What does grade 1 tricuspid regurgitation mean? How dangerous is tricuspid regurgitation? Possibilities of modern diagnostics

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

The concept of tricuspid regurgitation

The term "regurgitation" is medical. 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 the mitral, aortic, pulmonary artery and tricuspid (three-leaf). The latter connects the right ventricle and the right atrium. In each of the valves, for various reasons, blood flow disturbances can occur, which means that 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 during diagnosis one can confuse different forms of this pathology. In addition, sometimes disturbances in the functioning of different heart valves occur simultaneously in a patient.

An important point: tricuspid valve regurgitation is not an independent disease and a separate diagnosis. This condition usually develops due to other serious problems (heart, lung, etc.), and therefore is usually treated in combination. 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. In addition, it is much easier to keep a congenital anomaly under control if you take care of the 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 a variety of diseases - from dilatation (expansion) of the ventricle to obstruction of the pulmonary arteries.

Primary tricuspid anomaly is diagnosed against the background of heart disease. The patient does not have any problems with the respiratory system with this diagnosis. 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 of tricuspid insufficiency, that is, the valve disease itself:

Organic (absolute) failure, when the cause is damage to the valve leaflets due to a congenital disease.
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 different 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 graded as grade 0–1. Most often it is found in tall, thin people, and some medical sources report that 2/3 of absolutely healthy people have this 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.

The factors that cause the appearance of this heart disease are usually divided into 2 large groups depending on the type of pathology itself:

Causes of primary tricuspid regurgitation:
- rheumatism (systemic inflammation of 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 connective tissue disease);
- Ebstein's anomalies (a congenital defect in which the valve leaflets are displaced or absent);
- chest injuries;
- long-term use of medications (Ergotamine, Phentermine, etc.).
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;
various types of cardiopathy;
atrial septal defect (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.

In later stages, you can feel not only a 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 fatigue;
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 of 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, in the future there is a high chance that the valve will work on its own.

But if the 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 your child to regularly visit a cardiologist and follow all necessary measures to prevent heart disease.

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, ultrasound is considered the main diagnostic method for this 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 cardiac auscultation - 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 is required, only regular monitoring by a cardiologist.

If the patient has cardiovascular pathologies that provoked a disturbance in 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 involves taking special medications. These are diuretics (diuretic), vasodilators (agents for relaxing the muscles of blood vessels), potassium supplements, etc.

Surgical treatment of the tricuspid valve includes the following types of operations:

The prognosis for life with tricuspid regurgitation is quite favorable, provided that the patient leads a healthy lifestyle and takes care of his 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. These include body weight control and regular physical activity, proper nutrition, giving up cigarettes and alcohol, regular rest and as little stress as possible. And most importantly, constant monitoring by a cardiologist.

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Tricuspid regurgitation

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: causes

Most often, the development of tricuspid valve regurgitation occurs against the background of heart disease, occurring with dilatation of the right ventricle and pulmonary hypertension. Much less frequently, this disease occurs against the background of septic endocarditis, rheumatism, carcinoid syndrome, and Marfan syndrome. Tricuspid valve insufficiency can be a congenital pathology or develop as a result of long-term use of certain medications (phentermine, fenfluramine, ergotamine).

Symptoms

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

In severe tricuspid regurgitation, marked swelling of the jugular veins is observed. By placing your hand on the right jugular vein, you can feel it trembling. Significant valve insufficiency can lead to right ventricular dysfunction, atrial flutter or atrial fibrillation, and the formation of heart failure.

Tricuspid regurgitation: diagnosis

It is possible to make the correct diagnosis of tricuspid regurgitation, as well as 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 barely 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.

Additional research methods include ECG and chest x-ray. An electrocardiogram often reveals signs of right ventricular hypertrophy. Radiographs of grade 1 tricuspid regurgitation usually show no changes. 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 extremely rare.

Treatment of tricuspid regurgitation

Mild tricuspid regurgitation is well tolerated by people and does not require treatment. Therapy is usually prescribed for grade 2–4 tricuspid regurgitation. First of all, it is aimed at eliminating the cause that led to the development of tricuspid valve insufficiency (treatment of rheumatism, septic endocarditis, etc.). In addition, complications caused by tricuspid regurgitation - heart failure, arrhythmia - are also treated.

If there is no effect from the conservative treatment, as well as with further progression of valve insufficiency, surgical intervention is indicated - prosthetics, tricuspid valve repair or anuloplasty.

Anuloplasty is usually used in cases where the disease develops due to dilatation (widening) of the valve ring. Tricuspid valve replacement is indicated for valve insufficiency caused by Epstein's disease or carcinoid syndrome. A porcine valve is used for the prosthesis, which can significantly reduce the likelihood of developing thromboembolic complications in the postoperative period. As practice shows, the pig valve functions effectively for more than 10 years, after which it is replaced with a new one.

Video from YouTube on the topic of the article:

The information is generalized and is provided for informational purposes. At the first signs of illness, consult a doctor. Self-medication is dangerous to health!

