Pathology of tricuspid valve stenosis and pure tricuspid regurgitation—part III

Abstract

Summary: This three-part article examines the histologic and morphologic basis for stenotic and purely regurgitant tricuspid valves. In Part III, morphometric analysis of tricuspid valve annular circumference, leaflet area, and the product of annular circumference and leaflet area are shown to be useful in establishing etiology for the purely regurgitant tricuspid valves and in assessing the anatomic basis of pure tricuspid regurgitation in the presence of mitral stenosis.

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…When normal tricuspid valves develop dysfunction, the resulting hemodynamic abnormality is almost always pure regurgitation. This occurs with elevation of RV systolic and/or diastolic pressure, RV cavity enlargement, and tricuspid annular dilatation 662,663 ; RV systolic hypertension occurs in MS, pulmonic valve stenosis, and the various causes of pulmonary hypertension. RV diastolic hypertension occurs in dilated cardiomyopathy, RV infarction, and RV failure of any cause.…”

“…RV diastolic hypertension occurs in dilated cardiomyopathy, RV infarction, and RV failure of any cause. 662,663 Pacemaker-induced severe TR is rare but may require intervention.…”

“…Abnormalities of the tricuspid valve leading to TR can occur with rheumatic valvulitis, infective endocarditis, carcinoid, rheumatoid arthritis, radiation therapy, trauma (such as repeated endomyocardial biopsies), Marfan syndrome, tricuspid valve prolapse, tricuspid annular dilatation, or congenital disorders such as Ebstein's anomaly 663 or a cleft tricuspid valve as part of atrioventricular canal malformations. Anorectic drugs may also cause TR (see Section 3.9).…”

Proporção entre os segmentos do anel da valva tricúspide normal: um parâmetro para realização da anuloplastia valvar

“…It is known that tricuspid insufficiency is normally caused by dilation of valvar ring, that is, functional tricuspid insufficiency [4,12]. This valve disease is frequently related to valvar diseases involving the mitral or aortic valves.…”

“…Functional tricuspid insufficiency is characterized by dilatation of the valvar annulus due to pulmonary hypertension caused by valve diseases on the left [4]. Among patients with severe stenosis or mitral valve insufficiency, from 10% to 50% have tricuspid insufficiency [5].…”