Tricuspid valve insufficiency can be of several types:
- Absolute or organic deficiency. The pathology is caused by damage to the valve cusps, such as valve prolapse (sagging of the cusps), due to a congenital disease – connective tissue dysplasia, also include rheumatism, infectious endocarditis, carcinoid syndrome and others;
- Relative or functional impairment. It occurs when the valve is stretched, caused by resistance to the outflow of blood from the right ventricle, with severe dilatation of the ventricular cavity due to high pulmonary hypertension or diffuse myocardial damage.
According to the severity of the reverse blood flow, tricuspid regurgitation is divided into four degrees:
- 1 degree. A barely detectable reverse movement of blood;
- 2 degree. Regurgitation is determined at a distance of 2 cm from the tricuspid valve;
- 3 degree. The reverse movement of blood from the right ventricle is detected at a distance of more than 2 cm from the valve;
- 4 degree. Regurgitation is characterized by a large extension in the cavity of the right atrium.
The severity of blood return is determined by echocardiography.
The term tricuspid regurgitation is understood to mean a pathological condition in which blood flows in the opposite direction. The described process occurs in the right heart during systole. The reason is the insufficient function of the tricuspid valve. This occurs under the influence of the following factors:
- Rheumatic disease of the valves. The disease forms after a streptococcal infection (most often tonsillitis). Microorganisms in most cases affect the heart. A common localization in it is the tricuspid valve.
- Endocarditis. Inflammation of the inner lining of the heart occurs.
- Congenital malformations of Ebstein. With such a deviation, the normal position of the valve is disturbed.
- Myocardial infarction (necrosis) of cells.
- Mitral, tricuspid or aortic valve prolapse. Pathology indicates the appearance of protrusion in one of the valves. This occurs at the moment of their closure and filling of the heart cavity with blood. Most often, the child suffers from such violations.
- Carcinoid syndrome. When a tricuspid valve is affected, fibrous plaques begin to be deposited.
The above reasons apply to primary. Secondary factors lead to the dilatation (expansion) of the ring to which the flaps are attached.
Consider the main reasons as a result of which the disease develops. The following factors are important for the occurrence of primary forms:
- Prolapse of the tricuspid valve. This defect is associated with a pathological protrusion of one or more valves.
- Endocarditis. An inflammatory disease of heart tissue that develops against the background of an invasion of infection.
- All rheumatic diseases causing valvular fibrosis.
- A heart attack localized on the right.
- Carcinoid syndrome, in which connective tissue plaques can be deposited in the vessels and heart. The syndrome is due to excessive serotonin in the blood.
- Ebstein’s anomaly, a rare congenital malformation in which the atrioventricular valve is abnormally located in the wall of the right ventricle.
- Marfan syndrome, a genetic pathology that is accompanied by aneurysm and heart failure.
- The use of certain drugs over the long term.
- The consequences of traumatic injuries of the chest.
The causes of the secondary type of regurgitation are the following diseases:
- Cardiomyopathy is a disease associated with structural changes in the myocardium.
- Hypertrophy (thickening, enlargement) or expansion (dilatation) of the ventricle on the right.
- Pulmonary hypertension is an increase in internal pressure in the pulmonary vessels. Symptomatic picture
With mild and moderate manifestations of tricuspid regurgitation, which are classified by the 1st degree of pathology, a person does not feel unwell and does not complain. Pathology is detected by chance, with ultrasound diagnosis of the heart muscle. The only symptom that can alert the doctor is a slight pulsation of the cervical veins, aggravated by exertion.
With the transition of the disease in 2 and subsequent stages, the signs of the disease appear brighter, become very intense in stages 3 and 4.
The patient complains of shortness of breath, rapid fatigue and weakness, the appearance of edema on the legs, frequent urination, heaviness under the ribs on the right. On examination, swollen and trembling jugular veins are clearly visible, with auscultation of the heart, split heart sounds and pansystolic murmurs are heard. At stages 3-4 of the disease, the following clinical manifestations are observed:
- heart failure;
- rhythm disturbances;
- pulsation in the pulmonary artery on inspiration, in the right atrium, in the liver;
- when conducting an ultrasound of the heart, hypertrophic changes in the right atrium and ventricle, mitral and aortic malformations are revealed;
- with ultrasound diagnostics of the abdominal cavity, fluid accumulation in it, pathological enlargement of the liver are noted;
- the patient’s appearance changes – the face becomes puffy, the skin acquires a yellowish tint, the lower legs are postose or swollen.
All these symptoms require correction and indicate serious violations in the work of the heart muscle. However, one cannot call the clinic of regurgitation typical only for her – these manifestations are also characteristic of other pathologies. Therefore, patients need a thorough diagnosis.
Tricuspid regurgitation is a pathology that is found in patients of all ages, often by accident. The disease has 4 degrees of severity and several causes. Sometimes treatment is not required, and preventative measures help prevent deterioration of the heart. What is it, what symptoms indicate the presence of a condition and how it is dangerous.
A tricuspid valve separates the right atrium from the ventricle. Its valves normally pass the venous flow from the atrium, and then close tightly. Blood flow entering the ventricle moves further into the pulmonary artery and goes to the lungs.
With tricuspid regurgitation, as with mitral, not all blood from the ventricle goes to the lungs, some are thrown back into the atrium.
This occurs due to insufficiency of valve tissue – the valves after the ejection of blood from the atrium do not close tightly. With a regular increased load on the atrium, it hypertrophies, the muscle tissue of the cavity is stretched, its size increases.
At the same time, the ventricle is hypertrophied, which leads to malfunctions in its work, and stagnation of blood is observed in a large circle.
There are 2 types of valve insufficiency: absolute (organic) and relative (functional). In the first case, damage to the tricuspid valves is due to a congenital pathology, such as connective tissue dysplasia. As a result, the tissue is devoid of turgor, the sashes sag. However, with age and proliferation of tissue, the anomaly may disappear. Some diseases also lead to this:
- rheumatic heart disease;
- endocarditis of infectious origin;
- carcinoid tumor.
A relative variant develops as a result of a stretching of the valve, which occurred due to the resistance it renders to returning blood to the atrium. This occurs with excessive relaxation of the ventricle as a result of pulmonary hypertension or diffuse damage to the heart muscle.