I hope you don’t seriously think that the decision about the need for heart surgery is made on the Internet based on a two-sentence description. You need an in-person consultation with a cardiologist.

If you have complaints, you should consult with another cardiologist. It is also advisable to take a blood test to rule out anemia.

And if a child has the flu or a sore throat, will you also send him to an orphanage so that there are no problems? Tricuspid regurgitation of the 1st degree does not pose a serious problem, and in most cases it does not require treatment either. The doctor couldn't say such nonsense.

Good afternoon, Tasya555.

Indeed, there is no particular danger, but consultation with a cardiologist is necessary, and periodic examination is also required.

THANK YOU. We are going to see a cardiologist.

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Heart valve regurgitation: symptoms, degrees, diagnosis, treatment

The term “regurgitation” is quite often used by doctors of various specialties - cardiologists, therapists, functional diagnosticians. Many patients have heard it more than once, but have little idea what it means and what it threatens. Should we be afraid of having regurgitation and how to treat it, what consequences to expect and how to identify it? Let's try to find out these and many other questions.

Regurgitation is nothing more than the reverse flow of blood from one chamber of the heart to another. In other words, during contraction of the heart muscle, a certain volume of blood, for various reasons, returns to the cavity of the heart from which it came. Regurgitation is not an independent disease and therefore is not considered a diagnosis, but it characterizes other pathological conditions and changes (heart defects, for example).

Since blood continuously moves from one part of the heart to another, coming from the vessels of the lungs and leaving for the systemic circulation, the term “regurgitation” applies to all four valves on which reverse flow may occur. Depending on the volume of blood that returns, it is customary to distinguish the degrees of regurgitation that determine the clinical manifestations of this phenomenon.

A detailed description of regurgitation, identification of its degrees and detection in a large number of people became possible with the use of ultrasound examination of the heart (echocardiography), although the concept itself has been known for quite a long time. Listening to the heart provides subjective information, and therefore does not allow one to judge the severity of the return of blood, while the presence of regurgitation is not in doubt except in severe cases. The use of ultrasound with Doppler makes it possible to see in real time the contractions of the heart, how the valve flaps move and where the blood stream rushes.

Briefly about anatomy...

In order to better understand the essence of regurgitation, it is necessary to recall some aspects of the structure of the heart, which most of us conveniently forgot, having once studied in biology lessons at school.

The heart is a hollow muscular organ with four chambers (two atria and two ventricles). Between the chambers of the heart and the vascular bed there are valves that function as “gates”, allowing blood to pass in only one direction. This mechanism ensures adequate blood flow from one circle to another due to the rhythmic contraction of the heart muscle, which pushes blood inside the heart and into the vessels.

The mitral valve is located between the left atrium and the ventricle and consists of two leaflets. Since the left half of the heart is the most functionally burdened, works under heavy load and under high pressure, it is often here that various malfunctions and pathological changes occur, and the mitral valve is often involved in this process.

The tricuspid, or tricuspid, valve lies on the path from the right atrium to the right ventricle. It is already clear from its name that anatomically it consists of three interlocking valves. Most often, its damage is secondary in nature to an existing pathology of the left side of the heart.

The valves of the pulmonary artery and aorta each have three valves and are located at the junction of these vessels with the cavities of the heart. The aortic valve is located on the path of blood flow from the left ventricle to the aorta, and the pulmonary artery - from the right ventricle to the pulmonary trunk.

In the normal state of the valve apparatus and myocardium, at the moment of contraction of one or another cavity, the valve leaflets close tightly, preventing the reverse flow of blood. With various heart lesions, this mechanism may be disrupted.

Sometimes in the literature and in doctors’ reports you can find references to the so-called physiological regurgation, which means a slight change in blood flow at the valve leaflets. In fact, in this case, a “swirl” of blood occurs at the valve opening, and the leaflets and myocardium are completely healthy. This change does not affect blood circulation in general and does not cause clinical manifestations.

Physiological can be considered 0-1 degree regurgitation on the tricuspid valve, at the mitral valve leaflets, which is often diagnosed in thin, tall people, and according to some data, is present in 70% of healthy people. This feature of blood flow in the heart does not in any way affect your well-being and can be detected by chance during an examination for other diseases.

As a rule, pathological reverse blood flow through the valves occurs when their valves do not close tightly at the moment of myocardial contraction. The reasons may be not only damage to the leaflets themselves, but also to the papillary muscles, chordae tendineae involved in the mechanism of valve movement, stretching of the valve ring, and pathology of the myocardium itself.

Mitral regurgitation

Mitral regurgitation is clearly observed with valve insufficiency or prolapse. At the moment of contraction of the left ventricular muscle, a certain volume of blood returns to the left atrium through an insufficiently closed mitral valve (MV). At the same moment, the left atrium fills with blood flowing from the lungs through the pulmonary veins. This flooding of the atrium with excess blood leads to overdistension and increased pressure (volume overload). Excess blood during contraction of the atria enters the left ventricle, which is forced to push more blood into the aorta with greater force, as a result of which it thickens and then expands (dilatation).

