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Common Congenital Heart Lesions - page 26 / 126

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Regurgitant Atrioventricular Valve Disease Tricuspid Regurgitation (TR)

Clinical Presentation:

  • In absence of pulmonary hypertension, TR is usually asymptomatic.

  • If pulmonary hypertension and moderate-to-severe tricuspid regurgitation coexist, symptoms may include:

    • active jugular vein pulsations

    • swelling of abdomen

    • edema

    • fatigue

    • weakness

Physical Exam:

  • Typical findings:

    • o

      Auscultation: systolic murmur heard at lower left sternal border – soft but becomes louder on inspiration

      • o

        Jugular venous pulse: prominent “v” waves

  • o

    Can also have a pulsatile liver because of regurgitation of the RV blood into the systemic veins.

Etiology:

  • TR usually “functional” rather than structural in that it usually develops secondary to right ventricular enlargement.

  • In patients with rheumatic mitral stenosis, 20% have significant TR. oOf that 20%:

    • 80% have “functional” TR due to pulmonary hypertension w/ RV enlargement

    • the other 20% have “organic” TR due to rheumatic involvement of the tricuspid valve

  • Risk factor for TR is use of the diet medications called "Phen- fen" (phentermine and fenfluramine) or dexfenfluramine.

Diagnostic imaging/testing:

  • Echocardiography:

oDoppler echo is sensitive for the detection and quantification of TR.

Treatment:

  • Primary therapy for functional TR is directed at the conditions responsible for elevated RV size/pressure.

  • Diuretic therapy

  • Surgical repair of valve is indicated in severe cases.

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