In addition, the strength of the reverse blood flow is expressed differently. There are 4 degrees:
- A small amount of blood thrown back is noted.
- The length of the jet inward from the valve reaches 2 cm.
- The blood stream inward from the valve exceeds a distance of 2 cm
- Blood volume occupies a significant amount of atrium.
The insufficiency of the walls of the valve 1 st usually does not bother, the pathology is insignificant. Patients noted a slight pulsation in the veins on the neck. This is due to high pressure in the jugular vein. Later stages can be manifested by increased fatigue, bloating and anorexia. Atrial fibrillation or flutter can be detected.
At stages 2 and 3, the jugular veins can strongly swell, the liver also hypertrophies, and fluid accumulates in the peripheral tissues. Auscultation produces characteristic heart murmurs, changing when breathing, increasing when inhaling.
Symptoms are not specific. Such signs may indicate the presence of any other disease of the cardiovascular system.
The main symptom is a noticeable tremor of the jugular vein. 1 tricuspid regurgitation is present in many children born after 2010, and is considered a physiological norm. In addition, if the child has no other pathologies of the heart, then the valve is restored to the desired state. If the condition worsens, then there is a high probability of heart failure. In any case, observation by a cardiologist is required.
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Tricuspid regurgitation of the valve of 1 and 2 degrees is often detected with echocardiography performed for other indications. It is possible to assume the presence of the remaining three stages of the disease during medical history and physical examination (including auscultation), and the diagnosis will be confirmed by echocardiography in the presence of one or more signs:
- 2-dimensional insufficiency with rapprochement or pathological mobility;
- intense regurgitation flow on color doppler;
- a large flow of the proximal convergence zone to the valve;
- width of the isthmus of regurgitation gt; 7 mm;
- systolic backflow in the hepatic veins;
- transcuspidal wave dominance gt; 1 cm / sec;
- dense, triangular, peak at the beginning, continuous wave of a doppler of a TH stream.
To assess the size and function of the right ventricle, MRI is used. Often conduct ECG, ultrasound and chest x-ray.
Rarely prescribed cardiac catheterization. The method helps to accurately measure the pressure in the pulmonary artery in severe regurgitation and to assess the condition of the coronary vessels, if surgery is planned.
Therapy of pathology depends on the type and degree. In addition, the presence of concomitant diseases is taken into account. The initial degree of blood return to the aorta rarely requires correction; the patient does not feel any inconvenience. Usually, follow up by a cardiologist for 3 years. If the condition does not worsen, treatment is not prescribed.
The normal movement of blood along the right heart is ensured by the ability of the tricuspid valve cusps to move synchronously with the phases of the systole and myocardial diastole.
Valvular defects, depending on the morphological substrate and functional impairment, are divided into:
- stenosis, which develops due to calcification, an inflammatory lesion. Pathology is characterized by narrowing of the lumen of the opening, which reduces the volumetric flow rate from the atrium to the ventricle;
- regurgitation (in the old terminology – insufficiency) – lengthening of the chords, damage to valve structures by infectious processes contributes to the expansion of the lumen and pathological movement of blood during ventricular systole not only into the pulmonary artery, but also into the atrium;
- combined defect.
Pathologies of the tricuspid valve are rare acquired defects and most often develop as secondary changes against the background of decompensation of the condition.
The most common causes of tricuspid regurgitation:
- infectious endocarditis is a bacterial pathology characterized by the ingress of the pathogen in the blood and selective damage to the endocardial tissue. Involvement in the process of valves of the right half of the heart most often develops among injecting drug users;
- chronic rheumatic heart disease – a consequence of an infection with beta-hemolytic streptococcus having cross antigens with valve structures;
- systemic pathologies of connective tissue: Ellesra-Danlo syndrome, Marfan, undifferentiated dysplasia syndrome;
- Ebstein’s anomaly is a congenital malformation of the valve, in which the valves do not develop from the connective tissue of the fibrous ring, but from the myocardium of the right ventricle. The first signs of violations are diagnosed when examining a newborn in a maternity hospital;
- dilated cardiomyopathy. The resulting regurgitation is considered relative, since an increase in the size of the right atrioventricular opening is associated with a pathological expansion of the cardiac cavities;
- carcinoid syndrome is a specific reaction of the body in malignant tumors of various localization. It is formed in response to the ingestion of a product of the exchange of cancer cells into the bloodstream: diarrhea, nausea, hot flashes (as with menopause), abdominal pain.
Signs on the face: blue skin color, difficulty breathing, heart failure in the right heart. Such violations can lead to the death of the newborn, therefore, during pregnancy, it is necessary to attend scheduled examinations by a specialist.
In total, there are three types of return blood flow: mitral, aortic, tricuspid.
Mitral valve prolapse causes mitral regurgitation.
A certain amount of blood is thrown into the left atrium through a loosely closed MK. At the same time, part of the heart is stretched from the overflowing blood from the pulmonary artery.
Overload of the atrium causes its thickening and expansion, the so-called dilation.
For some time, the violation does not make itself felt, since compensation occurs due to an increase in the atrial cavities.
With mitral regurgitation of the first degree, a small casting does not cause clinical changes in the work of the heart, health problems in patients arise during the second and third stages of prolapse – with an increase in the reverse current of the cast blood.
Causes of prolapse:
- autoimmune diseases;
- valve leaf defects due to calcination;
- violation of metabolic processes;
- heart attack.
Cardiologists diagnose the 1st degree mitral regurgitation by the noise recorded in the upper part of the heart or during examination by ultrasound; the patient himself has no complaints.
The violation does not require treatment, only observation by specialists.
Blood flow problems in pediatric patients are associated with congenital heart abnormalities:
- defects of partitions;
- Fallot’s tetrad;
- underdevelopment of pulmonary artery valves.
A cardiologist examines newborns with such symptoms, they are referred for ultrasound, and then they are determined with the choice of a way to eliminate the problem – most often this is an operation.
The tricuspid or tricuspid valve is located between the right atrium and the right ventricle; during diastole, its valves open, passing venous blood from the right atrium into the ventricle. During systole (contraction), the valve cusps are tightly closed, and the blood entering the right ventricle enters the pulmonary artery, and then into the lungs.