For some time, disturbances in intracardiac hemodynamics may remain invisible to the patient, since the heart, as best it can, compensates for blood flow due to the expansion and hypertrophy of its cavities.

With mitral regurgitation of the 1st degree, there are no clinical signs for many years, and with a significant volume of blood returning to the atrium, it expands, the pulmonary veins become filled with excess blood and signs of pulmonary hypertension appear.

Among the causes of mitral regurgitation, which is the second most common acquired heart defect after changes in the aortic valve, we can highlight:

Rheumatism;
Prolapse;
Atherosclerosis, deposition of calcium salts on the valves of the mitral valve;
Some connective tissue diseases, autoimmune processes, metabolic disorders (Marfan syndrome, rheumatoid arthritis, amyloidosis);
Coronary heart disease (especially infarction with damage to the papillary muscles and chordae tendineae).

With mitral regurgitation of the 1st degree, the only sign may be the presence of a murmur in the area of the apex of the heart, detected by auscultation, while the patient has no complaints, and there are no manifestations of circulatory disorders. Echocardiography (ultrasound) can detect slight divergence of the leaflets with minimal disruption of blood flow.

Mitral valve regurgitation of the 2nd degree accompanies a more pronounced degree of insufficiency, and the stream of blood returning back to the atrium reaches its middle. If the amount of blood return exceeds a quarter of the total amount located in the cavity of the left ventricle, then signs of stagnation in the small circle and characteristic symptoms are detected.

The third degree of regurgitation is said to occur when, in the case of significant defects of the mitral valve, the blood flowing back reaches the posterior wall of the left atrium.

When the myocardium cannot cope with the excess volume of contents in the cavities, pulmonary hypertension develops, leading, in turn, to overload of the right half of the heart, resulting in circulatory failure in the systemic circle.

With grade 4 regurgitation, characteristic symptoms of severe disturbances in blood flow inside the heart and increased pressure in the pulmonary circulation are shortness of breath, arrhythmias, and the possible occurrence of cardiac asthma and even pulmonary edema. In advanced cases of heart failure, signs of damage to the pulmonary bloodstream include swelling, cyanosis of the skin, weakness, fatigue, a tendency to arrhythmias (atrial fibrillation), and pain in the heart. In many ways, the manifestations of severe mitral regurgitation are determined by the disease that led to damage to the valve or myocardium.

Separately, it is worth mentioning about mitral valve prolapse (MVP), quite often accompanied by regurgitation of varying degrees. In recent years, prolapse has begun to appear in diagnoses, although previously such a concept was quite rare. This state of affairs is largely due to the advent of imaging methods - ultrasound examination of the heart, which makes it possible to trace the movement of the valves of the MV during cardiac contractions. With the use of Doppler, it became possible to determine the exact degree of blood return to the left atrium.

MVP is typical for tall, thin people; it is often discovered accidentally in adolescents during examination before conscription into the army or undergoing other medical examinations. Most often, this phenomenon is not accompanied by any disturbances and does not in any way affect the lifestyle and well-being, so you should not be alarmed right away.

Mitral valve prolapse with regurgitation is not always detected; its degree in most cases is limited to the first or even zero, but at the same time, this feature of the functioning of the heart can be accompanied by extrasystole and disturbances in the conduction of nerve impulses through the myocardium.

If low-grade MVP is detected, you can limit yourself to observation by a cardiologist, and treatment is not required at all.

Aortic regurgitation

Reverse blood flow on the aortic valve occurs when it is insufficient or the initial part of the aorta is damaged, when, in the presence of an inflammatory process, its lumen and the diameter of the valve ring expand. The most common reasons for such changes are:

Rheumatic lesions;
Infectious endocarditis with inflammation of the leaflets, perforation;
Congenital malformations;
Inflammatory processes of the ascending aorta (syphilis, aortitis with rheumatoid arthritis, ankylosing spondylitis, etc.).

Such common and well-known diseases as arterial hypertension and atherosclerosis can also lead to changes in the valve leaflets, aorta, and left ventricle of the heart.

Aortic regurgitation is accompanied by the return of blood to the left ventricle, which becomes overfilled with excess volume, while the amount of blood entering the aorta and further into the systemic circulation may decrease. The heart, trying to compensate for the lack of blood flow and pushing excess blood into the aorta, increases in volume. For a long time, especially with stage 1 regurgitation, such an adaptive mechanism allows maintaining normal hemodynamics, and symptoms of disorders do not occur for many years.

As the mass of the left ventricle increases, its need for oxygen and nutrients, which the coronary arteries are unable to provide, also increases. In addition, the amount of arterial blood pushed into the aorta becomes less and less, and, therefore, it will not flow enough into the vessels of the heart. All this creates the preconditions for hypoxia and ischemia, resulting in cardiosclerosis (overgrowth of connective tissue).

