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Regurgitant Atrioventricular Valve Disease Tricuspid Regurgitation (TR)
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
Auscultation: systolic murmur heard at lower left sternal border – soft but becomes louder on inspiration
Jugular venous pulse: prominent “v” waves…
Can also have a pulsatile liver because of regurgitation of the RV blood into the systemic veins.
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.
oDoppler echo is sensitive for the detection and quantification of TR.
Primary therapy for functional TR is directed at the conditions responsible for elevated RV size/pressure.
Surgical repair of valve is indicated in severe cases.