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Name of the tricuspid valve regurgitation disease: tricuspid regurgitation respective areas: the chest clinic departments: Department of Cardiology, Cardiothoracic Surgery, signs and symptoms: palpitations, arrhythmia, heart failure, respiratory disorders, sudden death, heart sound abnormal tricuspid regurgitation Introduction
Because congenital or acquired factors, or tricuspid ring tricuspid valve disease caused by expansion, resulting in the contraction is not completely closed tricuspid valve, said tricuspid regurgitation. The disease has both functional and organic, the former more than the right ventricle secondary to lead the expansion of the lesion, the incidence rate is very high, such as primary pulmonary hypertension, mitral valve disease, pulmonary valve or infundibular stenosis, right ventricular myocardial infarction. The latter can be congenital abnormalities such as Ebstein anomaly and a common atrioventricular canal, but also of acquired diseases such as rheumatic inflammation, and coronary artery disease caused by tricuspid valve papillary muscle dysfunction, trauma and infective endocarditis, etc., the disease prognosis, as the primary disease, heart failure due to the nature and severity, depending on primary pulmonary hypertension and chronic pulmonary heart disease more often due to the prognosis of atrial septal defect or mitral valve disease caused by worse. Medical treatment can relieve symptoms, surgery cured. Knowledge of the tricuspid valve


regurgitation causes of tricuspid regurgitation: more than tricuspid valve regurgitation and tricuspid valve by the pulmonary hypertension caused by expansion. Common symptoms of tricuspid insufficiency: first, the symptoms are severe fatigue, abdominal distension and other symptoms of right heart failure. Tricuspid regurgitation complications . check: (a) X ray examination showed right ventricular and right atrial enlargement. Right atrial pressure is increased by . the differential diagnosis of tricuspid regurgitation: Mitral regurgitation should be differentiated from low ventricular septal defect. Tricuspid valve regurgitation mitral . Prevention: For some diseases, such as primary pulmonary hypertension, mitral valve disease, pulmonary complications . tricuspid regurgitation: rheumatic heart disease, tricuspid valve disease with left heart valve disease is usually the same . the treatment of tricuspid insufficiency: a relatively mild degree of tricuspid regurgitation in the primary repair of other valve disease .
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Tricuspid regurgitation tricuspid regurgitation (tricuspid insufficiency) involvement is rare in the leaflets themselves, but more by the expansion caused by pulmonary hypertension and tricuspid valve. Because congenital or acquired factors, or tricuspid ring tricuspid valve disease caused by expansion, resulting in the contraction is not completely closed tricuspid valve, said tricuspid regurgitation. The disease has both functional and organic, the former more than the right ventricle secondary to lead the expansion of the lesion, the incidence rate is very high, such as primary pulmonary hypertension, mitral valve disease, pulmonary valve or infundibular stenosis, right ventricular myocardial infarction. The latter can be congenital abnormalities such as Ebstein anomaly and a common atrioventricular canal, but also of acquired diseases such as rheumatic inflammation, and coronary artery disease caused by tricuspid valve papillary muscle dysfunction, such as trauma and infective endocarditis. Prognosis of the disease as the primary disease due to the nature and severity of heart failure, depending on primary pulmonary hypertension and chronic pulmonary heart disease more often due to the prognosis of atrial septal defect or mitral valve disease are even worse due to . Medical treatment can relieve symptoms, surgery cured. Clinical manifestations
Tricuspid regurgitati. Easy to fatigue, may have exertional palpitations, shortness of breath, the right rib area and right upper quadrant pain quarter, subcutaneous edema, persistent ascites. 2. Loss of appetite, nausea, belching and vomiting, some patients may have mild jaundice. 3. Sometimes a neck, head vein pulsating feeling. 4. Lesions clear when the systolic pulse and jugular vein distention, lower extremity edema, hepatomegaly, ascites, liver and jugular vein reflux symptoms. 5. Diffuse right ventricular beat, the heart to the right sector to expand, the first heart sound diminished, the pulmonary valve hyperthyroidism second sound, often audible third heart sound and right ventricular gallop. 