As aortic regurgitation progresses, the load on the left half of the heart reaches its maximum degree, the myocardial wall cannot hypertrophy indefinitely and it stretches. Subsequently, events develop in the same way as with damage to the mitral valve (pulmonary hypertension, congestion in the small and large circles, heart failure).

Patients may complain of palpitations, shortness of breath, weakness, and pallor. A characteristic feature of this defect is the appearance of angina attacks associated with inadequacy of coronary circulation.

Tricuspid regurgitation

Isolated lesions of the tricuspid valve (TC) are quite rare. As a rule, its insufficiency with regurgitation is a consequence of pronounced changes in the left half of the heart (relative TC insufficiency), when high pressure in the pulmonary circulation prevents adequate cardiac output into the pulmonary artery, which carries blood for oxygenation into the lungs.

Tricuspid regurgitation leads to disruption of complete emptying of the right half of the heart, adequate venous return through the vena cava and, accordingly, congestion appears in the venous part of the systemic circulation.

For tricuspid valve insufficiency with regurgitation, the occurrence of atrial fibrillation, cyanosis of the skin, edematous syndrome, swelling of the neck veins, enlarged liver and other signs of chronic circulatory failure are quite typical.

Pulmonary valve regurgitation

Damage to the pulmonary valve leaflets can be congenital, manifesting itself in childhood, or acquired as a result of atherosclerosis, syphilitic lesions, or changes in the leaflets due to septic endocarditis. Often, damage to the pulmonary valve with insufficiency and regurgitation occurs with existing pulmonary hypertension, lung diseases, and damage to other heart valves (mitral stenosis).

Minimal regurgitation on the pulmonary valve does not lead to significant hemodynamic disorders, while a significant return of blood to the right ventricle, and then to the atrium, causes hypertrophy and subsequent dilatation (expansion) of the cavities of the right half of the heart. Such changes are manifested by severe heart failure in the systemic circle and venous stagnation.

Pulmonary regurgitation is manifested by all kinds of arrhythmias, shortness of breath, cyanosis, severe edema, accumulation of fluid in the abdominal cavity, changes in the liver up to cirrhosis and other signs. With congenital valve pathology, symptoms of circulatory disorders occur already in early childhood and are often irreversible and severe.

Features of regurgitation in children

In childhood, the proper development and functioning of the heart and circulatory system is very important, but disorders, unfortunately, are not uncommon. Most often, valve defects with insufficiency and return of blood in children are caused by congenital developmental anomalies (tetralogy of Fallot, hypoplasia of the pulmonary valve, defects of the septa between the atria and ventricles, etc.).

Severe regurgitation with an abnormal structure of the heart manifests itself almost immediately after the birth of a child with symptoms of respiratory distress, cyanosis, and right ventricular failure. Often, significant violations end fatally, so every expectant mother needs to not only take care of her health before the intended pregnancy, but also promptly visit an ultrasound diagnostic specialist during pregnancy.

Possibilities of modern diagnostics

Medicine does not stand still, and the diagnosis of diseases is becoming more reliable and of high quality. The use of ultrasound has made significant progress in detecting a number of diseases. The addition of ultrasound examination of the heart (EchoCG) with Dopplerography makes it possible to assess the nature of blood flow through the vessels and cavities of the heart, the movement of valve leaflets at the time of myocardial contractions, establish the degree of regurgitation, etc. Perhaps EchoCG is the most reliable and informative method for diagnosing cardiac pathology in the mode real time and at the same time being accessible and inexpensive.

mitral regurgitation on echocardiography

In addition to ultrasound, indirect signs of regurgitation can be detected on an ECG, with careful auscultation of the heart and assessment of symptoms.

It is extremely important to identify disorders of the heart valve apparatus with regurgitation not only in adults, but also during fetal development. The practice of ultrasound examination of pregnant women at different stages makes it possible to detect the presence of defects that are beyond doubt even during the initial examination, as well as to diagnose regurgitation, which is an indirect sign of possible chromosomal abnormalities or developing valve defects. Dynamic observation of women at risk makes it possible to timely establish the presence of serious pathology in the fetus and resolve the issue of the advisability of continuing pregnancy.

Treatment

The treatment tactics for regurgitation are determined by the cause that caused it, the degree of severity, the presence of heart failure and concomitant pathology.

Both surgical correction of structural abnormalities of the valves (various types of plastic surgery, prosthetics) and medical conservative therapy aimed at normalizing blood flow in the organs, combating arrhythmia and circulatory failure are possible. Most patients with severe regurgitation and damage to both circulation circles require constant monitoring by a cardiologist, the prescription of diuretics, beta-blockers, antihypertensive and antiarrhythmic drugs, which will be selected by a specialist.

In case of low-grade mitral prolapse or prevalvular regurgitation of another localization, dynamic observation by a doctor and timely examination in case of worsening of the condition are sufficient.