During regurgitation of the tricuspid valve, blood from the right ventricle does not completely enter the pulmonary artery, but partially returns to the right atrium, and there is a reverse reflux of blood – regurgitation. This is due to dysfunction of the tricuspid valve – with loose closure of its valves, the entrance to the right atrium is not completely closed.
With tricuspid regurgitation, due to the increased load, the atrium hypertrophies, and then muscle tension and its increase in size occur. In turn, this leads to the ingress of a large amount of blood from the atrium into the right ventricle during the diastole period, its further hypertrophy and impaired functions, which provokes stagnation in a large circle of blood circulation.
Regurgitation can occur in 4 different stages (degrees). But sometimes doctors distinguish a separate, fifth, so-called physiological regurgitation. In this case, there are no changes in the myocardium, all three valve cusps are completely healthy, just a barely noticeable violation of the blood flow in the cusps themselves (“swirl” of blood) is observed.
- First stage. In this case, the patient has a small flow of blood backward, from the ventricle to the atrium through the valve flaps.
- Second stage. The length of the jet from the valve reaches 20 mm. Tricusp >
This condition does not threaten life at all, does not affect the well-being in any way and is accidentally detected during the examination. Unless, of course, does not begin to progress.
Reverse blood flow into the right ventricle is now increasingly recorded in children, and even before birth. Tricuspid regurgitation in the fetus may appear in the first trimester of pregnancy, at the 11-13th week.
This feature often happens in babies with chromosomal abnormalities (for example, with Down syndrome). But a certain percentage of regurgitation is also observed in an absolutely healthy fetus.
Pediatric cardiologists speak of a rapidly growing number of cases of tricuspid anomaly in children of different ages. In most of them, first degree regurgitation is diagnosed, and today it is already considered a variant of the norm.
If the child does not have other cardiac pathologies, in the future there is a big chance that the valve will recover by itself.
But if a congenital disease reaches the second or third stage, there is a risk of future heart failure, dysfunction of the right ventricle. Therefore, it is important for the child to regularly visit a cardiologist and follow all the necessary measures to prevent heart disease.
Classification of the disease
There are several options for pathology – primary and secondary, which are described above. Classification includes severity:
- I degree. The patient is practically not worried about anything. At this stage of development, it is traced during the ultrasound examination of the heart.
- II degree. There is a reverse blood flow, which has a distance of 2 cm from the ring with valves.
- III degree. A stream of blood is thrown into the right atrium by more than 2 cm.
- IV degree. Blood is thrown over a considerable distance. Symptoms are pronounced.
When the tricuspid valve is affected, degree 1 regurgitation is almost asymptomatic. If treatment is not done on time, then the pathology will progress.
In cardiology, it is customary to separate tricuspid regurgitation according to various signs. First of all, pathology is divided into congenital and acquired. Congenital regurgitation occurs in infants and most often accompanies congenital heart disease. Sometimes the disease is detected in the fetus during the pregnancy of the mother, and even before the birth of the baby, they plan further treatment if the valve did not normalize before delivery. The acquired form is detected later in adolescents and adults, and is already associated with existing heart diseases acquired during life.
Also, tricuspid regurgitation is divided into:
- Primary. This type of pathology is combined with organic pathologies of the myocardium, but is not accompanied by problems in the circulatory system of the lungs. Primary tricuspid regurgitation is often combined with malformations of other valves, sometimes combined pathology, mitral and tricuspid regurgitation of the 1st degree, in which reverse blood flow is present in the right and left heart chambers, is sometimes detected.
- Secondary. It always develops as a result of existing myocardial diseases and is accompanied by a violation of the blood supply to the lungs (pulmonary hypertension). With the secondary type of the disease, hypertrophy and increased functionality of the right ventricle are revealed.
The main classification that gives an idea of the prevalence of the process is the separation by degrees. There are only 4 of them.
- Tricuspid regurgitation of the 1st degree, what it is, how to identify it – not everyone knows. The return blood flow is almost not visualized, the volume and length of the stream are minimal. The condition does not affect the patient’s well-being, usually 1 degree is detected by chance. Sometimes the doctor does not use an exponent in the description of the pathology, but indicates that the patient has revealed minimal tricuspid regurgitation.
- Tricuspid regurgitation of 2 degrees. This type of pathology already needs drug therapy. The length of the jet during the reverse casting of blood is well visualized during the examination, but does not exceed a length of 20 mm.
- The third degree is clearly visible during the examination, the length of the blood flow exceeds 20 mm.
- With 4 degrees of pathology, the reverse current jet is visualized far in the depth of the right atrium. Severe pathology is accompanied by vivid symptoms.
Functional states are also distinguished when the phenomena of regurgitation 0 or 1 degree are not associated with defects in the tricuspid valve. More often, valvular functional abnormalities reveal in adults of high growth and lean complexion. According to medical statistics, functional regurgitation 0-1st is present in 2/3 of a healthy population and is considered the norm. It does not require treatment, is a physiological feature, but in the presence of provoking factors and an incorrect lifestyle can progress.
Often tricuspid regurgitation is accompanied by insufficiency of the tricuspid valve itself. The disease is classified into 4 degrees, and is also divided into absolute and relative. In the World Classifier of Diseases, pathology is located in the section of diseases of the circulatory system, the ICD-10 code is I07.1.
- Absolute or organic tricuspid insufficiency is more often observed in newborns and is associated with congenital defects of valve cusps. In cases where pathological manifestations are present on both sides of the myocardium, they speak of aortic and tricuspid combined valve insufficiency.
- Relative or functional valve insufficiency can be observed with diffuse heart lesions and pulmonary artery defects.