6. Intercostal space left sternal margin of 3-5 full-systolic murmur, even the loudest in the xiphoid area, caused when the right ventricle increased significantly when the heart of this noise can be shifted at the apex. 7. Severe regurgitation when left sternal border even after the third heart sound can be heard and a short diastolic rumble like noise. Tricuspid valve regurgitation caused by right side of the pathophysiology of the heart with mitral regurgitation on the left side of the heart were similar, but the compensation of longer term; disease if gradual progress, and ultimately can lead to right ventricular and right atrial hypertrophy, right ventricular failure. Caused by significant pulmonary hypertension, the disease developed rapidly. (A) of the symptoms of tricuspid regurgitation with pulmonary hypertension, reduced cardiac output can occur and systemic symptoms of congestion. Tricuspid regurgitation in patients with mitral valve disease, the symptoms of pulmonary congestion may be due to the development of tricuspid regurgitation reduced, but the fatigue and other symptoms of reduced cardiac output can be more important. (B) signs of the main signs of the left lower sternal edge of the whole systolic murmur, suction and compression noise can enhance the liver; However, if the failure of the right ventricle can not increase the noise is difficult to increase stroke volume. Only in the flow is large, a third heart sound and mid diastolic murmur tricuspid area low-key. Figure v jugular pulse wave (also known as the return wave, the right ventricle, blood flow to the right atrium and large veins caused by) increased; liver palpable pulse. Valve prolapse, tricuspid valve area could be heard in the non-ejection s and tone. The congestion and right heart failure signs the same. Etiology and pathogenesis
Tricuspid regurgitation, tricuspid regurgitation and more by the expansion caused by pulmonary hypertension and tricuspid valve. Common in mitral valve disease and significant chronic pulmonary heart disease, involving the right ventricle inferior wall myocardial infarction, rheumatic or congenital heart disease with advanced heart failure caused by pulmonary hypertension, ischemic heart disease, cardiomyopathy; rare three persons, such as rheumatic reduce inflammation after mitral valve deformation, often associated with tricuspid stenosis; congenital Ebstein malformation; valve endocarditis caused by damage; tricuspid valve prolapse, mitral valve prolapse accompanied with such patients, common in Marfan syndrome; can also be found right atrial myxoma, right ventricular myocardial infarction and chest trauma. Acquired pure tricuspid regurgitation can occur in carcinoid syndrome, carcinoid plaques often due to ventricular surface of calm in the tricuspid valve, and to tip and right ventricular wall flap adhesion, which led to tricuspid regurgitation, such patients also have pulmonary valve disease and more. Tricuspid regurgitation often have significantly expanded the right heart. Diagnosis is based on noise, according to the typical, right atrium and right ventricle and the systemic circulation increased signs and symptoms of congestion, the general is not difficult to make a diagnosis. Acoustic contrast echocardiography and Doppler ultrasound examination can be diagnosed, the cause and help make a diagnosis. 1. Light
Patients were asymptomatic tricuspid regurgitation, a heavy fatigue, abdominal distension, exertional palpitations, shortness of breath, edema, ascites, and occasionally jaundice. 2. Diffuse right ventricular beat, 3-5 intercostal space left sternal edge of the whole systolic murmur, when the right ventricle can significantly increases the noise in the apical area. Severe regurgitation when the left edge of the sternum can be heard a rumble like a short diastolic murmur. 3.X-ray examination shows the right ventricle, right atrial enlargement. Right atrial pressure is increased by, showing azygos vein dilatation and pleural effusion; have ascites, diaphragmatic elevation. Perspective can be seen when the right atrial systolic pulse. 4. ECG: right bundle branch block or right ventricular hypertrophy, often pulmonary P wave or atrial fibrillation. 5. Echocardiography shows the right ventricle, right atrial enlargement, inferior vena cava, and widened pulse; tricuspid flail about. Acoustic contrast echocardiography confirm reflux, Doppler ultrasound can determine the degree regurgitation and pulmonary hypertension. 1 differential diagnosis. Should mitral valve
Tricuspid regurgitation regurgitation low differentiated ventricular septal defect. 2. Mitral regurgitation: a typical hair-like apex systolic murmur and a left atrium and left ventricle enlarged. 3. Tricuspid regurgitation: Press the lower left sternal border and limitations of the full contraction of hair-like noise, inspiratory noise can increase due to increased blood volume Huixin, exhale less. Pulmonary hypertension, pulmonary valve hyperthyroidism second heart sound, jugular venous v wave increased. Pulse may have liver, swollen. ECG and X ray examination showed right ventricular hypertrophy. Echocardiography can confirm the diagnosis. Relative treatment was mild tricuspid regurgitation in the primary repair of other valve disease, after a period of recovery, due to right ventricular pressure drops, reducing the right heart, the most mitigate the degree of regurgitation, or even disappear. However, some patients with severe rheumatic heart disease, tricuspid regurgitation within a few days after the hemodynamic disorders caused by low cardiac output is contributed, which led to one of the factors operative death. There are some pulmonary hypertension patients are not expected, after a long period of right heart failure. Thus in recent years advocated a more moderate degree of tricuspid regurgitation after valve surgery in the other, earlier implementation of tricuspid valve ring plasty, in order to obtain satisfactory results. Organic c