The prognosis of valvular regurgitation depends on many factors: its degree, cause, age of the patient, the presence of diseases of other organs, etc. With a caring attitude towards your health and regular visits to the doctor, minor regurgitation does not threaten complications, and with pronounced changes, their correction, including including surgical, allows you to prolong the life of patients.

Tricuspid regurgitation (tricuspid valve insufficiency) is a heart defect in which blood flows back in systole through the tricuspid valve from the right ventricle into the cavity of the right atrium.

How does tricuspid valve regurgitation occur?

The tricuspid or tricuspid valve is located between the right atrium and the right ventricle; during diastole, its valves open, allowing venous blood to pass from the right atrium into the ventricle. During systole (contraction), the valve leaflets close tightly, and the blood entering the right ventricle enters the pulmonary artery and then into the lungs. When the tricuspid valve regurgitates, the blood from the right ventricle does not completely enter the pulmonary artery, but partially returns to the right atrium, and a reverse reflux of blood occurs - regurgitation. This occurs due to dysfunction of the tricuspid valve - when its valves do not close tightly, the entrance to the right atrium does not completely close. With tricuspid regurgitation, due to increased load, the atrium hypertrophies, and then the muscles stretch and increase in size. In turn, this leads to the entry of a large amount of blood from the atrium into the right ventricle during diastole, its further hypertrophy and dysfunction, which provokes stagnation in the systemic circulation.

Causes and types of tricuspid regurgitation

There are several types of tricuspid valve insufficiency:

Absolute or organic failure. The pathology is caused by damage to the valve leaflets, such as valve prolapse (sagging leaflets), due to a congenital disease - connective tissue dysplasia, also causes include rheumatism, infective endocarditis, carcinoid syndrome and others;
Relative or functional deficiency. Occurs when the valve is stretched due to resistance to the outflow of blood from the right ventricle, with pronounced dilatation of the ventricular cavity caused by high pulmonary hypertension or diffuse myocardial damage.

Based on the severity of reverse blood flow, tricuspid regurgitation is divided into four degrees:

1st degree. Barely detectable backflow of blood;
2nd degree. Regurgitation is determined at a distance of 2 cm from the tricuspid valve;
3rd degree. Reverse flow of blood from the right ventricle is detected at a distance of more than 2 cm from the valve;
4th degree. Regurgitation is characterized by a large extent in the cavity of the right atrium.

The severity of blood return is determined using echocardiographic examination.

Description of grade 1 tricuspid regurgitation

With regurgitation of the 1st degree, as a rule, the symptoms of the disease do not manifest themselves, and it can only be detected accidentally during electrocardiography. In most cases, grade 1 tricuspid regurgitation does not require treatment and can be considered normal. If the development of the disease is provoked by rheumatic defects, pulmonary hypertension or other diseases, it is necessary to treat the underlying disease that caused a minor defect in the tricuspid valve leaflets.

In children, this degree of regurgitation is considered an anatomical feature that may even disappear over time - without the presence of other cardiac pathologies, it usually does not affect the development and general condition of the child.

Symptoms of tricuspid regurgitation

With grade 2 tricuspid regurgitation, as with other degrees, the disease often occurs without obvious symptoms. In severe cases of the disease, the following manifestations are possible:

Weakness, fatigue;
Increased venous pressure, leading to swelling of the veins of the neck and their pulsation;
Enlarged liver with characteristic pain in the right hypochondrium;
Heart rhythm disturbances;
Edema of the lower extremities.

Auscultation (listening) reveals a characteristic systolic murmur, best heard in the 5th–7th intercostal space from the left edge of the sternum, intensifying with inspiration, quiet and inconsistent. With enlargement of the right ventricle and a large volume of blood entering it during diastole, a systolic murmur is also heard over the right jugular vein.

Diagnosis of tricuspid regurgitation

To diagnose tricuspid regurgitation, in addition to the history, physical examination and auscultation, the following studies are performed:

ECG. The dimensions of the right ventricle and atrium, heart rhythm disturbances are determined;
Phonocardiogram. The presence of systolic murmur is detected;
Ultrasound of the heart. Signs of compaction of the valve walls, the area of the atrioventricular orifice, and the degree of regurgitation are determined;
Chest X-ray. The location of the heart and its size, signs of pulmonary hypertension are revealed;
Catheterization of the heart cavities. The method is based on the introduction of catheters to determine the pressure in the cavities of the heart.

In addition, coronary angiocardiography can be used before surgery. It is based on the introduction of a contrast agent into the vessels and cavities of the heart to assess the movement of blood flow.

Treatment of tricuspid regurgitation

Treatment of the defect can be carried out conservatively or surgically. The surgical method may be indicated already for grade 2 tricuspid regurgitation, if it is accompanied by heart failure or other pathologies. With functional tricuspid regurgitation, the disease that caused the lesion is treated first.

