Every patient wants to know why grade 1 tricuspid regurgitation occurs, what it is and how it is treated when this diagnosis is found in a medical card or other document. The name sounds scary, but don't panic. It is important to understand what the disease is, why this deviation is dangerous, why it occurs and how to deal with it.

Characteristics of the disease

First, you need to figure out what the name of this disease implies. Its first component refers to the name of the part of the organ that is not working correctly: the tricuspid valve. It performs the function of protecting against the reverse flow of blood after each release from the heart. It is located between the right atrium and the ventricle.

Regurgitation of the tricuspid valve of the 1st degree is manifested by the fact that after each flow of blood to the ventricle, some of it returns in a weak stream back through the cracks in the valve, which, in turn, causes difficulties in the functioning of the heart, since it has to beat more often to normalize the volume of fluid in its cavity.

Tricuspid valve insufficiency appears due to a disturbance in the movement of its components and deterioration of their properties. Or it could be a birth defect where part of the hole is left open. Due to insufficiency, grade 1 tricuspid regurgitation develops.

This deviation from the norm is not serious, so people do not notice the disease until initial stage. But if measures are not taken, grade 1 tricuspid insufficiency may develop. If you pay attention to this deviation in time and take action, you can avoid complications.

So, regurgitation is the process of returning some of the blood back through the valve. Since the human heart has 4 valves, regurgitation is distinguished:

• aortic;
• mitral;
• pulmonary trunk;
• tricuspid.

The last one on the list, also known as the tricuspid valve, works on the following principle:

1. 1. When the heart is relaxed, it opens and releases the accumulated blood, already enriched with oxygen, into the corresponding ventricle.
2. 2. Then it closes again at the time of contraction of the heart muscle.

This cycle repeats throughout a person’s life.

If the tricuspid valve is insufficient and through the hole some of the blood returns back into the cavity, this is not very good. In this case, you need to take care of your health as soon as possible so that the disease does not develop further.

Etiology of occurrence and symptoms of the disease

Due to the fact that problems appear in the main organ, which is responsible for the blood supply to the body, the consequences affect the entire human body. Whatever happens serious complications, it is important to diagnose the deviation in time. To do this you need to know possible reasons and signs of disease.

The causes of tricuspid regurgitation can be different:

• consequences of heart attacks;
• valve insufficiency;
• tricuspid valve prolapse;
• rheumatic myocarditis;
• use of drugs and tobacco products.

The last statement is indirect, since there is a deterioration in activity of cardio-vascular system, which can subsequently cause many abnormalities, including blood flowing back into the heart.

The second degree of this deviation differs from the first in that the length of the returning jet is longer and amounts to 2 cm. This interferes normal functioning hearts. In addition, in the second degree, the ventricle begins to expand, and sounds become more obvious during examination.

If you experience the corresponding symptoms, it is recommended to undergo a heart examination to confirm or refute the suspected diagnosis. Reasons to see a doctor are:

• swelling of the neck and other parts of the body;
• shortness of breath with little physical activity;
• swelling of the veins in the neck;
• palpable heartbeat.

Due to the fact that blood flow deteriorates, problems with the movement of arms and legs and the appearance of chilliness may occur ( hypersensitivity to cold) in the extremities.

Diagnosis, prevention and treatment

As a rule, grade 2 tricuspid regurgitation is a reason to take care of your heart health. Usually during examination this problem is found quite quickly, since this disease is a complication of other abnormalities. For example, grade 2 tricuspid valve insufficiency in most cases leads to regurgitation. In this case, the deficiency itself must be treated.

In order to identify and diagnose the disease in question, you will need to undergo the following examinations:

1. 1. Echocardiography (EchoCG). There they listen to the heartbeat and use it to determine whether there is a deviation from the norm or not.
2. 2. Physical examination by a cardiologist. He directs for procedures. At the appointment, he will listen to the heartbeat, its tones and noises.
3. 3. Electrocardiography (ECG). This procedure performed to detect dilation of the ventricle and atria, which is a sign of valve dysfunction.
4. 4. Breast X-ray. It refutes or confirms the previous point if there is any doubt.

