BY-K.

Hemant Kumar

TRICUSPID REGURGITATION
Tricuspid insufficiency (TI), a valvular heart disease also called tricuspid regurgitation (TR),
refers to the failure of the heart'stricuspid valve to close properly during systole. As a result, with
each heart beat some blood passes from the right ventricle to theright atrium, the opposite of the
normal direction. Tricuspid regurgitation occurs in roughly less than 1% of people and is usually
asymptomatic, but may also be a feature of pulmonary hypertension and right-sided heart failure.

Signs and symptoms

Tricuspid insufficiency may be asymptomatic, especially if right ventricular function is well preserved.
Signs and symptoms are generally those of right-sided heart failure, such as ascites, an enlarged
liver, edema and jugular venous distension. Vague upper abdominal discomfort (from a congested
liver), and fatigue (due to diminished cardiac output) can all be present to some degree.
Tricuspid insufficiency may lead to the presence of a pansystolic heart murmur. Such a murmur is
usually of low frequency and best heard low on the lower left sternal border. It tends to increase with
inspiration, and decrease with expiration and Valsalva maneuver.However, the murmur may be
inaudible reflecting the relatively low pressures in the right side of the heart.Atrial fibrillation is usually
present

Causes
Although congenital causes of tricuspid insufficiency exist, most cases are due to dilation of the right
ventricle. Such dilation leads to derangement of the normal anatomy and mechanics of the tricuspid
valve and the muscles governing its proper function. The result is incompetence of the tricuspid
valve. Left ventricular failure is, in turn, the most common cause of right ventricular dilation.Other
common causes of right ventricular dilation include right ventricular infarction, inferior myocardial
infarction and cor pulmonale.
Other diseases can directly affect the tricuspid valve. The most common of these is rheumatic fever,
which is a complication of untreated strep throat infections. It is usually accompanied by mitral and
aortic valvular disease. Another condition directly harming the valve is tricuspid endocarditis
It may be found in those with a type of congenital heart disease called Ebstein's anomaly
Other infrequent causes of tricuspid regurgitation include:

Carcinoid tumors, which release a hormone which damages the valve

Connective tissue diseases such as Marfan syndrome
Systemic lupus erythematosus
Myxomatous degeneration
Injury
Rheumatoid arthritis
Radiation therapy
Another important risk factor for tricuspid regurgitation is use of the diet medications called "Fen-
Phen" (phentermine and fenfluramine) or dexfenfluramine.