In accordance with the localization of violations of the heart valves, they are divided into classifications:
- Mitral regurgitation is that blood flow from the left ventricle of the heart enters the atrium. This leads to its stretching and increased work and wear. At first, this is not noticed by man at all, because the heart compensates for the pathology by changing its shape. Its causes include diseases of the heart and blood vessels, joints and muscles, impaired valve function, deposition of cholesterol and calcium on the inner walls of blood vessels and myocardium, some pathologies of connective tissue, autoimmune processes, improper functioning of metabolic processes, decreased blood supply to some parts of the body;
- Aortic regurgitation is formed with incomplete closure of the valves or pathologies associated with the structure of the largest unpaired vessel, when, expanding, the valve ring also increases and the valve simply cannot close completely. Here there is a reverse flow of blood into the ventricle, which begins to fill up excessively, stretching, it takes more blood, and much less comes into the vessel. In this case, the heart begins to pump blood faster and stronger. As a result, oxygen starvation, stagnation of blood in large vessels;
- Tricuspid regurgitation is less common. It occurs with excessive pressure in a small circle. It leads to the devastation of the right heart, after which stagnation occurs in the veins of a large circle. Outwardly, this can manifest itself in blue skin, an increase in the size of the liver, swelling of the veins in the neck, atrial fibrillation;
- Pulmonary regurgitation can occur with atherosclerosis, syphilis, endocarditis, or be congenital. Not infrequently, such a pathology occurs with diseases of the pulmonary system. Represents incomplete valve closure in the arteries of the small circle of blood circulation.
Forms of mitral regurgitation
- Tricusp />
- Tricuspid regurgitation of 2 degrees. This type of pathology already needs drug therapy. The length of the jet during the reverse casting of blood is well visualized during the examination, but does not exceed a length of 20 mm.
- The third degree is clearly visible during the examination, the length of the blood flow exceeds 20 mm.
- With 4 degrees of pathology, the reverse current jet is visualized far in the depth of the right atrium. Severe pathology is accompanied by vivid symptoms.
Functional states are also distinguished when the phenomena of regurgitation 0 or 1 degree are not associated with defects in the tricuspid valve. More often, valvular functional abnormalities reveal in adults of high growth and lean complexion.
According to medical statistics, functional regurgitation 0-1st is present in 2/3 of a healthy population and is considered the norm.
It does not require treatment, is a physiological feature, but in the presence of provoking factors and an incorrect lifestyle can progress.
The reverse reflux of blood through AK is caused by valve insufficiency, damage to the vessel or the inflammatory process in it.
- valve leaf inflammation caused by endocarditis or mechanical tissue damage;
- ankylosing spondylitis;
- rheumatoid arthritis;
- arterial hypertension.
What is characteristic of the aortic form? Left ventricular overflow due to reverse flow from the aorta.
Blood does not enter the large circle of blood circulation completely, oxygen starvation sets in, the phenomenon is compensated by increasing the total volume of the heart.
Violation has several degrees. The first does not affect the state of health. An insignificant degree allows a person to lead a normal life for many years.
Hemodynamic impairment occurs gradually, it is associated with an increase in the volume of the left ventricle, whose coronary arteries no longer provide for nutrients and oxygen. Such phenomena as ischemia and cardiosclerosis occur.
The progression of the problem is fraught with the following symptoms:
- pale skin;
- heart palpitations;
- angina attacks.
In the initial stages, there are no signs. In rare cases, unpleasant sensations in the heart area, weakness remaining after rest disturb. With the progression of pathology in a newborn or an adult, the following symptoms appear:
- expansion of veins on the neck, visible pulsation;
- the skin on the fingers, earlobes, nasolabial triangle acquires a blue color;
- aching sensations or pain in the liver;
- swelling on the legs;
- sensation of an accelerated heartbeat;
- yellow skin tone;
During the examination, splitting of tones, atrial fibrillation are revealed. On inspiration during listening – a heart murmur. If there is 1 degree regurgitation on the tricuspid valve, then the listed manifestations of the patient will not be disturbed.
Cases of the appearance of pathology in the fetus or newborn are known. During pregnancy, the expectant mother succeeds during the study to make a diagnosis at 11-13 weeks. An anomaly of development most often appears with a chromosomal mutation. In rare cases, it occurs in healthy babies.
Currently, there are enough ways to accurately indicate the presence of a disease.
Diagnosis of heart valve regurgitation includes:
- Ultrasound examination allows you to assess the nature of blood flow through the vessels and heart, the movement of the valves and if a disease is detected, it is possible to establish its degree after the first examination. This method is the most affordable and not expensive;
- An electrocardiogram (ECG of the heart) detects indirect signs of pathology, therefore it is less applicable.
It is very important to identify the ailment not only in the adult population, but also in unborn children. The distinguished diagnostic methods are able to detect disorders at different stages of the mother’s pregnancy, which helps to resolve the issue of preserving the fetus.
Diagnostic results of heart valve regurgitation on doppler echocardiography
The diagnosis is established after evaluating the clinical picture and the results of the studies. The following methods are applied:
- echocardiography (echocardiography);
- electrocardiography (ECG);
- transesophageal echocardiography;
- chest x-ray;
- cardiac catheterization.
If the patient has a suspicion of regurgitation of the tricuspid valve or other disease of the cardiovascular system, an ECG is performed. Research is part of the gold standard for diagnosis. Its purpose is to determine the electrical activity of cardiomyocytes. The method is referred to compulsory examinations of children, adolescents and adults (school, army).
The most effective is an ultrasound scan of the heart. It helps the doctor to study the condition of the cavities, blood flow, valve apparatus. With its help, it is possible to distinguish a defect or defect from the norm. An electrocardiogram may be performed at the same time as the echoCG recording. The technique allows not only to study the structure and function of the myocardium, but also blood vessels.
Echocardiography is considered a modern and informative option. Her doctor does through the esophagus, in which a special sensor is inserted. The condition of the myocardium is assessed by conducting ultrasound through the chest.
The main advantage is the absence of barriers to the device. In ordinary echocardiography, the beam has to penetrate through the soft and hard tissues of the whole organism.
Catheterization of the heart cavities gives a complete picture of the state of the blood vessels. Special needles puncture the femoral or ulnar vein. Then, a contrast agent is introduced, which facilitates the transmission of the image.
The diagnosis of tricuspid regurgitation is carried out according to:
- clinical examination: edema, ascites, an increase in the size of the liver, hepatojugular syndrome (pulsation of the liver). With auscultation, systolic murmur is determined along the left edge of the sternum, weakening of the basic tones;
- electrocardiogram (ECG): signs of hypertrophy of the right departments, often – atrial fibrillation, blockade of the right leg of the bundle of Giss;
- radiography of the chest cavity – expansion of the heart shadow due to the right departments;
Verification method is echocardiography (echocardiography), with the help of which the degree and stage of disturbances are established, pressure in the cavities, blood flow velocity and regurgitation volume are measured.