In some cases (if equipment is available), catheterization may be performed to identify additional problems throughout the cardiovascular system. It's relative new method examinations.

Tricuspid regurgitation of the 1st degree is a disease that rarely occurs as a single deviation. In most cases, it is a complication, and sometimes you can find a similar entry in the medical record: grade 1 tricuspid valve prolapse with grade 1 regurgitation. Prolapse is one of the possible violations in the functioning of the valve, leading to regurgitation.

Treatment and prevention are prescribed only by a specialist. In most cases, tricuspid regurgitation is treated with special medications. Sometimes exercise therapy may be prescribed in the form of walking fresh air or other activities to strengthen the heart muscle. It all depends on the characteristics of the human body and the degree of his disease.

Tricuspid regurgitation is one of the types of heart defects in which there is insufficiency of the tricuspid (tricuspid) valve, leading during systole to the reverse flow of blood from the right ventricle into the atrium.

Tricuspid regurgitation: circumstances

Much more often, the development of tricuspid valve regurgitation appears against the background of heart disease that occurs with dilatation of the right ventricle and pulmonary hypertension. This disease appears much less frequently against the background septic endocarditis, rheumatism, carcinoid syndrome, Marfan syndrome. Tricuspid valve insufficiency is possible congenital pathology or develop as a consequence long reception some medicines(phentermine, fenfluramine, ergotamine).

Symptoms

With a small deficiency of the tricuspid valve leaflets (grade 1 tricuspid regurgitation), the disease in most cases does not manifest itself in any way and is considered a benign condition for which no treatment is carried out. Only some patients experience pulsation of the neck veins, caused by an increase in pressure in them.

In severe tricuspid regurgitation, marked swelling of the jugular veins is noted. Putting your hand to your right jugular vein it is possible to feel it trembling. Severe valve insufficiency can lead to dysfunction of the right ventricle, the occurrence of atrial flutter or atrial fibrillation, and the formation of heart failure.

Tricuspid regurgitation: diagnosis

It is possible to make a correct diagnosis of tricuspid regurgitation and determine the extent of the disease based on Doppler echocardiography data. With grade 1 tricuspid regurgitation, the reverse flow of blood from the right ventricle back into the right atrium is slightly noticeable. Tricuspid regurgitation of the 2nd degree is characterized by 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 ways studies do ECG and radiography chest. The electrocardiogram often reveals indicators of right ventricular hypertrophy. Radiographs of grade 1 tricuspid regurgitation do not reveal transformations in most cases. With tricuspid regurgitation of grade 2 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 very rarely performed.

Treatment of tricuspid regurgitation

Minor tricuspid regurgitation is well tolerated by people and does not lack treatment. Therapy in most cases is prescribed for tricuspid regurgitation of degrees 2–4. First of all, it is aimed at eliminating the circumstances that led to the formation of tricuspid valve insufficiency (treatment of rheumatism, septic endocarditis, etc.). In addition, they also treat complications caused by tricuspid regurgitation - heart failure, arrhythmia.

In the absence of results from conservative treatment, and with the impending progression of valve insufficiency, timely intervention is demonstrated - prosthetics, tricuspid valve repair or anuloplasty.

In most cases, anuloplasty is resorted to in cases where the disease begins due to dilatation (expansion) of the valve ring. Tricuspid valve replacement has been demonstrated for valve insufficiency caused by Epstein's disease or carcinoid syndrome. A pig valve is used for the prosthesis, which significantly reduces the possibility of developing postoperative period thromboembolic complications. Experience shows that the pig valve functions effectively for more than 10 years, after which it is replaced with a new one.