During drug therapy, the following are prescribed: diuretics, vasodilators (drugs that relax the smooth muscles of the walls of blood vessels), potassium preparations, cardiac glycosides. If conservative treatment is ineffective, surgical intervention is prescribed, including plastic surgery or annuloplasty and prosthetics. Plastic surgeries, suture and semicircular annuloplasty are performed in the absence of changes in the valve leaflets and expansion of the fibrous ring to which they are attached. Prosthetics are indicated for tricuspid valve insufficiency and extremely severe changes in its valves; prostheses can be biological or mechanical. Biological prostheses created from animal aortas can function for more than 10 years, then the old valve is replaced with a new one.

With timely treatment of tricuspid regurgitation, the prognosis is favorable. After it is performed, patients must be regularly monitored by a cardiologist and undergo examinations to prevent complications.

His whole life depends on how healthy a person’s heart is. Among a number of cardiac diseases, there is tricuspid regurgitation, because of which sometimes people are not even accepted into the army. This means that a person is already limited in his life activities.

Key symptoms of regurgitation

Regurgitation of the tricuspid valve (i.e., tricuspid) refers to heart defects and is manifested by a number of symptoms that can be expressed as single signs or act as a whole complex. It all depends on the extent of the problem:

The patient quickly gets tired, he experiences shortness of breath and chilliness in the extremities.
An increased heartbeat occurs, and an unpleasant pulsation can be traced in the left sternum (especially on inhalation).
It can also be observed in the liver area, as well as in the neck - in the jugular vein.
The patient often complains of discomfort in the right hypochondrium, painful cramps in the abdomen and a frequent urge to urinate.
Yellowness of the skin can also be called a characteristic sign.

Along with subjective signs of the development of regurgitation, there are also clinical signs that the doctor can identify during examination. These include:

pulmonary hypertension,
abdominal dropsy,
enlargement of the liver, right ventricle and atrium, as well as a number of other defects.

In part, a person may not always know about problems that have arisen in the heart. In the first stages, the disease even goes away without obvious symptoms. And if any of the described symptoms suddenly appear, you should immediately consult a doctor for an examination, during which tests are taken and hardware diagnostics are performed.

Regurgitation can become an acquired disease, but sometimes there are congenital cases. Changes in the heart occur during the intrauterine development phase of the fetus.

This deviation from the norm appears in infants immediately after birth:

In a newborn, pronounced cyanosis can be observed.
There are breathing disorders.
Examination reveals right ventricular failure.

The disease is so serious that it can lead to the death of a child. This is why it is so important to examine the fetus before birth.

Possible causes of tricuspid pathology

The heart is a complex structure. And among other components, 4 valves can be distinguished - pulmonary, aortic, mitral and tricuspid. Their responsibilities include ensuring the one-way movement of blood through the vessels. When something like this access system“fails, and pathologies arise.

The tricuspid valve stands between the ventricle and the right atrium. The heartbeat is a complex of muscle contractions and relaxations. The valve closes when a moment of muscle contraction occurs, thereby pushing venous blood into the pulmonary artery. In this case, the path for the return flow of blood into the atrium is blocked. But this is how a healthy heart works.

At some point, the valve simply stops closing completely, and some of the blood may flow “backwards”. This is regurgitation.

The degrees of the disease are distinguished based on how large the stream goes into the outflow:

I degree – barely perceptible traces of blood;
at stage II, the jet already has a width of up to 2 cm;
at III – the flow exceeds 2 cm;
grade IV is the most severe, the atrium is abundantly filled with return blood.

Heart failure develops against the background of many factors that lead to expansion of the right ventricle (which makes the valve unable to completely close it):

chronic diseases leading to narrowing of the airways in which mucus accumulates;
the formation of a carcinoid (tumor) in the body, which releases excess hormones into the blood;
various heart failures;
rheumatic fevers;
infective endocarditis (especially develops in drug addicts).

The main reason that influenced the development of the defect will be determined by a cardiologist after an extensive examination.

How to get rid of the disease

Tricuspid regurgitation in the initial stages is easily tolerated by patients, without affecting their professional activities. Sometimes even with such a diagnosis they are taken to serve in the army. But this is all individual.

Right-sided outflow is considered a more harmless abnormality compared to left-sided regurgitation, which is sometimes fatal.

Drug therapy

When treating tricuspid outflow of blood, the degrees of the disease and their symptoms are taken into account:

Grade 1 tricuspid valve regurgitation does not require special intervention and is often considered normal. So with this form they are often recruited for service. If the provocateur was another disease, then drug therapy will be aimed at curing it.
Grade 2 tricuspid valve regurgitation requires intervention only when serious development of cardiac pathologies is observed. In this situation, the patient is prescribed diuretics and drugs that help relax the muscles in the walls of blood vessels.
With tricuspid outflow of the 3rd and 4th degrees, surgical intervention cannot be avoided:

a) plastic surgery involves suturing the valve and reducing the number of leaflets;

b) annuloplasty is the introduction of a support ring on the valve, which allows you to restore working functions;

c) prosthetics – complete replacement (used in the most extreme cases).