Echocardiography is used to safely diagnose fetal Ebstein anomaly in the third trimester of pregnancy.
Conservative and surgical methods of treatment are used to correct the patient’s condition.
Pharmacological support is aimed at eliminating signs of right ventricular failure:
- diuretics (diuretics) – Furosemide, Torsid for removing excess fluid from the body;
- antihypertensive drugs to reduce systemic pressure in the vessels;
- cardiac glycosides – Digoxin, Korglikon – to maintain the strength and frequency of myocardial contractions;
Surgical correction is prescribed to patients with moderate regurgitation and implies a complete replacement of the valve with a prosthesis (biological or mechanical) or plastic surgery of the right atrioventricular opening (narrowing of the lumen with sutures). Patients who underwent surgical correction of regurgitation are not suitable for military service.
A correct diagnosis of tricuspid regurgitation, as well as determining the degree of the disease, can be made on the basis of Doppler echocardiography. With tricuspid regurgitation of 1 degree, the reverse flow of blood from the right ventricle back to the right atrium is barely noticeable. Tricuspid regurgitation of the 2nd degree is characterized by a reverse blood flow no more than 2,0 cm from the tricuspid valve. With the third degree of insufficiency, regurgitation exceeds 2,0 cm, and with the fourth – it spreads throughout the entire volume of the right atrium.
As additional research methods, ECG and chest x-ray are performed. The electrocardiogram often reveals signs of right ventricular hypertrophy. On radiographs with tricuspid regurgitation of the 1st degree, changes are usually not detected. With tricuspid regurgitation of 2 degrees and higher, an enlarged shadow of the superior vena cava and right atrium is detected, and in some cases the presence of effusion in the pleural cavity.
Cardiac catheterization as a diagnostic method for tricuspid valve regurgitation is extremely rare.
The factors that cause the appearance of this heart disease are usually divided into 2 large groups depending on the type of pathology itself:
- Causes of primary tricuspid regurgitation:
- rheumatism (systemic inflammation of the connective tissue);
- infectious endocarditis (inflammation of the endocardium, often found in injecting drug addicts);
- valve prolapse (sashes bend several millimeters);
- Marfan syndrome (hereditary connective tissue disease);
- Ebstein’s anomalies (congenital malformation in which the valve leaves are displaced or absent);
- chest injuries;
- long-term use of drugs (Ergotamine, Phentermine, etc.).
- Causes of secondary tricuspid regurgitation:
- increased pressure in the pulmonary arteries (hypertension);
- expansion or hypertrophy of the right ventricle;
- right ventricular dysfunction;
- mitral valve stenosis;
- failure of the right and severe failure of the left ventricle;
- various types of cardiopathy;
- atrial septal defect (congenital malformation);
- obstruction of the pulmonary artery (and its efferent tract).
Doctors have learned to determine pronounced tricuspid regurgitation for a long time, but the diagnosis of mild forms has become possible relatively recently, with the advent of ultrasound. That is, about 40 years ago.
Today, ultrasound is considered the main diagnostic method for such a pathology. It allows you to distinguish the slightest opening of the valve flaps, the size and direction of the blood stream.
A comprehensive diagnosis of tricuspid regurgitation includes the following:
- anamnesis collection;
- physical examination (including auscultation of the heart – listening);
- Ultrasound of the heart (normal and with Doppler) or echocardiography;
- chest x-ray;
- cardiac catheterization.
Catheterization is a diagnostic and treatment method that requires careful preparation of the patient. To study problems with blood flow through the tricuspid valve, it is rarely used. Only in those cases when the most profound diagnosis is required, for example, to assess the condition of the coronary vessels of the heart.
For the diagnosis of tricuspid regurgitation, in addition to an anamnesis, physical examination and auscultation, the following studies are carried out:
- ECG. The sizes of the right ventricle and atrium, cardiac arrhythmias are determined;
- Phonocardiogram. The presence of systolic noise is detected;
- Ultrasound of the heart. The signs of valve wall compaction, the area of the atrioventricular foramen, the degree of regurgitation are determined;
- Chest x-ray. The location of the heart and its size, signs of pulmonary hypertension are revealed;
- Cardiac catheterization. The method is based on the introduction of catheters to determine the pressure in the cavities of the heart.
In addition, coronary cardiography performed before surgery can be used. It is based on the introduction of a contrast agent into the vessels and cavities of the heart to evaluate the movement of blood flow.
Tricuspid valve regurgitation is a condition in which during the period of contraction (systole) of the ventricles, blood is thrown from the pancreas (right ventricle) into the pancreas (right atrium), which occurs due to the failure of the tricuspid valve. Thus, the term “regurgitation” means the reverse, improper blood flow (you can read more about regurgitation in our article here).
Sometimes ultrasound of the heart reveals such a pathology by accident, most often it is physiological or valvular regurgitation.
Patients in this case are concerned about the question “tricuspid regurgitation of 1 degree what is it.”
You can get answers to this and other questions by reading the article, which will examine in more detail the types, causes, manifestations of the pathology, as well as its identification and treatment.
According to the degrees, it is customary to distinguish four types of TR (tricuspid regurgitation):
- The first degree – the reverse stream of blood is almost not visualized, the patient does not feel the changes;
- The second degree – blood flow in the opposite direction is observed at a distance of not more than 2 cm from the valve cusps.
- The third degree is the reverse reflux of blood in the PP (right atrium) is determined further than at a distance of 2 cm from the valve, the stream is clearly visualized;
- The fourth degree – the reflux of blood in the wrong direction is noticeable at a considerable distance from the tricuspid valve.
In addition, there are two types of regurgitation on the TC:
- Primary – as a manifestation of an organic pathology of the heart, it is often combined with other heart defects and lesions of the valvular apparatus. In this case, only the right heart is involved, and pulmonary hypertension is not characteristic.
- Secondary – this species occurs against the background of existing heart diseases and is always accompanied by hypertrophy and increased right ventricular function and pulmonary hypertension.