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In 2012, I had a plastic surgery of the triscupidal valve, but after six months a reverse flow appeared and I began to choke and fluid began to accumulate in the tissues, they diagnosed the insufficiency as 2+. And a year later it was already 3+, they said that the ring was loose, but “tighten” it It is prohibited, due to numerous adhesions at the end of three operations (2 commissuratomies and replacement of the mitral valve, three-leaf plastic) and only to completely replace the valve. Question: how much longer can I survive with this valve without surgery?

Nadezhda Bundus, there is no correct answer to your question. It may last a couple of years, or it may not last several months, depending on many factors.

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Tricuspid regurgitation, like many other cardiac pathologies, is rapidly becoming younger today. Detect malfunction heart valve It is possible even before the baby is born, during an ultrasound.

Tricuspid valve regurgitation is often diagnosed in preschool children, and in adults it usually develops against the background serious illnesses himself of different nature. This anomaly has several forms, different symptoms and correspondingly, different approaches to treatment.

The concept of tricuspid regurgitation

The term "regurgitation" is a medical one. It comes from the Latin word gurgitare (translated as “to flood”) and the prefix re-, meaning “again, back.” In cardiology, regurgitation is the reverse flow (reflux) of blood from one chamber of the heart to another.

The heart consists of four chambers (2 atria and 2 ventricles), separated by septa and equipped with four valves. These are mitral, aortic, pulmonary artery and tricuspid (three-leaf). The latter connects the right ventricle and the right atrium. In each of the valves various reasons Blood flow disturbances may occur, which means there are four types of this disease.

Aortic and mitral regurgitation are most often diagnosed; tricuspid regurgitation is slightly less common. But the danger is that the diagnosis can be confused different shapes this pathology. In addition, sometimes disturbances in the functioning of different heart valves occur simultaneously in a patient.

Important point: tricuspid valve regurgitation is not independent disease and a separate diagnosis. This condition usually develops due to other serious problems(cardiac, pulmonary, etc.), which is why it is usually treated in a complex manner. And most importantly - an anomaly with a frightening Latin name should not be considered a death sentence. It is quite easy to diagnose, it is quite possible to cure or at least strictly control it.

Types of tricuspid regurgitation

There are 2 main classifications of this pathology - according to the time of appearance and the reasons for its occurrence.

• By time of appearance: congenital and acquired.

Congenital is registered during the intrauterine development of the child or in the first months after birth. In this case, heart valve function may return to normal over time. Besides, congenital anomaly It is much easier to keep under control if you take care of your heart and follow measures to prevent cardiovascular diseases.

Acquired disease appears in adults already during life. This pathology almost never occurs in isolation; it can be caused by the most various diseases- from dilatation (expansion) of the ventricle to obstruction of the pulmonary arteries.

• For reasons: primary and secondary.

Primary tricuspid anomaly is diagnosed against the background of heart disease. No problems with respiratory system the patient with this diagnosis does not. The main cause of secondary disruption of blood flow in the tricuspid valve is pulmonary hypertension, that is, too high pressure in the pulmonary artery system.

Regurgitation of the tricuspid valve traditionally goes hand in hand with insufficiency of the valve itself. Therefore, some classifications divide the types of reverse blood flow based on the form, that is, the valve disease itself:

1. Organic (absolute) failure, when the cause is damage to the valve leaflets due to a congenital disease.
2. Functional (relative), when the valve is stretched due to problems with the pulmonary vessels or diffuse damage to the cardiac tissue.

Degrees of tricuspid valve regurgitation

Regurgitation can occur in 4 various stages(degrees). But sometimes doctors identify a separate, fifth, so-called physiological regurgitation. In this case, there are no changes in the myocardium, all three valve leaflets are completely healthy, there is simply a barely noticeable disturbance in the blood flow at the leaflets themselves (“swirling” of the blood).

• First stage. In this case, the patient experiences a small flow of blood back, from the ventricle into the atrium through the valve leaflets.
• Second stage. The length of the jet from the valve reaches 20 mm. Tricuspid regurgitation of the 2nd degree is already considered a disease that requires special treatment.
• Third stage. Blood flow is easily detected during diagnosis and is greater than 2 cm in length.
• Fourth stage. Here the blood flow already goes a considerable distance deep into the right atrium.

