Name
TRICUSPID REGURGITATION
DESCRIPTION
DETAIL
CAUSES : - RHEUMATIC HEART DISEASE - ENDOCARDITIS - EBSTEIN ANOMALY - CONGENITAL MALFORMATION OF VALVE - PROLAPSE - CARCINOID SYNDROME - PAPILLARY MUSCLE DYSFUNCTION - TRAUMA - CONNECTIVE TISSUE DISEASES LIKE MARFAN SYNDROME, OSTEOGENESIS IMPERFECTA, EHLERS DANLOS SYNDROME - ANATOMICALLY NORMAL TRICUSPID VALVES -------------------------------------------------------------------------- D.D. : - ASCITES - ATRIAL FIBRILLATION - BILIARY DISEASE - CARCINOID TUMOR, INTESTINAL - CARDIAC CIRRHOSIS - CARDIOGENIC SHOCK - CARDIOMYOPATHY, DILATED - CIRRHOSIS - COR-PULMONALE - EBSTEIN ANOMALY - EISENMENGER SYNDROME - HEART FAILURE - MITRAL REGURGITATION* ECG - MAY SHOW INCOMPLETE RBBB, RA ENLARGEMENT & Q WAVE IN V1 & MAY BE ATRIAL FIBRILLATION. * X-RAY CHEST - RT & RV ENLARGEMENT. *
TYPENOTES
RISK FACTORS : INTRAVENOUS DRUG ABUSERS SUSCEPTIBLE TO STAPHYLOCOCCUS ENDOCARDITIS WITH RESULTANT TRICUSPID REGURGITATIONMedical Care: For patients in whom tricuspid regurgitation is secondary to left-sided heart failure, treatment centers on adequate control of fluid overload and failure symptoms. Diuretic therapy with interventions to address the primary pathology is of paramount importance. Surgical Care: Surgical intervention is indicated when structural deformity of the valve (eg, Ebstein anomaly) exists, when the valve is destroyed by bacterial endocarditis, or when ventricular dilatation is severe and uncontrolled with medical therapy. " Tricuspid regurgitation associated with mitral valve disease and pulmonary hypertension o Assess the severity of the regurgitation by palpation of the valve at the time of mitral valve intervention. Patients with mild tricuspid regurgitation do not require intervention. o As pulmonary vascular pressures fall with successful mitral valve therapy, the tricuspid regurgitation tends to disappear. o Severe regurgitation has been successfully treated with tricuspid annuloplasty. " Organic disease of the tricuspid valve o Corrective measures for organic disease of the tricuspid valve usually involve valve replacement. Because of the increased incidence of prosthetic valve thrombosis in this low-flow position, a porcine heterograft is the valve of choice. o Tricuspid valve replacement has been used in carcinoid heart disease and cardiogenic shock with RV infarction, and after cardiac transplantation. " Tricuspid valve endocarditis o Total excision of the tricuspid valve without immediate replacement is recommended and is well tolerated. o Diseased valvular tissue is excised to eradicate the endocarditis, and antibiotic treatment is continued. Most patients tolerate loss of the tricuspid valve well. o If medical management does not control the tricuspid regurgitation well and the infections have been controlled, an artificial valve can be inserted. " Ebstein anomaly: If this anomaly produces uncontrollable tricuspid regurgitation, then tricuspid valve replacement is necessary. DRUG TREATMENT : 1. DIURETICS : - FRUSEMIDE 2. CARDIAC GLYCOSIDES : - DIGOXIN 3. ACE INHIBITORS : - CAPTOPRIL 4. ANTICOAGULANTS : - WARFARIN -
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
X-RAY CHEST P.A. VIEW( NORMAL ), ECHOCARDIOGRAPHY, ECG, CARDIAC DOPPLER