A great variety of causative factors can be divided into those that lead to primary regurgitation on the TC and those that cause the appearance of secondary tricuspid regurgitation. Common causes of primary tricuspid regurgitation are:
- Rheumatic diseases (including acute rheumatic fever, rheumatoid arthritis, etc.);
- Endocarditis of an infectious nature (inflammatory process of the inner layer of the heart);
- Prolapse TK;
- Right ventricular infarction;
- Carcinoid syndrome (deposition of plaques from connective tissue on the valves, in the wall of the heart muscle and large vessels);
- Marfan Syndrome;
- Epstein’s vice;
- The use of certain medications (phentermine, ergotamine, fenfluramine).
Therapy depends on the cause and extent of the problem. Its tactics are determined by the presence of concomitant diseases.
A slight reverse casting does not require medical and surgical treatment, patients undergo a ultrasound examination during a certain period.
In more complex cases, surgical intervention is necessary, it can be plastic or prosthetics. The ongoing drug treatment is aimed at restoring normal blood circulation, getting rid of arrhythmias and heart failure.
According to the indications, patients are prescribed beta-blockers, diuretic drugs, antihypertensive drugs.
The prognosis of valve insufficiency depends on the degree of violation, somatic diseases of the internal organs and the age of the patients. The ongoing surgical correction allows patients to live a long, active life.
The prognosis for regurgitation of heart valves of the first degree is favorable. With constant monitoring by the attending physician, complications are identified immediately and treatment is prescribed if necessary.
In the second degree, the situation is different. After diagnosis, only sixty percent continue to remain on their feet and then, only for fifteen years. Death occurs due to a heart attack, heart failure, embolism, pulmonary pneumonia.
Preventive measures are aimed at reducing the risk of reverse blood flow in the heart.
Thus, regurgitation of heart valves is a serious disease. Which can be both acquired and congenital. It is localized between different parts of the heart (in its right side or left). It has various degrees of development, the first of which is the simplest, has no symptoms, so the disease is difficult to calculate.
If pathology is detected, they are treated with surgical methods or with medication. The main thing is not to be late, therefore, a systematic examination of the body by a specialist is recommended.
As preventive measures, antibiotics are administered to the patient. To avoid relapse of rheumatism, do benzylpenicillin in the muscle. To each person, to eliminate the risk of joining infectious endocarditis, the drug is also indicated.
In addition to drugs, adhere to the following scheme:
- Exercise with moderate exercise to train the body.
- Avoid excessive physical stress and hypothermia.
- Timely treat all infections.
- Limit salty foods and liquids.
- If surgery is planned, then antibiotic prophylaxis is carried out.
- When a patient is prescribed medication, it is important to monitor their well-being. If you experience shortness of breath and pain in the heart, it is recommended to consult your doctor.
If after correction of positive dynamics is not observed, then it is sent for surgery.
With tricuspid valve insufficiency, a long recovery period is characteristic.
The prognosis is more favorable with the rheumatic origin of the pathology, compared with ischemic.
The first degree of violations is considered the most favorable. A person does not need treatment, but enough prevention and control. The absence of positive changes becomes the basis for medical or surgical intervention.
The onset of symptoms of cardiovascular disease is directly related to circulatory disorders due to insolvency of intracardiac hemodynamics or vascular pathology. The normal functioning of the valves provides an adequate discharge of blood into the great vessels, in case of a disorder secondary changes occur in the chambers of the heart.
A healthy lifestyle is recommended as the prevention of any disease. The normal mode of work and rest, reasonable physical exertion, the absence of stress and harmful addictions makes the probability of getting sick with something minimal. A very important aspect is the timely and correct treatment of colds, the mandatory clarification of the causes of systematic ailments.
The prognosis for tricuspid regurgitation is positive, in childhood it can be leveled with age. For an adult, a degree of pathology revealed by chance is considered a functional norm that does not require treatment. If tricuspid insufficiency occurs in combination with other complications, the patient is assigned a disability group.
Be attentive to yourself and your children, do not ignore periodic ailments. Behind them dangerous conditions can be masked.
Therapy of tricuspid regurgitation includes 2 large blocks – conservative and surgical treatment. When the disease is at the first stage, no special therapy is required, only regular monitoring by a cardiologist.
When the disease reaches the second degree, conservative treatment already involves taking special medications. These are diuretics (diuretic), vasodilators (means for relaxing the muscles of blood vessels), potassium preparations, etc.
Surgical treatment of the tricuspid valve is the following types of operations:
The prognosis of life with tricuspid regurgitation is quite favorable, provided that the patient leads a healthy lifestyle and takes care of his heart. And when the disease is detected in the very first stage, and when the valve operation has already been performed.
Doctors in this case are advised to use standard measures for the prevention of heart failure. These are body weight control and regular physical activity, proper nutrition, giving up cigarettes and alcohol, regular rest and as little stress as possible. And most importantly – constant monitoring by a cardiologist.
Proper nutrition with a slight degree of violation
There are four degrees of blood transfusion in the opposite direction:
- With 1 degree of regurgitation of the valves, there are no symptoms for several years. A large amount of returning blood increases the heart, which can cause, if proper treatment was not followed upon detection, a persistent increase in blood pressure. An examination of the patient reveals a noise in the heart, an ultrasound scan shows a slight discrepancy in the valve and a slight disturbance in blood flow.
- 2 degree of regurgitation of heart valves is characterized by a greater severity of the return flow. There is stagnation in a small circle.
- 3 degree of regurgitation of the valves is characterized by a large reverse jet, the flow of which reaches the posterior wall of the atrium. Here the increase in arterial pressure in the pulmonary artery develops, because of which there is an overload on the right side of the heart muscle. As a result of such a violation, insufficiency occurs in a large circle of blood circulation.
Assessment of the severity of the stages is determined by the power of the blood stream, which returns to the ventricle or atrium:
- does not go beyond the front leaflet of the valve connecting the left ventricle to the atrium;
- reaches or crosses the sash;
- the size of the flow approaches half the length of the ventricle;
- the jet touches its top.
Another prolapse of a bicuspid heart valve is isolated, due to which there is a backflow of liquid tissue of the body of varying degrees. Previously, this diagnosis was not often made. This is due to newer methods for detecting the disease. Using the Doppler method has helped to establish the exact amount of the returning jet.
Prolapse of heart valves is found in thin, tall people, adolescents. In more cases, the disease does not cause any discomfort in the patient and is detected in young people by chance, undergoing various medical examinations, for example, when entering the institute, or before being drafted into the army.