Functional tricuspid regurgitation is usually numbered as grade 0-1. Most often it is found in tall, thin people, and some medical sources They report that 2/3 of absolutely healthy people have such an anomaly.

This condition is absolutely not life-threatening, does not affect well-being in any way, and is discovered during examination by chance. Unless, of course, it starts to progress.

Causes of pathology

The main cause of impaired blood flow through the tricuspid valve is dilatation of the right ventricle along with valvular insufficiency. This anomaly is provoked by pulmonary hypertension, heart failure, obstruction (obstruction) of the pulmonary arteries. Less common causes of blood reflux are infective endocarditis, rheumatism, medication, etc.

Factors that cause this to occur heart disease, are usually divided into 2 large groups depending on the type of pathology itself:

1. Causes of primary tricuspid regurgitation:
   • rheumatism ( systemic inflammation connective tissue);
   • infective endocarditis (inflammation of the endocardium, often found in injection drug users);
   • valve prolapse (the valves bend by several millimeters);
   • Marfan syndrome ( hereditary disease connective tissue);
   • Ebstein's anomalies (a congenital defect in which the valve leaflets are displaced or absent);
   • chest injuries;
   • long-term use medications (Ergotamine, Phentermine, etc.).
2. Causes of secondary tricuspid regurgitation:
   • increased pressure in the pulmonary arteries (hypertension);
   • enlargement or hypertrophy of the right ventricle;
   • right ventricular dysfunction;
   • mitral valve stenosis;
   • failure of the right and severe failure of the left ventricle;
   • different kinds cardiopathy;
   • defect interatrial septum(congenital defect);
   • obstruction of the pulmonary artery (and its outflow tract).

Symptoms

In mild forms of impaired blood flow between the chambers of the heart, there are no specific symptoms.

Tricuspid regurgitation of the 1st degree can manifest itself only by one sign - increased pulsation of the veins in the neck.

This effect occurs due to high pressure in the jugular veins, and it is easy to feel the pulsation by simply placing your hand on the right side of the neck.

For more late stages You can feel not only the beating pulse, but also a clear trembling of the neck veins. The following symptoms will indicate problems with blood flow in the right ventricle:

• the jugular veins not only tremble, but also swell noticeably;
• 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 sounds;
• holosystolic heart murmur (increases with inspiration);
• shortness of breath and fast fatiguability;
• pain and heaviness in the right hypochondrium;
• enlarged liver, etc.

Most of these signs can signal a variety of problems with the cardiovascular system. Therefore, the clearest visible symptom of tricuspid regurgitation is the swelling and trembling of the jugular vein.

Tricuspid regurgitation in children

Reverse reflux of blood into the right ventricle is now increasingly being recorded in children, even before birth. Tricuspid regurgitation in the fetus can appear in the first trimester of pregnancy, at 11-13 weeks.

This feature often occurs in babies with chromosomal abnormalities (for example, Down syndrome). But a certain percentage of regurgitation is also observed in an absolutely healthy fetus.

Pediatric cardiologists report a rapidly growing number of cases of tricuspid anomaly in children different ages. In most of them, regurgitation of the first degree is diagnosed, and today it is already considered a normal variant.

If the child does not have other heart pathologies, there will be big chance that the valve operation will restore itself.

But if congenital disease reaches the second or third stage, there is a risk of developing heart failure and right ventricular dysfunction in the future. Therefore, it is important for the child to regularly visit a cardiologist and follow all necessary measures prevention of heart diseases.

Diagnostics

Doctors learned to identify severe tricuspid regurgitation a long time ago, but diagnosing mild forms became possible relatively recently, with the advent of ultrasound. That is about 40 years ago.

