Tricuspid regurgitation is one of the varieties of heart defects in which blood is refluxed during systole from the right ventricle to the cavity of the right atrium. The reason for this is the insufficiency of the tricuspid (tricuspid) valve, i.e., incomplete closure of its valves. Tricuspid regurgitation is acquired or congenital.
Origin of the term
The word "regurgitation" came from the Latin gurgitare - "flood" - and the prefix re-, denoting the opposite action, that is, it assumes the opposite direction to the normal direction. In this case, the reverse flow of blood.
Causes of Congenital Tricuspid Regurgitation
The most common causes of this congenital pathology are:
- underdevelopment of valve flaps;
- abnormal development (quantity) of valve flaps;
- connective tissue dysplasia;
- Ehlers-Danlos syndrome;
- Marfan syndrome;
- Ebstein's anomaly.
Tricuspid regurgitation in the fetus in isolation is very rare, usually it is combined with other heart defects. This valve insufficiency can be part of the mitral-aortic-tricuspid malformation.
Causes of Acquired Tricuspid Regurgitation
Acquired tricuspid valve regurgitation is much more common than congenital. It is primary and secondary. The primary causes of this pathology include rheumatism, drug addiction, carcinoid syndrome.
- Rheumatism is the most common cause of this pathology. In 20% of cases, it is recurrent rheumatic endocarditis that leads to deformation (thickening and shortening) of the valve cusps, and tendon filaments change in the same way. Very often, stenosis of the right atrioventricular opening joins this pathology. This combination is called a combined tricuspid defect.
- Rupture of the papillary muscles can also lead to tricuspid regurgitation. Such breaks occur with myocardial infarction or may be traumatic.
- Carcinoid syndrome can also lead to this pathology. It occurs in certain types of oncology, for example, cancer of the small intestine, ovaries or lungs.
- Taking heavy drugs very often leads to infectious endocarditis, and it, in turn, can cause tricuspid regurgitation.
The causes of secondary tricuspid insufficiency are most often the following diseases:
- dilation of the fibrous ring that occurs with dilated cardiomyopathy;
- high degree of pulmonary hypertension;
- myocardial weakness of the right ventricle, which occurs with the so-called pulmonary heart;
- chronic heart failure;
- myocarditis;
- myocardial dystrophy.
Symptoms in children
Congenital tricuspid regurgitation in infants in 25% of cases manifests itself as supraventricular tachycardia or atrial fibrillation, later severe heart failure may occur .
In older children, even with minimal exertion, shortness of breath and a strong heartbeat appear. A child may complain of heart pain. Dyspeptic disorders (nausea, vomiting, flatulence) and pain or a feeling of heaviness in the right hypochondrium may be observed. If stagnation occurs in a large circle of blood circulation, then peripheral edema, ascites, hydrothorax or hepatomegaly appear. All these are very serious conditions.
Symptoms of the disease in adults
If this pathology is acquired at a later age, then at the initial stage a person may not even suspect about it. Minor tricuspid regurgitation is manifested only in some patients by pulsation of the cervical veins. The patient does not note other symptoms. Regurgitation of the tricuspid valve of the 1st degree may not manifest itself in any way. Usually this pathology is detected quite by accident at the next physical examination. The patient undergoes echocardiography, in which he reveals tricuspid regurgitation of 1 degree. What is it - he learns only after examination. Such patients are usually registered with a cardiologist and observed.
In more severe valve failure, a significant swelling of the jugular veins is observed. In this case, if you put a palm on the right of the jugular vein , you can feel its trembling. In severe cases, this pathology leads to dysfunction of the right ventricle, atrial fibrillation, or can provoke heart failure.
Diagnostics
The diagnosis of “tricuspid regurgitation of 1 degree" or some other one can be made only after a thorough examination of the patient. To do this, go through the following procedures:
- physical examination method, i.e. listening with a stethoscope to heart sounds and sounds;
- Echocardiography (echocardiography) is an ultrasound of the heart that reveals the functional and morphological state of the heart muscle and valves;
- An ECG in which you can see signs of an enlarged right atrium and ventricle of the heart;
- chest x-ray - this study also shows increased sizes of the right ventricle, you can see signs of pulmonary hypertension and deformation of the mitral and aortic valves;
- produce a biochemical blood test;
- general blood analysis;
- cardiac catheterization - this latest invasive procedure is used both for the diagnosis of cardiac pathologies and for treatment.
Classification
We found that the tricuspid valve regurgitation by etiology can be congenital and acquired, primary (organic) or secondary (functional). Organic deficiency is expressed by deformation of the valve apparatus: thickening and wrinkling of the valve cusps or calcification. Functional failure is manifested in valve dysfunction caused by other diseases, and is manifested by rupture of the papillary muscles or tendon chords, as well as a violation of the fibrous ring.
Degrees of disease
There are 4 degrees of this disease, which are characterized by the length of the jet throwing back the blood stream into the cavity of the right atrium.