Tricuspid valve regurgitation mitral regurgitation, generally require surgery. Mild disease, could be asked to look directly at the junction of open integration, re-valve ring plasty; lesions heavier, valve replacement surgery should be performed. Tricuspid valve plasty: There are three common methods valve surgery girth reduction, along front flap and the flap at the junction and headed after the prosthetic ring with atraumatic suture needles for 1 to 2 mattress suture, lining both sides gaskets, valve annulus shortening after ligation. DeVega patients with non-invasive with double needle stitching along the front flap and double-cross after the prosthetic ring for continuous suture, both ends of the pin out of the zone at a gasket, tighten the suture ligation to reduce the expansion of After the flap and the front flap of the base valve ring. Carpentier ring fixation, Carpentier ring is modeled on the tricuspid annulus shape, made of stainless steel oval-shaped semi-circle, the external polyester fabric wrapped, there are different numbers. Placed along the tricuspid annulus during surgery mattress sutures, and then slit in the appropriate number of Carpentier ring. Ligation can be fixed before the expansion valve and flap valve ring narrow base, leaving the restoration of the tricuspid valve together well. Modified carpentier ring, ring with flexible materials that can adapt to the activities of the cardiac cycle of atrioventricular ring to reduce the stress on the suture loop, thereby reducing the possibility of avulsion. Pure tricuspid regurgitation, without pulmonary hypertension, such as endocarditis secondary to infection or trauma and generally does not require surgery. Aggressive treatment of other causes of heart failure, can improve the functional severity of tricuspid regurgitation. Mitral valve disease with pulmonary hypertension and right ventricular expanded significantly, the corrected mitral valve abnormalities, decreased pulmonary artery pressure, tricuspid regurgitation can be gradually reduced or disappeared without special treatment; organic tricuspid valve disease in serious condition people, especially those with rheumatic without severe pulmonary hypertension, may be imposed annulus angioplasty or artificial heart valve replacement. Complication of rheumatic heart disease, tricuspid valve disease usually associated with left heart valve disease exist, simple involving the tricuspid valve are extremely rare. This shows that the United valve disease is one of the characteristics of such patients is not only associated with increased pulmonary vascular resistance, secondary to respiratory dysfunction. Venous pressure but also increased the systemic circulation, gastrointestinal bleeding, digestive dysfunction. Rheumatic heart disease and tricuspid valve disease, poor heart function post-surgery or death was mainly due to concurrent right heart failure and venous hypertension, the main clinical manifestations of jugular vein distention, hepatomegaly, ascites, low blood protein disease, drug treatment only short-term relief, but again, operative mortality is very high. Tricuspid regurgitation can be complicated by the diseases? 1 efficacy evaluation. Cure: cure the primary disease or tricuspid valve surgery, the symptoms disappeared, signs of significant improvement in cardiac function returned to normal. 2. Improvement: medical treatment or tricuspid valve surgery, symptoms improved. 3. Invalid: tricuspid valve surgery or medical treatment, signs and symptoms were not improved or further increase. Prevention of common sense symptoms should seek immediate medical attention as soon as a clear cause, decided to treatment. Once rheumatic activities easily aggravate the condition, it should be a positive control. When bleeding due to liver jaundice caused by liver damage, it should promptly make the appropriate checks to clear lesions. When the required operation, should have a good time. For some diseases, such as primary pulmonary hypertension, mitral valve disease, pulmonary valve or infundibular stenosis, right ventricular myocardial infarction, or should always be alert and prevention of functional tricuspid regurgitation occurred; and in other diseases such as Ebstein anomaly in congenital malformations and common atrioventricular canal, and some acquired diseases such as rheumatic inflammation, and coronary artery disease caused by tricuspid valve papillary muscle dysfunction, trauma and infective endocarditis, also should pay attention to whether the performance of tricuspid regurgitation occurred. Tricuspid regurgitation should be how to prevent? Notes 1 medication. There rheumatic activity or concurrent infection, should be timely application of anti-rheumatic treatment and antibiotics. 2. Occur heart failure, the application of "A", "B", "C" key with vasodilators, diuretics, cardiac drugs and symptomatic support integrated treatment. 3. Added electrolytes, vitamins, human serum albumin. Note medication by your doctor. Have heart failure symptoms, limit salt and water intake. Dental procedures (including cleaning teeth), or before and after surgery, routine use of antibiotics. To exercise tolerance. Do not overwork. If the exercise becomes intolerant, should rest. Until doctors re-evaluate


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