Today ultrasonography is considered the main diagnostic method for such 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 valve regurgitation includes the following:

• taking anamnesis;
• physical examination (including auscultation of the heart - listening);
• Ultrasound of the heart (regular and with Doppler) or echocardiography;
• electrocardiography;
• chest x-ray;
• cardiac catheterization.

Catheterization is a diagnostic and therapeutic method that requires careful preparation of the patient. It is rarely used to study problems with blood flow through the tricuspid valve. Only in cases where the most in-depth diagnostics are required, for example, to assess the condition of the coronary vessels of the heart.

Treatment and prevention

Therapy for tricuspid regurgitation includes 2 large blocks - conservative and surgical treatment. When the disease is in the first stage, no special therapy not required, only regular monitoring by a cardiologist.

If the patient has cardiovascular pathologies, which provoked a violation of blood flow, all treatment is aimed specifically at them, that is, at eliminating the cause of regurgitation.

When the disease reaches the second stage, conservative treatment already presupposes reception special medicines. These are diuretics (diuretics), (agents for relaxing vascular muscles), potassium preparations, etc.

Surgery tricuspid valve is the following types operations:

• annuloplasty;
• excision;
• prosthetics.

The prognosis for life with tricuspid regurgitation is quite favorable, provided that the patient follows healthy image life and protects your heart. And when the disease is detected at the very first stage, and when valve surgery has already been performed.

In this case, doctors advise using standard measures to prevent heart failure. This includes body weight control and regular physical exercise, proper nutrition, giving up cigarettes and alcohol, regular rest and as little stress as possible. And most importantly, constant monitoring by a cardiologist.

Some heart pathologies do not manifest themselves in any way and do not interfere with a person’s life full life. One of them is dysfunction of the tricuspid valve. Tricuspid regurgitation of the 1st degree is the initial stage of valvular dysfunction that does not require specific treatment. But the person’s condition should be monitored by an experienced cardiologist.

general information

In cardiological practice, the complex term “tricuspid regurgitation” is usually used to describe a condition in which a change in blood flow occurs in reverse side. That is, blood is pumped from one chamber of the heart to another. The culprit for what is happening is the tricuspid (three-leaf) valve, which loses the ability to fully close the leaflets.

Grade 1 tricuspid valve regurgitation is not a diagnosis, but a consequence of other disorders in the body. Therefore, you can get rid of it only by curing the underlying disease.

The disease is divided into several types:

• congenital, which is diagnosed in the fetus or in born child in the first months of life;
• acquired, discovered already in adulthood;
• primary, developing against the background of cardiac pathologies;
• secondary, occurring against the background of lung disease.

The disease is also classified based on the stage (degree) of development:

• 1 - characterized by the return of an insignificant blood flow from the ventricle to the atrium and does not require treatment;
• 2 - diagnosed when the jet length is 2 cm and requires specialized treatment;
• 3 - characterized by an increase in flow length of more than 2 cm;
• 4 - diagnosed if the length of the stream exceeds 3 cm.

What factors contribute to the development of the disease?

All factors contributing to the development of tricuspid regurgitation are divided into two large groups. Primary tricuspid regurgitation develops against the background of the following diseases:

• rheumatic heart disease;
• infective endocarditis;
• sagging valve flaps;
• genetic damage to connective tissue;
• congenital displacement or absence of valve leaflets;
• severe chest injuries;
• long-term use of certain medications.

The following pathologies contribute to the development of secondary tricuspid regurgitation:

• increased pressure in the arteries supplying the lungs, or their obstruction;
• enlargement or dysfunction of the right ventricle;
• narrowing of the mitral valve;
• congenital defect of the septum located between the right ventricle and the atrium.

Causes of congenital anomaly

The congenital form of the disease is very rare. More often it develops against the background of other cardiac disorders. The function of the tricuspid valve in the fetus may be impaired due to the following pathologies:

• underdevelopment of valve leaflets;
• congenital increase or decrease in the number of valves;
• disruption of connective tissue development;
• chromosomal disorders.