Tricuspid regurgitation of the 1st degree - what is it? In this case, the return of blood is negligible and barely determined. In this case, the patient does not complain about anything. The clinical picture is absent.
With a diagnosis of “tricuspid regurgitation of 2 degrees”, the reverse jet of blood reflux is carried out within 2 cm from the walls of the valve. The clinic at this stage of the disease is almost absent; pulsation of the jugular veins may be weakly expressed.
Regurgitation of the tricuspid valve of the 3rd degree is determined by throwing back the blood flow more than 2 cm from the tricuspid valve. In addition to pulsations of the cervical veins, patients can feel palpitations, weakness and fatigue, even with small physical exertion, slight dyspnea can be observed.
Grade 4 disease is characterized by a pronounced jet of reflux of blood flow over a large length from the valve into the cavity of the right atrium. In severe cases, the patient may experience symptoms of severe heart failure and pulmonary hypertension (pulmonary and tricuspid regurgitation). In this case, others join the symptoms listed above. Namely: swelling of the lower extremities, a feeling of pulsation on the left in the sternum, which is intensified by inhalation, a violation of heart sounds, cold extremities, an increase in liver size, ascites (fluid accumulation in the abdominal cavity), abdominal pain, and with the rheumatic nature of this disease can be observed aortic or mitral defect.
Treatment
The methods of treatment depend on the degree of the disease, and also on whether it is accompanied by other heart defects and pathologies or not. With a diagnosis of tricuspid valve regurgitation of the 1st degree, treatment, as a rule, is not required. Doctors consider this condition as a variant of the norm. If tricuspid regurgitation of the 1st degree is caused by some disease, for example, lung disease, rheumatism or infectious endocarditis, then a provocateur disease should be treated. If you get rid of the underlying disease, further deformation of the tricuspid valve will stop. So, tricuspid regurgitation of the 1st degree - what it is and how to treat it is now clear. Consider the next stage of this disease.
Grade 2 tricuspid regurgitation often also does not require treatment. If this pathology is associated with other heart diseases or diseases, for example, heart failure, then treatment with conservative methods should be carried out. For this, diuretics are used to reduce puffiness and drugs that relax the smooth muscles of the walls of blood vessels (vasodilators). Tricuspid regurgitation of the 2nd degree does not require other measures.
Treatment of grade 3 and 4 is also aimed at eliminating the disease that caused regurgitation. In case it does not bring results, surgical intervention is indicated. At the same time, plastic is provided for valve flaps, their annuloplasty (hemming of an elastic or rigid ring, it is also possible to suture the valve ring by suturing) or prosthetics.
Mitral regurgitation
If the mitral valve is inconsistent , when its valves do not close tightly enough, a backflow of blood from the left ventricle to the cavity of the left atrium occurs during systole. This condition is called mitral regurgitation or mitral valve prolapse. This pathology, like tricuspid regurgitation, can be either congenital or acquired. The causes and diagnosis for the diagnosis of mitral and tricuspid regurgitation are also similar. The degrees that determine the severity of the disease are only 4, they depend on the amount of reverse blood flow:
- 1 degree - mitral regurgitation is negligible;
- 2 degree - mitral regurgitation is moderate;
- 3 degree - mitral regurgitation is pronounced;
- Grade 4 - severe mitral regurgitation, often there is a complicated course.
Insignificant mitral, tricuspid regurgitation of the 1st degree, which does not cause objective complaints in the patient, does not require any treatment. Therapeutic treatment is carried out with a complicated course of the disease, for example, cardiac arrhythmias or pulmonary hypertension. Surgery is indicated for severe or severe mitral regurgitation, in these cases plastic surgery or valve replacement is performed.
The combination of mitral and tricuspid insufficiency
Often, mitral and tricuspid regurgitation are diagnosed simultaneously in one patient. A cardiologist, after a detailed examination and analysis results, will decide on the treatment tactics of such a patient. If valve insufficiency is not pronounced, perhaps no treatment will be needed, but it will be necessary to periodically be observed by a cardiologist and undergo the necessary examinations.
If the cause that caused the valve insufficiency is established, then therapeutic treatment will be prescribed aimed at eliminating the provocative disease. In the absence of positive dynamics, surgical treatment of regurgitation is indicated. This usually happens with severe and severe illness.
Patients who have undergone surgical treatment of valve insufficiency are usually prescribed indirect anticoagulants.
Forecast
Secondary regurgitation is considered prognostically the most unfavorable. The death of patients in this case usually occurs from myocardial infarction, increasing heart failure, pneumonia or pulmonary embolism.
According to statistics, after surgical treatment of heart valve insufficiency, the survival rate of patients up to 5 years or more is 65% after prosthetics and 70% after annuloplasty.
The prognosis is favorable with a diagnosis of tricuspid regurgitation of 1 degree. What is it, patients usually learn only with preventive examinations. With minor insufficiency of heart valves, there is no direct threat to life.
Conclusion
Prevention of mitral and tricuspid insufficiency consists in the prevention of diseases that provoke valve failure. Namely, the treatment of rheumatism and other diseases that cause damage to heart valves.