Tricuspid Regurgitation

Retrograde blood flow from the right ventricle into the right atrium caused by inadequate closure of the tricuspid valve orifice during ventricular systole.

In the elderly, tricuspid regurgitation is most often caused by a dilated valve ring secondary to right ventricular failure, which usually results from left-sided heart failure or pulmonary hypertension related to primary pulmonary disease. Infective endocarditis is a less common cause. Tricuspid regurgitation may be silent, or a short ejection or holosystolic murmur may be present.

The diagnosis is made by finding the characteristic systolic murmur, usually heard in the third or fourth intercostal space at the left sternal border. The murmur increases in intensity with inspiration (Carvallo's sign) in about 50% of patients. If tricuspid regurgitation is severe, a prominent large V wave may be seen in the jugular venous pulse. The diagnosis is confirmed by Doppler echocardiography.

Medical treatment of heart failure ameliorates tricuspid regurgitation. Surgery is rarely necessary.