Grade 1 tricuspid valve regurgitation most often occurs in children with chromosomal abnormalities. It often appears after birth. The initial stage of tricuspid valve regurgitation is considered normal in the absence of other heart pathologies. With age, the valve's function is restored on its own without specific treatment.

Signs of the initial stage of the disease

An experienced cardiologist can recognize the first degree of regurgitation even in the absence of complaints from the patient. And it is determined by palpation of the jugular veins, which are located on the neck. It is enough to put your hand on your neck to feel an unnaturally strong pulsation. As the disease progresses, the following signs appear:

• audible gurgling in the veins of the neck;
• bluish skin color, mainly on the face;
• swelling of the lower extremities;
• atrial fibrillation;
• disturbance of the heartbeat, audible during auscultation;
• increased heart murmur on inspiration;
• increased fatigue and shortness of breath;
• liver enlargement and accompanying discomfort in the right hypochondrium.

Methods of treatment and prevention

The first degree of regurgitation does not require treatment. After its diagnosis, the patient only needs to systematically visit a cardiologist. In other cases, two types of treatment are used:

• medicinal;
• surgical.

In the presence of cardiac or pulmonary pathologies, therapeutic measures, contributing to their elimination. When diagnosing the second degree of tricuspid valve regurgitation, the patient is prescribed the following groups of drugs:

• diuretics;
• means aimed at relaxing vascular muscles;
• preparations containing potassium, etc.

Surgical treatment involves the use of one of several types of surgical intervention:

• installation of the support ring;
• excision of the tricuspid valve;
• removal of the valve followed by installation of a prosthesis.

What are the dangers of lack of treatment?

The initial stage of dysfunction of the tricuspid valve does not threaten the patient’s life. But the disease cannot be left to chance, as it can progress. The secondary form of tricuspid regurgitation is especially dangerous. Failure to provide assistance causes fatal outcome, occurring from progressive heart failure and myocardial infarction.

Video: Tricuspid valve insufficiency

Tricuspid regurgitation is regurgitation of the tricuspid valve, resulting in blood flowing from the right ventricle into the right atrium during systole. Most common reason- dilatation of the right ventricle. There are usually no symptoms of tricuspid regurgitation, but severe tricuspid regurgitation may cause pulsation of the neck veins, holosystolic murmur, and right ventricular heart failure or atrial fibrillation. Diagnosis is made by physical examination and echocardiography. Tricuspid regurgitation is usually a benign condition that does not require treatment, but some patients require anuloplasty, valve repair, valve replacement, or excision.

Causes of tricuspid regurgitation

Most often, tricuspid regurgitation is caused by dilatation of the right ventricle (RV) with disruption of the functioning of the normal valve. Such situations occur with pulmonary arterial hypertension caused by right ventricular dysfunction, heart failure (HF) and pulmonary outflow tract obstruction. Less commonly, tricuspid regurgitation develops as a result of infective endocarditis in drug addicts who practice intravenous injections; carcinoid syndrome, rheumatic fever, idiopathic myxomatous degeneration, ischemic dysfunction of the papillary muscles, birth defects(eg, bicuspid tricuspid valve, endocardial defects), Epstein's disease (downward displacement of abnormal tricuspid valve cusps in the right ventricle), Marfan syndrome, and with the use of certain drugs (eg, ergotamine, fenfluramine, phentermine).

Prolonged, severe tricuspid regurgitation can lead to associated right ventricular dysfunction, heart failure, and atrial fibrillation (AF).

Symptoms of tricuspid regurgitation

Tricuspid regurgitation usually does not cause any symptoms, but some patients notice pulsation of the neck veins due to high blood pressure in the jugular veins. Acute or severe tricuspid regurgitation can precipitate heart failure due to RV dysfunction. Manifestations of atrial fibrillation or atrial flutter are possible.

