関: tricuspid insufficiency、tricuspid regurgitation、tricuspid valve incompetence、tricuspid valve insufficiency、tricuspid valve regurgitation

WordNet

inability of a part or organ to function properly
lack of physical or intellectual ability or qualifications (同)incompetency
having three cusps or points (especially a molar tooth); "tricuspid molar"; "tricuspid valve" (同)tricuspidate

PrepTutorEJDIC

無能,無力;不適当,無答格
(歯が)三尖の / (歯の)三尖頭

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/06 21:22:17」(JST)

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Tricuspid insufficiency (TI), a valvular heart disease also called tricuspid regurgitation (TR), refers to the failure of the heart's tricuspid valve to close properly during systole. As a result, with each heart beat some blood passes from the right ventricle to the right atrium, the opposite of the normal direction. Tricuspid regurgitation occurs in roughly less than 1% of people and is usually asymptomatic, but may also be a feature of pulmonary hypertension and right-sided heart failure.

Signs and symptoms

Tricuspid insufficiency may be asymptomatic, especially if right ventricular function is well preserved. Signs and symptoms are generally those of right-sided heart failure, such as ascites, an enlarged liver, edema and jugular venous distension.^[1] Vague upper abdominal discomfort (from a congested liver), and fatigue (due to diminished cardiac output) can all be present to some degree.

On examination, the jugular venous pressure is usually elevated, and 'CV' waves can be seen. It features prominent V waves and rapid y descents in jugular venous pressure^[1] Peripheral edema is often found. Examination of the abdomen may reveal a pulsatile liver, a finding which is essentially diagnostic of tricuspid insufficiency. In severe cases, there may be ascites and even cirrhosis (so-called 'cardiac cirrhosis').

Tricuspid insufficiency may lead to the presence of a pansystolic heart murmur.^[1] Such a murmur is usually of low frequency and best heard low on the lower left sternal border. It tends to increase with inspiration, and decrease with expiration and Valsalva maneuver.^[1] However, the murmur may be inaudible reflecting the relatively low pressures in the right side of the heart. A third heart sound may also be present, also heard best with inspiration at the left lower sternal border.^[1] Parasternal heave may be felt along the left lower sternal border as well, although it is not specific for the presence of tricuspid insufficiency.^[1]

Atrial fibrillation is usually present.^[1]

Causes

Although congenital causes of tricuspid insufficiency exist, most cases are due to dilation of the right ventricle.^[1] Such dilation leads to derangement of the normal anatomy and mechanics of the tricuspid valve and the muscles governing its proper function. The result is incompetence of the tricuspid valve. Left ventricular failure is, in turn, the most common cause of right ventricular dilation.^[1] Other common causes of right ventricular dilation include right ventricular infarction,^[1] inferior myocardial infarction^[1] and cor pulmonale.^[1]

Other diseases can directly affect the tricuspid valve. The most common of these is rheumatic fever, which is a complication of untreated strep throat infections. It is usually accompanied by mitral and aortic valvular disease.^[1] Another condition directly harming the valve is tricuspid endocarditis.^[1]

It may be found in those with a type of congenital heart disease called Ebstein's anomaly.^[1]

Other infrequent causes of tricuspid regurgitation include:

Carcinoid tumors, which release a hormone which damages the valve^[1]
Connective tissue diseases such as Marfan syndrome^[1]
Systemic lupus erythematosus^[1]
Myxomatous degeneration^[1]
Injury
Rheumatoid arthritis
Radiation therapy

Another important risk factor for tricuspid regurgitation is use of the diet medications called "Fen-Phen" (phentermine and fenfluramine) or dexfenfluramine

Diagnosis

Diagnosis is usually made by echocardiography identifying tricuspid prolapse or flail.^[1] The finding of a pulsatile liver and/or the presence of prominent CV waves in the jugular pulse is also essentially diagnostic.

Electrocardiography assists in the diagnosis, indicating enlargement of right ventricle and atrium.^[1]

Management

Tricuspid insufficiency is managed with treatment of the underlying cause.^[1] In most cases, surgery is not indicated since the root problem lies with a dilated or damaged right ventricle. Medical therapy with diuretics is the mainstay of treatment. Unfortunately, this can lead to volume depletion and decreased cardiac output. Indeed, one must often accept a certain degree of symptomatic tricuspid insufficiency in order to prevent a decrease in cardiac output. Treatment with medicines to reduce cardiac afterload may also be of benefit but a similar risk of depressed cardiac output applies.