If at stages 1 and 2 they still take young people to serve in some branches of the military, then at the 2 subsequent stages they take patients only for dispensary registration.

ethnoscience

Not a single human disease can be treated without folk remedies. So, for tricuspid regurgitation, you can use grandmothers’ recipes as an addition to the main treatment (but not as an alternative to it):

It is recommended to prepare a rosemary tincture. For 50 g of dried leaves take 1 liter of red wine (dry). The tincture is kept in a dark place for 50-60 days. Take 2 tbsp before meals.
Herbal decoction is very useful. They make a collection of thorn, heather and hawthorn flowers. Take 1 tbsp per glass of boiling water. collection and steamed for 15 minutes in a water bath. After straining the decoction, it is drunk throughout the day in 2-3 doses. This drink should not be prepared in advance; it is better to prepare a fresh decoction every day.
Dry mint is brewed like tea, infused for about an hour, and taken three times a day, half a glass.

You can also use lemon balm, oregano, thyme, chamomile, motherwort, etc. in treatment. both individually and in combination with each other.

Prevention of further development of the disease

The main prevention of the development of tricuspid regurgitation comes down to the treatment of diseases that lead to heart pathology. This is especially true for rheumatoid manifestations.

It is necessary to lead a healthy lifestyle, giving up bad habits (smoking, alcoholism, drugs). Proper nutrition also plays an important role, which does not load the heart with cholesterol. It is also worth thinking about therapeutic exercises - physical activity (of an optimal nature) promotes muscle elasticity.

Regurgitation is nothing more than reverse flow of blood from one chamber of the heart to another. In other words, during contraction of the heart muscle, a certain volume of blood, for various reasons, returns to the cavity of the heart from which it came. Regurgitation is not an independent disease and therefore is not considered a diagnosis, but it characterizes other pathological conditions and changes (for example).

A detailed description of regurgitation, identification of its degrees and detection in a large number of people became possible with the use of ultrasound examination of the heart (echocardiography), although the concept itself has been known for quite a long time. Listening to the heart provides subjective information, and therefore does not allow one to judge the severity of the return of blood, while the presence of regurgitation is not in doubt except in severe cases. The use of ultrasound with Doppler makes it possible to see in real time the contractions of the heart, how the valve flaps move and where the blood stream rushes.

Briefly about anatomy...

The mitral valve is located between the left atrium and ventricle and consists of two doors. Since the left half of the heart is the most functionally burdened, works under heavy load and under high pressure, it is often here that various malfunctions and pathological changes occur, and the mitral valve is often involved in this process.

The tricuspid, or tricuspid, valve lies on the path from the right atrium to the right ventricle. It is already clear from its name that anatomically it consists of three interlocking valves. Most often, its damage is secondary in nature to an existing pathology of the left side of the heart.

In the normal state of the valve apparatus and myocardium, at the moment of contraction of one or another cavity, the valve leaflets close tightly, preventing the reverse flow of blood. With various heart lesions, this mechanism may be disrupted.

Physiological can be considered regurgitation of 0-1 degree on the tricuspid valve, at the mitral valves, which is often diagnosed in thin, tall people, and according to some data is present in 70% of healthy people. This feature of blood flow in the heart does not in any way affect your well-being and can be detected by chance during an examination for other diseases.

As a rule, pathological reverse blood flow through the valves occurs when their valves do not close tightly at the moment of myocardial contraction. The reasons may be not only damage to the leaflets themselves, but also to the papillary muscles, chordae tendineae involved in the mechanism of valve movement, stretching of the valve ring, and pathology of the myocardium itself.

Mitral regurgitation

Mitral regurgitation is clearly observed with or. At the moment of contraction of the left ventricular muscle, a certain volume of blood returns to the left atrium through an insufficiently closed mitral valve (MV). At the same moment, the left atrium fills with blood flowing from the lungs through the pulmonary veins. This flooding of the atrium with excess blood leads to overdistension and increased pressure (volume overload). Excess blood during contraction of the atria penetrates into the left ventricle, which is forced to push more blood into the aorta with greater force, as a result of which it thickens and then expands ().

For some time, disturbances in intracardiac hemodynamics may remain invisible to the patient, since the heart compensates for blood flow as best it can by expanding its cavities.

With mitral regurgitation of the 1st degree, there are no clinical signs for many years, and with a significant volume of blood returning to the atrium, it expands, the pulmonary veins become overfilled with excess blood and signs appear.

Among the causes of mitral regurgitation, which is the second most common acquired heart defect after changes in the aortic valve, we can highlight:

Prolapse;
, on the valves of the MK;
Some connective tissue diseases, autoimmune processes, metabolic disorders (Marfan syndrome, rheumatoid arthritis, amyloidosis);
(especially with damage to the papillary muscles and chordae tendineae).

