Tricuspid valve is the largest of the four heart valves. Tricuspid regurgitation is most often secondary to elevated right ventricular pressure as a consequence of pulmonary hypertension. Hence it is often associated with other valvular disorders like mitral stenosis. In rheumatic heart disease, isolated tricuspid regurgitation will be very unlikely as the mitral valve will be invariably affected in such cases.
Tricuspid regurgitation can be divided into hypertensive and non-hypertensive. Non-hypertensive tricuspid regurgitation occurs due to structural abnormalities of the tricuspid valve like Ebstien’s anomaly. Tricuspid valve endocarditis is also an important cause of tricuspid regurgitation, especially in intravenous drug abusers. Tricuspid regurgitation is also a feature of carcinoid heart disease. Severe tricuspid regurgitation produces right atrial dilatation and a prominent V wave in the jugular venous pulse.
Severe tricuspid regurgitation requires surgical repair. de Vega’s annuloplasty is useful in controlling tricuspid regurgitation. Rare cases may require prosthetic valve replacement. Bioprosthesis is preferred in tricuspid location because of the tendency for thrombosis due to the low velocity of blood flow across the tricuspid valve. Unlike in the mitral and aortic position, degeneration of bioprosthesis is lesser in the tricuspid position due to lower hemodynamic load.
Colour Doppler echocardiogram in apical four chamber view showing tricuspid regurgitation (blue TR jet)
RA: right atrium; LA: left atrium; RV: right ventricle; LV: left ventricle