Tricuspid regurgitation of the 1st degree - what is it and what is the treatment?

Tricuspid regurgitation is one of the varieties of heart defects, in which there is a reverse transfer of blood during systole from the right ventricle into the cavity of the right atrium. The reason for this is the insufficiency of the tricuspid (tricuspid) valve, i.e., the incomplete closure of its valves. The tricuspid valve regurgitation is acquired or congenital.

Origin of the term

The word "regurgitation" comes from the Latin gurgitare - "flood" - and the prefixes re-, denoting the reverse action, ie, it assumes the reverse of the normal flow direction. In this case - the reverse flow of blood.

Causes of congenital tricuspid regurgitation

The most common causes of this congenital pathology are:

• Underdevelopment of valve flaps;
• Abnormal development (number) of valve flaps;
• Connective tissue dysplasia;
• Ehlers-Danlos syndrome;
• Marfan syndrome;
• The Ebstein anomaly.

Tricuspid regurgitation in the fetus is isolated very rarely, it is usually combined with other heart defects. This failure of the valve can be a part of mitral-aortic-tricuspidal defect.

The causes of acquired tricuspid regurgitation

Regurgitation of the tricuspid valve acquired occurs much more often than the congenital. It is primary and secondary. The primary causes of this pathology include rheumatism, drug addiction, carcinoid syndrome.

1. Rheumatism is the most common cause of this pathology. In 20% of cases, it is the recurrent rheumatic endocarditis that leads to deformation (thickening and shortening) of valve flaps, and the tendon threads also change in the same way. Very often, this pathology is joined by stenosis of the right atrioventricular aperture. This combination is called a combined tricuspidal defect.
2. The rupture of the papillary muscles can also lead to tricuspid regurgitation. Such breaks occur with myocardial infarction or may have a traumatic origin.
3. Carcinoid syndrome can also lead to this pathology. It occurs with certain types of oncology, for example, cancer of the small intestine, ovaries or lungs.
4. The use of heavy drugs very often leads to infective endocarditis, and he, in turn, can cause tricuspid regurgitation.

The causes of secondary tricuspid insufficiency are most often caused by the following diseases:

• Dilatation of the fibrous ring arising during dilated cardiomyopathy;
• High degree of pulmonary hypertension;
• Weakness of myocardium of the right ventricle, which occurs in the so-called pulmonary heart;
• Chronic heart failure;
• myocarditis;
• Myocardial dystrophy.

Symptoms in children

Congenital tricuspid regurgitation in infants in 25% of cases is manifested as supraventricular tachycardia or atrial fibrillation, later severe heart failure may appear .

Dyspnea and palpitations appear in even older children, even under the minimum load . The child can complain of pain in the heart. There may be dyspeptic disorders (nausea, vomiting, flatulence) and pain or a feeling of heaviness in the right hypochondrium. If there is stagnation in a large circle of circulation, then peripheral edema, ascites, hydrothorax or hepatomegaly appear. All these are very serious conditions.

Symptoms of the disease in adults

If this pathology is acquired at a later age, then at the initial stage a person about it may not even suspect. Minor tricuspid regurgitation occurs only in some patients with pulsation of the cervical veins. The patient does not mark other symptoms. Regurgitation of the tricuspid valve of the 1st degree may not manifest itself in any way. Usually, this pathology is discovered quite accidentally during the next physical examination. The patient undergoes echocardiography, in which he has tricuspid regurgitation of the 1st degree. What it is - he learns only after the survey. Such patients are usually registered with a cardiologist and observed.

With more severe valve failure, there is a significant swelling of the jugular veins. In this case, if you put a palm on the right side of the jugular vein , you can feel its trembling. In severe cases, this pathology leads to right ventricular dysfunction, atrial fibrillation, or can provoke heart failure.

Diagnostics

The diagnosis of "tricuspid regurgitation of 1 degree" or some other can be made only after a thorough examination of the patient. To do this, you must complete the following procedures:

• The physical method of examination, ie, listening to the tones and heart sounds with the help of a stethoscope;
• Echocardiography (echocardiography) is an ultrasound of the heart, which reveals the functional and morphological state of the heart muscle and valves;
• ECG, in which you can see the signs of an enlarged right atrium and ventricle of the heart;
• Chest x-ray - this study also shows increased right ventricular size, it is possible to see signs of pulmonary hypertension and deformation of the mitral and aortic valves;
• Produce a biochemical blood test;
• general blood analysis;
• Cardiac catheterization - this newest invasive procedure is used both for the diagnosis of cardiac pathologies and for treatment.

Classification

We found that regurgitation of the tricuspid valve by etiology can be congenital and acquired, primary (organic) or secondary (functional). Organic insufficiency is expressed by deformation of the valve apparatus: by thickening and wrinkling of valve flaps or by calcification. Functional failure manifests itself in valve dysfunction caused by other diseases, and manifests itself by rupture of papillary muscles or tendon chords, as well as a violation of the fibrous ring.

Degrees of disease

There are 4 degrees of this disease, which are characterized by the length of casting a jet of reverse blood flow into the cavity of the right atrium.

