What is mild tricuspid regurgitation

The tricuspid valve is like a one-way control valve that ensures that blood can flow from the right atrium to the right ventricle. As ordinary people, we don't have a deep understanding of the blood circulation in the heart, but the condition in this area may be very serious, and the cause must be found out as soon as possible, just like the tricuspid valve, which can cause tricuspid regurgitation. So, what is mild tricuspid regurgitation?

Tricuspid regurgitation is generally caused by pulmonary hypertension, right ventricular enlargement, and tricuspid ring dilatation. Clinically, it is often manifested by the causes of tricuspid regurgitation (left heart failure, pulmonary hypertension, etc.). After the occurrence of tricuspid regurgitation, symptoms of right heart failure such as fatigue, ascites, edema, liver pain, indigestion, and poor appetite are aggravated.

The pathophysiology of tricuspid regurgitation is the result of tricuspid regurgitation, that is, the systolic blood flow returns from the right ventricle to the right atrium, causing the right atrium to be highly enlarged, the pressure to increase, and the venous blood return to be obstructed. Due to the increased load on the right ventricle, it compensates and hypertrophies, making right heart failure more likely to occur.

Clinical manifestations

The signs and symptoms of tricuspid regurgitation are related to the degree of tricuspid regurgitation. Mild regurgitation is not easily detected clinically. More serious cases may cause fatigue, poor appetite, bloating and pain in the liver area, abdominal distension, and lower limb edema.

Typical signs

There is distended, pulsating jugular veins; an enlarged liver with a palpable pulsation; and a holosystolic blowing murmur at the fourth intercostal space on the left side of the sternum that increases with late inspiration (Carvallo sign). Classic signs may be absent in patients with severe tricuspid regurgitation. If the liver is sclerotic due to long-term congestion, it will no longer pulsate; when the right heart volume load reaches its limit, the murmur will no longer increase with inspiration, so the Carvallo sign can be negative.

The radiograph showed right atrium and right ventricle hypertrophy, bulging of the right edge of the heart, and changes caused by other valvular diseases. The electrocardiogram shows atrial hypertrophy, tall and wide P waves; there is also right bundle branch block or right ventricular hypertrophy, and even myocardial strain. Atrial fibrillation is common.

Echocardiography and Doppler examination: Cross-sectional ultrasound can detect the size of the tricuspid valve annulus and understand the thickening of the valve, which is helpful to distinguish between relative and organic lesions. When the tricuspid valve is regurgitant, ultrasound angiography can show microbubbles moving back and forth between the tricuspid valve; Doppler can directly monitor abnormal signals from the right ventricle to the right atrium and estimate the degree of reflux.

Cardiac catheter examination showed a prominent V wave of the right atrial pressure waveform and a steepening of the Y descending branch, which was more obvious during inspiration. The right atrial pressure waveform is similar to the right ventricular pressure waveform, but with a smaller amplitude. This is called right ventricularized right atrial pressure and is a manifestation of severe tricuspid regurgitation.

Cardiovascular angiography: Right ventriculography and right anterior oblique film photography can show tricuspid regurgitation and its degree. However, since the cardiac catheter crosses the tricuspid valve, there is a potential for false positives.

The diagnosis of tricuspid regurgitation should include an understanding of the degree of regurgitation. Typical clinical signs are of certain value in diagnosing severe tricuspid regurgitation. In the past, right ventriculography was used as a means to diagnose suspicious cases and estimate the extent of regurgitation. In recent years, ultrasound and Doppler examinations have gradually replaced invasive examinations.