What is mild mitral and tricuspid regurgitation?

Mild mitral and tricuspid regurgitation is a relatively common chronic cor pulmonale, which is prone to manifest as pulmonary hypertension and other symptoms of decreased cardiac output. Therefore, patients should receive treatment for these diseases based on these symptoms and signs to reduce the possible harm caused.

The pathophysiological changes in the right side of the heart caused by tricuspid regurgitation are similar to the effects of mitral regurgitation on the left side of the heart, but the compensatory period is longer; if the disease progresses gradually, it can eventually lead to hypertrophy of the right ventricle and right atrium, and right ventricular failure. If it is caused by significant pulmonary hypertension, the disease progresses rapidly.

(I) Symptoms When tricuspid regurgitation is combined with pulmonary hypertension, symptoms of decreased cardiac output and systemic congestion may occur. In patients with tricuspid regurgitation and mitral valve disease, the symptoms of pulmonary congestion may be alleviated due to the development of tricuspid regurgitation, but fatigue and other symptoms of decreased cardiac output may be aggravated.

(B) Physical signs The main sign is a holosystolic murmur at the lower left edge of the sternum. The murmur may be enhanced after inspiration and compression of the liver. However, if the failing right ventricle cannot increase the stroke volume, the murmur is difficult to enhance. Only when the flow is very high, there is a third heart sound and a low-pitched mid-diastolic murmur in the tricuspid area. The V wave of the jugular venous pulse graph (also called the return wave, caused by the return of blood to the right atrium when the right ventricle contracts) is enlarged; the liver pulsation can be felt. In case of valve prolapse, a non-ejective click may be heard in the tricuspid valve area. The signs of congestion are the same as those of right heart failure.

3. Etiology and pathogenesis

Tricuspid regurgitation is often caused by pulmonary hypertension and tricuspid valve dilatation. It is common in patients with significant mitral valve disease and chronic cor pulmonale, myocardial infarction involving the inferior wall of the right ventricle, late-stage heart failure caused by pulmonary hypertension due to rheumatic or congenital heart disease, ischemic heart disease, and cardiomyopathy; rare cases include shortening and deformation of the valve after rheumatic tricuspid valvulitis, often accompanied by tricuspid stenosis; congenital Ebstein anomaly; valvular damage caused by infective endocarditis; tricuspid valve prolapse, such patients are often accompanied by mitral valve prolapse, which is common in Marfan syndrome; it can also be seen in right atrial myxoma, right ventricular myocardial infarction and after chest trauma.