Grade 2 mitral valve regurgitation accompanies a more severe degree of regurgitation, and the stream of blood returning back to the atrium reaches its middle. If the amount of blood return exceeds a quarter of the total amount located in the cavity of the left ventricle, then signs of stagnation in the small circle and characteristic symptoms are detected.

The third degree of regurgitation is said to occur when, in the case of significant defects of the mitral valve, the blood flowing back reaches the posterior wall of the left atrium.

With grade 4 regurgitation, characteristic symptoms of severe disturbances in blood flow inside the heart and increased pressure in the pulmonary circulation are shortness of breath, arrhythmias, and the possible occurrence of cardiac asthma and even pulmonary edema. In advanced cases, signs of damage to the pulmonary bloodstream include swelling, cyanosis of the skin, weakness, fatigue, a tendency to (atrial fibrillation), and pain in the heart. In many ways, the manifestations of severe mitral regurgitation are determined by the disease that led to damage to the valve or myocardium.

Separately, it is worth mentioning about mitral valve prolapse (MVP), quite often accompanied by varying degrees of regurgitation. In recent years, prolapse has begun to appear in diagnoses, although previously such a concept was quite rare. This state of affairs is largely due to the advent of imaging methods - ultrasound examination of the heart, which makes it possible to trace the movement of the valves of the MV during cardiac contractions. With the use of Doppler, it became possible to determine the exact degree of blood return to the left atrium.

If low-grade MVP is detected, you can limit yourself to observation by a cardiologist, and treatment is not required at all.

Aortic regurgitation

Rheumatic lesions;
Infectious with inflammation of the valves, perforation;
Congenital malformations;
Inflammatory processes of the ascending aorta (syphilis, rheumatoid arthritis, ankylosing spondylitis, etc.).

Such common and well-known diseases as atherosclerosis can also lead to changes in the valve leaflets, aorta, and left ventricle of the heart.

Aortic regurgitation is accompanied by the return of blood to the left ventricle, which becomes overfilled with excess volume, while the amount of blood flowing into the aorta and further into the systemic circulation may decrease. The heart, trying to compensate for the lack of blood flow and pushing excess blood into the aorta, increases in volume. For a long time, especially with stage 1 regurgitation, such an adaptive mechanism allows maintaining normal hemodynamics, and symptoms of disorders do not occur for many years.

Tricuspid regurgitation

Tricuspid regurgitation leads to a violation of complete emptying of the right side of the heart, adequate venous return through the vena cava and, accordingly, a systemic circulation appears.

Pulmonary valve regurgitation

Minimal regurgitation on the pulmonary valve does not lead to significant hemodynamic disorders, while significant return of blood to the right ventricle and then to the atrium, causing hypertrophy and subsequent dilatation(expansion) of the cavities of the right half of the heart. Such changes are manifested by severe heart failure in the systemic circle and venous stagnation.

Pulmonary regurgitation is manifested by all kinds of arrhythmias, shortness of breath, severe edema, accumulation of fluid in the abdominal cavity, changes in the liver up to cirrhosis and other signs. With congenital valve pathology, symptoms of circulatory disorders occur already in early childhood and are often irreversible and severe.

Features of regurgitation in children

In childhood, the proper development and functioning of the heart and circulatory system is very important, but disorders, unfortunately, are not uncommon. Most often, valve defects with insufficiency and blood return in children are caused by congenital developmental anomalies (hypoplasia of the pulmonary valve, defects of the septa between the atria and ventricles, etc.).

Possibilities of modern diagnostics

Medicine does not stand still, and the diagnosis of diseases is becoming more reliable and of high quality. The use of ultrasound has made significant progress in detecting a number of diseases. The addition of ultrasound examination of the heart (EchoCG) with Dopplerography makes it possible to assess the nature of blood flow through the vessels and cavities of the heart, the movement of valve leaflets at the time of myocardial contractions, establish the degree of regurgitation, etc. Perhaps this is the most reliable and informative method for diagnosing cardiac pathology in real time time and at the same time being accessible and inexpensive.

In addition to ultrasound, indirect signs of regurgitation can be detected by careful auscultation of the heart and assessment of symptoms.

Treatment

The treatment tactics for regurgitation are determined by the cause that caused it, the degree of severity, the presence of heart failure and concomitant pathology.

Both surgical correction of structural abnormalities of the valves (various types) and medical conservative therapy aimed at normalizing blood flow in the organs, combating arrhythmia and circulatory failure are possible. Most patients with severe regurgitation and damage to both circulation circles require constant monitoring by a cardiologist, the prescription of diuretics, beta-blockers, antihypertensive and antiarrhythmic drugs, which will be selected by a specialist.

In case of low-grade mitral prolapse or prevalvular regurgitation of another localization, dynamic observation by a doctor and timely examination in case of worsening of the condition are sufficient.

Tricuspid regurgitation: causes

Symptoms

Tricuspid regurgitation: diagnosis

Cardiac catheterization as a diagnostic method for tricuspid valve regurgitation is extremely rare.

Treatment of tricuspid regurgitation

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