WordNet

backflow of blood through a defective heart valve
recall after rote memorization; "he complained that school was just memorization and regurgitation"
having three cusps or points (especially a molar tooth); "tricuspid molar"; "tricuspid valve" (同)tricuspidate

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逆流 / (未消化食物の)吐きもどし,反芻(はんすう) / 血液の逆流
(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）』「2015/06/07 09:30:00」(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. 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.^[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.

External links

http://www.merck.com/mmpe/sec07/ch076/ch076i.html
http://emedicine.medscape.com/article/158484-overview
http://www.nlm.nih.gov/medlineplus/ency/article/000169.htm
http://www.heartupdate.com/valvulopathy/tricuspid-valve-insufficiency_272/

UpToDate Contents

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1. 三尖弁閉鎖不全症の病因、臨床的特徴、および評価 etiology clinical features and evaluation of tricuspid regurgitation
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. 三尖弁の心エコー評価 echocardiographic evaluation of the tricuspid valve
4. 心臓カテーテル検査で測定した弁膜疾患の血行動態 hemodynamics of valvular disorders as measured by cardiac catheterization
5. 心雑音の聴診 auscultation of cardiac murmurs

English Journal

The functional right ventricle and tricuspid regurgitation in Ebstein's anomaly.

Fratz S, Janello C, Müller D, Seligmann M, Meierhofer C, Schuster T, Schreiber C, Martinoff S, Hess J, Kühn A, Vogt M, Stern H.SourceDepartment of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Klinikum an der Technischen Universität München, Munich, Germany. Electronic address: fratz@dhm.mhn.de.
International journal of cardiology.Int J Cardiol.2013 Jul 15;167(1):258-61. doi: 10.1016/j.ijcard.2011.12.081. Epub 2012 Jan 24.
BACKGROUND: The size of the functional right ventricle of patients with Ebstein's anomaly is, according to contemporary opinion, small. However, the in vivo size of the functional right ventricle in patients with Ebstein's anomaly is unknown. Furthermore, it is unknown how the apical displacement an
PMID 22280553

Contemporary management of tricuspid regurgitation: an updated clinical review.

Taylor JT, Chidsey G, Disalvo TG, Byrne JG, Maltais S.SourceFrom the *Division of Cardiovascular Surgery and †Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute, Nashville, TN.
Cardiology in review.Cardiol Rev.2013 Jul-Aug;21(4):174-83. doi: 10.1097/CRD.0b013e3182880751.
Tricuspid regurgitation (TR) is a complex and insidious valvular pathology that represents a complex decision and management algorithm for patients. TR is present in a significant proportion of the population and is especially prevalent in patients with advanced heart failure. Patients with TR have
PMID 23422019

Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging.

Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA, Badano L, Zamorano JL; Scientific Document Committee of the European Association of Cardiovascular Imaging: Thor Edvardsen, Oliver Bruder, Bernard Cosyns, Erwan Donal, Raluca Dulgheru, Maurizio Galderisi, Patrizio Lancellotti, Denisa Muraru, Koen Nieman, Rosa S.SourceDepartment of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Valvular Disease Clinic, CHU Sart Tilman, Liège 4000, Belgium.
European heart journal cardiovascular Imaging.Eur Heart J Cardiovasc Imaging.2013 Jul;14(7):611-44. doi: 10.1093/ehjci/jet105. Epub 2013 Jun 3.
Valvular regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular regurgitation. The echocardiographic assessment of valvular regurgitation should integrate the quantifica
PMID 23733442

Japanese Journal

症例ペースメーカリードによる三尖弁閉鎖不全に対する弁置換術の2例

立石渉,岡田修一,小此木修一 [他]
胸部外科 = The Japanese journal of thoracic surgery 68(2), 109-112, 2015-02
NAID 40020333534

心室中隔欠損閉鎖に用いるパッチ幅を基準化した完全型房室中隔欠損修復術

山内早苗,川田博昭,盤井成光,上仲永純,荒木幹太,萱谷太,稲村昇,岸本英文
日本小児循環器学会雑誌 31(3), 119-123, 2015
背景：完全型房室中隔欠損（CAVSD）修復術後，再手術の最大のリスクファクターとなる左側房室弁逆流（LAVVR）を防ぐため，われわれは，心室中隔欠損（VSD）閉鎖のパッチ幅を造影検査の正常三尖弁輪径（31.1×BSA0.56）＋4 mmとしている．今回その手術成績を検討した．方法：1995年1月から2011年12月までに当院でCAVSD修復術を行った27例を対象とし，手術成績を後方視検討した．結果 …
NAID 130005074633

Different Implications of Functional Tricuspid Regurgitation Between Heart Failure (HF) With Reduced Ejection Fraction (EF) and HF With Preserved EF

,
Circulation Journal advpub(0), 2015
NAID 130005073176

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★リンクテーブル★

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