should be as soon as possible to have an operation, if symptoms are present, despite medical treatment or when a moderate, progressive enlargement or dysfunction of the RV is present. During an operation for left-sided heart lesions, moderate or mild TI should also be resolved with extended to> 40 mm annulus. Surgical options include annuloplasty valve repair heart valve replacement The annuloplasty, in which the tricuspid is sewn to a prosthetic ring or carried an adapted reduction of the circumferential size of the annulus, is indicated in a TI due to Anulusdilatation. A valve repair is indicated when the TI has arisen due to primary valve disorders or when the annuloplasty is not feasible technically. A tricuspid valve is indicated if the TI is due to carcinoid syndrome or Ebstein’s anomaly. It is used a bioprosthetic valve, to reduce the risk of thromboembolism, which is at the low pressures of the right heart; in the right heart keep bioprosthetic valves as opposed to the left heart> 10 years. A Bioprothetikklappe does not require anticoagulation beyond the immediate postoperative period. Summary A tricuspid regurgitation usually occurs at a normlen flap which is affected by RV dilation on. More rarely there is an intrinsic valve dysfunction (eg. As a result of infectious endocarditis, carcinoid syndrome, or certain drugs). It can be a jugular venous expansion occur. Heavy TI can cause abdominal stretch, liver enlargement or peripheral edema. The heart sounds include a holosystolic sound that is best left of center or listen to the lower Sternumgrenze or epigastric when the patient is sitting up or standing. The noise gets louder with inspiration. A TI is well tolerated in general; in severe cases, annuloplasty, a valve repair or valve replacement may be necessary.

Comments

Leave a Reply

Sign In

Register

Reset Password

Please enter your username or email address, you will receive a link to create a new password via email.