Tricuspid regurgitation of 1 degree - what is it? In this case, the return of blood is negligible and barely detectable. In this case, the patient does not complain about anything. The clinical picture is absent.

With the diagnosis of "tricuspid regurgitation of the 2nd degree", the return flow of the blood is carried out within 2 cm from the valve walls. The clinic is almost absent in this stage of the disease, the pulsation of the jugular veins may be poorly expressed.

Regurgitation of the tricuspid valve of the 3rd degree is determined by throwing back blood flow more than 2 cm from the tricuspid valve. Patients, in addition to pulsation of the cervical veins, may experience palpitations, weakness and rapid fatigue, even with low physical exertion, minor dyspnea may occur.

Disease of the 4th degree is characterized by a pronounced flow of return flow of blood from the valve to the cavity of the right atrium. In severe cases, the patient may experience symptoms of severe heart failure and pulmonary hypertension (pulmonary and tricuspid regurgitation). In this case, the other symptoms are added to the symptoms listed above. Namely: edema of the lower extremities, a feeling of pulsation on the left in the sternum, which is strengthened by inhalation, violation of heart sounds, cold extremities, enlargement of liver size, ascites (accumulation of fluid in the abdominal cavity), abdominal pain, and with the rheumatic nature of the disease Aortic or mitral defect.

Treatment

Methods of treatment depend on the degree of the disease, as well as whether it is accompanied by other heart defects and pathologies or not. With the diagnosis of "regurgitation of the tricuspid valve 1 degree" of treatment, as a rule, no one is required. Such a state of medicine is considered as a variant of the norm. In the event that tricuspid regurgitation of 1 degree is caused by some disease, for example, lung disease, rheumatism or infectious endocarditis, then a provocative disease therapy should be performed. If you get rid of the underlying disease, further deformation of the tricuspid valve will stop. So, tricuspid regurgitation of 1 degree - what it is and how to treat it, it is now clear. Consider the next stage of this disease.

Regurgitation of the tricuspid valve of the 2nd degree often also does not require treatment. If this pathology is associated with other heart defects or diseases, for example, heart failure, then conservative methods should be used. To do this, use diuretics to reduce swelling and drugs that relax the smooth muscles of the walls of blood vessels (vasodilators). No other measures require tricuspid regurgitation of grade 2.

Treatment of 3 and 4 degrees is also aimed at eliminating the disease that caused regurgitation. If it does not work, surgery is indicated. In this case, the plastic of the valve flaps, their annuloplasty (binding of the elastic or rigid ring, it is also possible to suture the valve ring by suturing) or prosthetics.

Mitral regurgitation

If the mitral valve fails, when its valves close not tight enough, a reverse flow of blood from the left ventricle to the left atrial cavity occurs during the systole period. This condition is called mitral regurgitation or mitral valve prolapse. This pathology, like tricuspid regurgitation, can be both congenital and acquired. Causes and diagnosis in the diagnosis of "mitral" and "tricuspid regurgitation" are also similar. The degrees determining the severity of the disease, total 4, they depend on the amount of reverse blood flow:

• 1 degree - mitral regurgitation is insignificant;
• 2 degree - mitral regurgitation is moderate;
• 3 degree - mitral regurgitation is much pronounced;
• 4 degree - mitral regurgitation is severe, often there is a complicated course.

Minor mitral, tricuspid regurgitation of 1 degree, which does not cause objective complaints in the patient, does not require any treatment. Therapeutic treatment is performed in the complicated course of the disease, for example, violations of heart rhythm or pulmonary hypertension. Surgery is indicated for severe or severe mitral failure, in these cases, plastic or prosthetic valve.

The combination of mitral and tricuspid insufficiency

Often, mitral and tricuspid regurgitation are diagnosed simultaneously in one patient. The cardiologist will make a decision about the tactics of treating such a patient after a detailed examination and obtaining the results of the tests. If the insufficiency of the valves is not significant, perhaps no treatment is needed, but it will be necessary to periodically observe the cardiologist and undergo the necessary examinations.

If the cause that caused the failure of the valves is established, then a therapeutic treatment aimed at eliminating the provocative disease will be prescribed. In the absence of positive dynamics, treatment of regurgitation by surgery is indicated. Usually it happens with severe and severe disease.

Patients who underwent surgical treatment of valve failure usually receive indirect anticoagulants.

Forecast

Secondary regurgitation is considered to be prognostically most unfavorable. The death of patients in this case usually results from myocardial infarction, increasing heart failure, pneumonia or pulmonary embolism.

According to statistics, after surgical treatment of cardiac insufficiency, the survival rate of patients up to 5 years and more is 65% after prosthetics and 70% after annuloplasty.

The prognosis is favorable for the diagnosis of "tricuspid regurgitation of the 1st degree". What it is, patients usually find out only with preventive examinations. With insignificant insufficiency of the heart valves, there is no direct threat to life.

Conclusion

Prevention of mitral and tricuspid insufficiency is the prevention of diseases that cause failure of the valves. Namely, the treatment of rheumatism and other diseases that cause damage to the heart valves.