Where surgery has to be performed, the following alternatives are available:

- Tricuspid valvular repair^[1]
- Valvuloplasty^[1]
- Valve replacement^[1]

References

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease in: Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6. ^{[page needed]}

External links

http://www.merck.com/mmpe/sec07/ch076/ch076i.html
Tricuspid Regurgitation at eMedicine
MedlinePlus Encyclopedia Tricuspid regurgitation
http://www.heartupdate.com/valvulopathy/tricuspid-valve-insufficiency_272/

UpToDate Contents

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1. リウマチ性心疾患の自然史、スクリーニング、およびマネージメント natural history screening and management of rheumatic heart disease
2. 三尖弁閉鎖不全症のマネージメントおよび予後 management and prognosis of tricuspid regurgitation
3. 三尖弁狭窄 tricuspid stenosis
4. 三尖弁の心エコー評価 echocardiographic evaluation of the tricuspid valve
5. 頚静脈波の検討 examination of the jugular venous pulse

English Journal

[Traumatic tricuspid valve insufficiency with right-to-left shunt : Bridging using extracorporeal venovenous membrane oxygenation.]

Weber SU, Hammerstingl C, Mellert F, Baumgarten G, Putensen C, Knuefermann P.SourceKlinik und Poliklinik fur Anasthesiologie und Operative Intensivmedizin, Universitatsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
Der Anaesthesist.Anaesthesist.2011 Sep 8. [Epub ahead of print]
The case of a young male motor vehicle driver is reported who suffered multiple trauma in a car accident with pulmonary and cardiac contusions. In the course of severe pneumonia and traumatic tricuspid valve insufficiency a right-to-left shunt with refractory hypoxemia developed across a pre-existin
PMID 21901648

Permanent transvenous left ventricular endocardial pacing in a patient with univentricular atrioventricular connection.

Scott PA, Veldtman GR, Yue AM, Morgan JM.SourceWessex Cardiothoracic Unit, Southampton University Hospital, Southampton, UK University of Southampton, Southampton, UK Congenital Cardiac Unit, Southampton University Hospital NHS Trust, Southampton, UK.
Congenital heart disease.Congenit Heart Dis.2011 Sep;6(5):475-8. doi: 10.1111/j.1747-0803.2011.00517.x. Epub 2011 May 5.
Chronotropic incompetence is associated with poorer effort tolerance and worse mortality outcomes, not only in the general cardiac population but also in patients with congenital heart disease. When present in complex patients, pacing options may be limited by difficult pacing access, and an open su
PMID 21545465

Japanese Journal

左房粘液腫により僧帽弁狭窄を呈し腫瘍切除後僧帽弁形成術を要した1例

片山桂次郎,季白雅文,石井修,小林弘典
日本心臓血管外科学会雑誌 37(1), 40-43, 2008-01-15
症例は58歳,女性.3ヵ月前より労作時息切れを自覚し,心エコーで左房腫瘍を指摘された.腫瘍は心房中隔から発生し広基性であった.また,拡張期に左室へ逸脱し,pressure half timeは415msecと上昇しており,計測上の僧帽弁口面積は0.53cm^2であった.重度の三尖弁閉鎖不全(TR)を認め,僧帽弁狭窄(MS)に伴う肺高血圧を呈していた.手術は軽度低体温完全体外循環を確立し,心停止下に …
NAID 110006548685

成人Ebstein奇形に対するHetzer法による手術経験

長濱博幸,福島靖典,福田卓也,早瀬崇洋,吉岡誠
日本心臓血管外科学会雑誌 35(1), 57-59, 2006-01-15
成人Ebstein奇形に合併する三尖弁逆流に対し, Hetzer法による手術症例を経験した.症例は51歳, 男性.主訴は労作時呼吸困難で, 診断はNYHA III度の成人Ebstein奇形である.高度三尖弁逆流と心房化右室を認め, Carpentierの形態分類のType Bであり, さらに前尖には裂隙を認めた.三尖弁形成術はHetzer法にて, プレジェット付き3-0モノフィラメント糸で前尖・後 …
NAID 110004054204

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★リンクテーブル★

リンク元	「三尖弁閉鎖不全症」「tricuspid valve incompetence」「tricuspid valve insufficiency」「tricuspid valve regurgitation」
関連記事	「incompetence」「tricuspid」

「三尖弁閉鎖不全症」

Tricuspid insufficiency
Classification and external resources
Specialty	cardiology
ICD-10	I07.1, I36.1
ICD-9-CM	397.0
DiseasesDB	13348
MedlinePlus	000169
eMedicine	med/2314
MeSH	D014262