Tricuspid Regurgitation

What is the most common cause of TR? (Functional)

Annular dilation due to RV or RA enlargement. (From left heart failure, PHTN, left to right shunts, RV infarction)

What are the causes of primary TR?

Rheumatic heart disease, tricuspid endocarditis, TV prolapse, Ebstein anomaly, carcinoid heart disease, traumatic injury of the TV apparatus

What is the most common cause of significant TR?

Right heart failure secondary to left heart failure. LV dysfunction of any cause raises LAP and PAP, leading to RV and LV dilation.

Symptoms of TR:

Fatigue, decreased exercise tolerance, “right sided HF” from elevated RAP

(Acites, congestive hepatomegaly, peripheral edema, decreased appetite, abdominal fullness), AFib can result from RA enlargement

What are the effects of TR?

Pressure and volume overload in the RV. Causing the septum to bulge into the LV which gives a D-shaped appearance in PSAX. Increased pressure may also go back to the RA and venous system, resulting in IVC dilation

Severe TR: systolic reversal in hepatic veins

What does a severe TR jet look like?

Triangular shaped, early parking jet, density similar to TV inflow velocity

How do you calculate PASP (pulmonary artery systolic pressure)?

4v² + RAPmean

V= peak TR velocity

RAP is estimated using IVC diameter and collapsibility (3,8,15)

Hemodynamically significant TR includes:

Dilated RV, RA, IVC. Diastolic flattening of the IVS. Systolic flow reversal of the hepatic veins.

Treatment options for TR:

Diuretics, TV repair (widen or tighten TV leaflets), TV replacement (mechanical or bioprosthetic), transcatheter valve repair or replacement