If the degree is first or even zero, then treatment is not necessary. The main thing is not to miss the transition formation of complications, for this it is necessary to be examined by a doctor.
In the diet of adults and children with a small severity of heart failure include plant foods, dairy and other animal proteins, in the amount necessary for normal heart function. A diet for patients with cardiac problems is prescribed by a doctor.
When overweight, it is important to use low-calorie foods in which the cholesterol content should be minimal.
Animal fats in the diet are replaced with vegetable fats containing polyunsaturated acids. However, here you need to remember that cooking oils reduces the beneficial properties, so it is advisable to add them to salads.
Carbohydrates are a source of energy. However, it is advisable for cardiological patients to use products containing these substances in a simple, easily digestible form: fructose, sucrose, galactose.
Complex carbohydrates contain starch and fiber (vegetables, fruits, cereals, herbs).
For heart problems, it is recommended to reduce the amount of animal fats, replacing them with vegetable. Forbidden butter, strong broths, fatty meat, lard.
Unlike the dietary table for other groups of patients, smoked foods, pickles and marinades are allowed, but in minimal portions.
If edema is a concern, it is recommended that you reduce the amount of fluid you drink.
Tricuspid regurgitation (tricuspid valve insufficiency) is a heart defect in which blood flows back in the systole phase through the tricuspid valve from the right ventricle to the cavity of the right atrium.
With regurgitation of the 1st degree, as a rule, the symptoms of the disease do not manifest themselves in any way, and it can only be detected by chance during electrocardiography. In most cases, tricuspid regurgitation of the 1st degree does not require treatment and can be considered as a variant of the norm. If the development of the disease is provoked by rheumatic defects, pulmonary hypertension or other diseases, it is necessary to treat the underlying disease that caused a slight defect in the tricuspid valve cusps.
In children, this degree of regurgitation is considered an anatomical feature, which may even disappear with time – without the presence of other cardiac pathologies, it usually does not affect the development and general condition of the child.
The defeat of the tricuspid valve is accompanied by nonspecific signs, the severity of which depends on the stage of pathology and the level of decompensation of functions. In clinical practice, 3 degrees of acquired valvular defect are distinguished:
- 1st degree regurgitation on the tricuspid valve (“soft”) is characterized by insignificant manifestations of stagnation of blood in a large circle (moderate swelling of the legs by the end of the day);
- with regurgitation of the tricuspid valve of the 2nd degree, there is an expansion of the lumen of the right atrioventricular opening to 10 cm 2, with moderate impairment of blood flow in the portal vein of the liver, swelling of the cervical veins, severe swelling in the lower extremities;
- degree 3 regurgitation (“acute”) with expansion of the cavities of the right chambers, increased pressure in the cavity veins, enlargement of the liver and spleen, pronounced edema in the limbs, and accumulation of fluid in the chest and abdominal cavities.
The main complaints of the patient are associated with stagnation of blood and are presented:
- pain in the right hypochondrium (violation of the outflow of blood from the liver stretches the capsule of the organ and causes pain);
- shortness of breath, heaviness in the chest due to accumulation of fluid;
- swelling of the cervical veins (pulsation of the latter is visible upon examination);
- swelling on the legs, develop in the late afternoon, cyanotic, cold, dense;
- an increase in the volume of the abdomen (due to free fluid).
Secondary symptoms include a feeling of constriction in the chest, interruptions in the work of the heart, and fading.
With a slight defect in the valves of the tricuspid valve (tricuspid regurgitation of 1 degree), the disease usually does not manifest itself and is considered a benign condition, the treatment of which is not carried out. Only in a small part of patients does the pulsation of the cervical veins occur, caused by an increase in pressure in them.
In severe regurgitation of the tricuspid valve, pronounced swelling of the jugular veins is observed. Having laid a hand to the right jugular vein, you can feel its trembling. Significant valve insufficiency can lead to dysfunction of the right ventricle, the occurrence of atrial flutter or atrial fibrillation, the formation of heart failure.
In mild forms of impaired blood flow between the heart chambers, there are no specific symptoms.
This effect occurs due to high pressure in the jugular veins, and it is easy to feel the pulsation simply by putting your hand to the neck on the right.
At later stages, you can feel not only a beating pulse, but also a clear trembling of the cervical veins. The following symptoms will also tell about problems with blood flow in the right ventricle:
- The jugular veins not only tremble, but also noticeably swell;
- bluish skin color (primarily on the nasolabial triangle, under the nails, on the lips and tip of the nose);
- swelling of the legs;
- atrial fibrillation;
- splitting of heart tones;
- vocalistic murmur in the heart (increased by inspiration);
- shortness of breath and fatigue;
- pain and heaviness in the right hypochondrium;
- enlarged liver, etc.
Most of these signs can signal a wide variety of problems of the cardiovascular system. Therefore, the most visible symptom of tricuspid regurgitation is called swelling and trembling of the jugular vein.
- Hypertrophic changes in the right ventricle;
- Pulmonary hypertension;
- Expansion (dilatation) of the right ventricle.
Among all of the above factors, most often this pathology occurs with dilatation of the right ventricle and increased pressure on the pulmonary artery.
If the patient has tricuspid regurgitation of the 1st degree, usually he will not feel anything subjectively. The general condition does not suffer. Such changes are often detected only with ultrasound of the heart at random.
Such a condition also does not require treatment in most cases. The exception is cases when the underlying causative disease is detected, which led to the initial changes on the valve.
However, if the condition has developed sharply or is severe, the following complaints may appear:
- fatigue due to the development of heart failure;
- swelling of the jugular veins on the neck, a feeling of increased pulsation – associated with an increase in pressure in the veins;
- pain in the area under the ribs on the right (projection of the liver), its increase beyond the costal arch – due to congestion in a large circle of blood circulation;
- swelling of the legs;
- limb cooling – associated with insufficient blood supply to the arms and legs;
- myocardial interruptions.
Objectively, through an auscultation, the doctor can identify:
- systolic murmur to the left of the sternum in the 5th intercostal space, which will be better audible when inhaling;
- percussion with a significant increase in the right atrium and ventricle, the boundaries of the relative dullness of the heart will be expanded accordingly to the right.
The diagnosis of regurgitation on the tricuspid valve is established by a cardiologist or therapist.