The only one visible sign moderate or severe tricuspid regurgitation - distension of the jugular veins, with markedly smoothed c-v (or s) wave and a steep decrease in y. In severe tricuspid regurgitation, fluttering of the right jugular veins can be palpated, as well as systolic hepatic pulsations and right ventricular contractions at the left lower sternal border. On auscultation I heart tone(S1 may be normal or diminished if a tricuspid regurgitation murmur is present.

The second heart sound (S2) may be split (with a loud pulmonary P component in pulmonary arterial hypertension) or single due to rapid closure of the pulmonary valve coinciding with the P and aortic component (A).

A right ventricular third heart sound (S3), a fourth right ventricular heart sound (S4), or both may be heard in heart failure caused by right ventricular dysfunction or RV hypertrophy. These sounds can be distinguished from left ventricular heart sounds because they are located in the fourth intercostal space to the left of the sternum and increase in intensity with inspiration.

The murmur of tricuspid regurgitation is a holosystolic murmur. It is heard best on the right or left of the sternum at the level of its middle or in the epigastric region through a stethoscope with a diaphragm when the patient is sitting upright or standing. The murmur may be high-frequency if the tricuspid regurgitation is functional or caused by pulmonary hypertension, or mid-frequency if the tricuspid regurgitation is severe and has other causes. The noise changes with breathing, becoming louder with inspiration (Carvalho's sign), and with other techniques that increase venous inflow (elevating the leg, pressing on the liver, after ventricular extrasystole). The noise usually does not radiate, but is sometimes heard over the liver.

Diagnosis of tricuspid regurgitation

Mild tricuspid regurgitation is most often detected by echocardiography performed for other reasons. A presumptive diagnosis of more severe or severe tricuspid regurgitation is made by history, physical examination, and confirmed by Doppler echocardiography. An ECG and chest x-ray are often performed. ECG findings are usually normal, but in some cases reveal tall pointed P waves caused by enlargement of the right atrium, tall R waves or QR in lead V1, characterizing right ventricular hypertrophy, or MA. Chest x-ray is usually normal, but in some cases of right ventricular hypertrophy or heart failure caused by right ventricular dysfunction, an enlarged superior vena cava, enlarged right atrium, or right ventricular contour (behind the top part sternum in lateral projection) or detect pleural effusion.

Cardiac catheterization is rarely prescribed. If it is performed (eg, to evaluate coronary vascular anatomy), findings include a pronounced atrial systolic wave V during ventricular systole and normal or elevated atrial systolic pressure.

Prognosis and treatment of tricuspid regurgitation

Since isolated severe tricuspid regurgitation develops in a small number of patients, there is little reliable data regarding the prognosis.

Tricuspid regurgitation is usually well tolerated and does not require treatment in itself. Elimination of the causes of tricuspid regurgitation (for example, heart failure, endocarditis) is indicated. Surgical treatment is indicated for patients with moderate or severe tricuspid regurgitation and left-sided valve disease (eg, mitral stenosis), leading to the development of pulmonary arterial hypertension and high pressure in the right ventricle (mitral valve repair is required). In such patients surgical intervention can prevent death due to low functional state hearts. Surgery may also be considered for patients with severe mitral regurgitation accompanied by clinical symptoms when pressure in the left atrium

Surgical methods include anuloplasty, valve repair and valve replacement. Anuloplasty, in which the tricuspid valve ring is sutured to the prosthetic ring or a reduction in the size of the ring circumference, is prescribed in cases where tricuspid regurgitation develops due to dilatation of the ring. Valve repair or replacement is indicated when tricuspid regurgitation develops due to primary valve disease or when anuloplasty is not technically feasible. Tricuspid valve replacement is performed when tricuspid regurgitation is a consequence of carcinoid syndrome or Epstein's disease. Use a porcine valve to reduce the risk of thromboembolism associated with low flow and pressure in the right heart; Unlike the left sections, the right pork valves have been functioning for more than 10 years.

If the tricuspid valve is damaged due to endocarditis, if the latter cannot be cured with antibiotics, the valve is completely excised and a new one is not implanted for 6-9 months; patients tolerate this intervention well.