If we are talking about TR 1 degree, then it is exposed more often only on the basis of instrumental examination, namely, echocardiography, which is performed for some other purpose.
In other cases, the diagnosis can be established on the basis of:
- Patient Complaints
- Examination of the patient, listening to heart tones and determining noise
- Electrocardiography In this case, there will be signs of overload of the right heart, namely: increased in amplitude and pointed z. P, enlarged s. R in the chest leads corresponding to the right heart (V1, V2, V3), signs of atrial fibrillation, as complications of mainly pathology
- Ultrasound of the heart with Doppler. It allows you to identify structural changes in the heart (the thickness of the myocardium of the right ventricle, the size of the cavity of the right atrium, etc.) and the length of the jet of back-abandoned blood, on the basis of which the degree of TR is set: one, two, three or four. In addition, it is possible to determine the pressure gradient on the TC (normal lt; 25 mm Hg) and flow velocity (normally less than 2,5 m / s)
- Roentgenography. Take a chest picture. With slight regurgitation, changes are usually not observed. In more severe cases, signs may appear such as an increase in the shadow of the superior vena cava (ERW), expansion of the shadow from the right atrium and the same ventricle. In addition, with the development of complications, an x-ray will help to identify effusion fluid in the pleural cavity
- Cardiac catheterization. The method is invasive, and therefore it is rarely prescribed. With it, you can detect an amplified systolic wave of the atria and measure the pressure in the atria during the systole, which will be normal or elevated
Tricuspid regurgitation in most cases is a consequence of another pathology, so treatment should be at the initial stages to eliminate the main causative factor.
If the patient has regurgitation on TK of the 1st degree with good health, treatment does not need to be carried out, since hemodynamic disturbances are not significant at all, this reverse blood reflux can be considered physiological.
Drug treatment is usually carried out with TP of the 2nd degree in the presence of complications from the blood circulation: arrhythmias or circulatory failure. The following tools are used:
With the development of tricuspid regurgitation of 3 and 4 degrees, surgical intervention may be required. General indications:
- Pulmonary hypertension and increased pressure in the pancreas (right ventricle)
- The combination of TP with severe mitral regurgitation, which manifests itself clinically
- Surgical treatment and its options
- Annuloplasty. The essence of the operation is that the artificial ring is sutured to the natural ring of the valve, due to which its diameter can be reduced. It is advisable to carry out this type of surgical intervention, if the cause of regurgitation was the expansion of the ring.
- Valvular plastic surgery. It is performed in two cases: the valve is primarily affected, or annuloplasty is impossible for some reason.
- Valve prosthetics. This type of surgical treatment is indicated if pathologies such as Epstein’s disease or carcinoid syndrome were the cause of regurgitation. For prosthetics, they take a pork valve that can last 10 years in the right heart and even more.
Apart is such an operation as excision of the valve. It is carried out in the only case: with the development of infectious endocarditis, the conservative treatment of which had no effect.
Now it becomes clear what tricuspid regurgitation is and how dangerous it is. We emphasize once again that the 1st degree of this pathology usually does not cause concern among doctors and does not require therapy. Regurgitation of high degrees with severe course can cause serious complications, therefore, requires treatment, including surgical.
With tricuspid regurgitation of the 2nd degree, as with other degrees, the disease often proceeds without obvious symptoms. With a severe course of the disease, the following manifestations are possible:
- Weakness, fatigue;
- Increased venous pressure, leading to swelling of the neck veins and their pulsation;
- Enlarged liver with characteristic pain in the right hypochondrium;
- Heart rhythm disturbances;
- Swelling of the lower extremities.
Auscultation (listening) reveals a characteristic systolic murmur that is better heard in the 5–7 intercostal space from the left edge of the sternum, amplified by inspiration, quiet and unstable. With an increase in the right ventricle and a large amount of blood entering it during diastole, systolic murmur is heard over the right jugular vein.
Tricuspid valve insufficiency is a rare pathology, which is accompanied by a significant decrease in the quality of human life. Diagnosis of disorders is most often carried out in a complex of studies for other diseases. For military examination, patients with a mild form are suitable for military service, with moderate and acute – no. Timely surgical correction of the defect completely relieves the patient of signs of heart failure.
The following sources of information were used to prepare the material.
Even a person uninformed in medicine knows about the valves of the heart. The topic of our conversation today is the pathology of one of them, tricuspid or tricuspid, as cardiologists call it. It is located on the right side of the heart, between the right ventricle and the atrium. It consists of 3 petals (valves) that open during systole (contraction) of the myocardium, allowing blood from the ventricle to move into the atrium, and then into the pulmonary circulation.
If there are defects in the valve structure, the valves cannot fully close after the release of blood, some part of it returns back to the ventricle, forming stagnation. Such a reverse, incorrect reflux of blood (reverse current) is a pathology that must be treated. The name of the phenomenon is tricuspid regurgitation.
To diagnose tricuspid regurgitation and other diseases of the heart and blood vessels, doctors prescribe:
- Ultrasound of the heart with dopplerometry, which allows you to evaluate vascular blood flow.
Doppler ultrasound with regurgitation
The modern diagnostic base allows you to accurately differentiate the diagnosis and assign the patient adequate therapy or surgery.
It is possible to detect manifestations of tricuspid regurgitation during prenatal screening of the first trimester of pregnancy, during the period from 1 to 11 weeks of fetal formation. Pathology is characteristic in the presence of chromosomal diseases of the fetus, as well as in cases when during pregnancy a woman was systematically exposed to toxic effects, x-ray radiation and other harmful factors.
Pediatric cardiologists often diagnose tricuspid regurgitation in a child of 1 degree. This pathology is not treated, the condition of the child is regularly monitored, in the absence of other heart diseases with age, everything goes away on its own.
If the pathology is associated with congenital diseases and grades 3 or 4 are classified, the child requires the supervision of a cardiologist and complex, sometimes surgical treatment. Complications in these cases are heart failure and impaired right ventricular function.
Children with tricuspid regurgitation of the 1st degree are not contraindicated in sports. However, this does not mean that the child can practice professionally. Physical activity should be health-improving in nature until the symptom disappears completely. With the 2nd degree of pathology, the issue of sport is solved individually, and with the 3rd and 4th stages only physiotherapy exercises with an instructor are allowed.
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