Materiały źródłowe

• #1 Tricuspid valve disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5494422/

  The tricuspid valve of the heart is situated between the upper and lower chambers of the right side of the heart, known as the right atrium and right ventricle respectively. It opens and closes in a coordinated fashion to ensure that blood flows in a forward direction from the right atrium to the right ventricle. This enables blood to be pumped efficiently from the right side of the heart to the lungs for adequate oxygenation. Tricuspid valve disease occurs when this function is impaired. The more common form of tricuspid disease, known as tricuspid regurgitation or insufficiency, occurs when the valve cannot close adequately, resulting in the backward leakage of blood into the right atrium with each heart contraction. Alternatively, the valve may become stiff and narrowed preventing the forward flow of blood from the atrium to the ventricle, known as tricuspid stenosis. If severe, surgical repair or replacement of the valve may be necessary to relieve symptoms, prevent complications, prolong survival and improve ones quality of life.

• #2 Tricuspid valve disease – Harris- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/15056/html

  Tricuspid valve disease occurs when this function is impaired. […] Tricuspid regurgitation most commonly occurs in conditions which cause the right ventricle to expand or dilate, resulting in enlargement of the valves ring-like base. […] Tricuspid stenosis most commonly results from rheumatic heart disease, which causes the leaflets of the valve to become thick, hardened and less able to open widely, thus restricting forward blood flow.

• #3 Tricuspid Regurgitation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526121/

  Tricuspid regurgitation is a condition characterized by the backward flow of blood from the right ventricle into the right atrium during systole due to an incompetent tricuspid valve. This regurgitation often results from structural abnormalities of the valve apparatus, including issues with the valve leaflets, annulus, or papillary muscles. Contributing factors may include valve degeneration, annular dilation, or damage from conditions such as pulmonary hypertension or infective endocarditis. The condition can lead to symptoms such as right-sided heart failure, including edema and ascites, and requires careful evaluation to determine its severity and impact on cardiac function. […] Primary structural abnormalities of the tricuspid valvular apparatus or secondary abnormalities due to myocardial dysfunction or dilatation are responsible for the structural incompetence of the tricuspid valve. The backflow of blood from the right ventricle into the right atrium during systole defines tricuspid regulation. In mild to moderate cases of tricuspid regurgitation, no significant hemodynamic consequences are noted due to the comparatively compliant nature of the right atrium. However, in severe cases, right ventricular volume overload develops, which eventually results in right-sided congestive heart failure presenting with peripheral edema, ascites, and hepatic congestion.

• #4 Tricuspid valve regurgitation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-regurgitation/symptoms-causes/syc-20350168

  In tricuspid valve regurgitation, the valve between the two right heart chambers doesn’t close properly. The upper right chamber is called the right atrium. The lower right chamber is called the right ventricle. As a result, blood flows backward. […] Tricuspid valve regurgitation is a type of heart valve disease. The valve between the two right heart chambers doesn’t close as it should. Blood flows backward through the valve into the upper right chamber. If you have tricuspid valve regurgitation, less blood flows to the lungs. The heart has to work harder to pump blood. […] In tricuspid valve regurgitation, the tricuspid valve doesn’t close tightly. So, blood leaks backward into the upper right heart chamber. […] Causes of tricuspid valve regurgitation include: A heart problem you’re born with, also called a congenital heart defect. Some congenital heart defects affect the shape of the tricuspid valve and how it works. Tricuspid valve regurgitation in children is usually caused by a rare heart problem present at birth called Ebstein anomaly. In this condition, the tricuspid valve does not form correctly. It also is lower than usual in the lower right heart chamber.

• #4 Tricuspid valve regurgitation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tricuspid-valve-regurgitation/symptoms-causes/syc-20350168

  Rheumatic fever. This complication of strep throat can cause permanent damage to the heart and heart valves. When that happens, it’s called rheumatic heart valve disease. […] Infection of the lining of the heart and heart valves, also called infective endocarditis. This condition can damage the tricuspid valve. IV drug misuse increases the risk of infective endocarditis. […] Carcinoid syndrome. This condition occurs when a rare cancerous tumor releases certain chemicals into the bloodstream. It can lead to carcinoid heart disease, which damages heart valves, most commonly the tricuspid and pulmonary valves. […] Chest injury. An injury to the chest, such as from a car accident, may cause damage that leads to tricuspid valve regurgitation. […] Pacemaker or other heart device wires. Tricuspid valve regurgitation might happen if wires from a pacemaker or defibrillator cross the tricuspid valve. […] Heart biopsy, also called an endomyocardial biopsy. Heart valve damage can sometimes happen when a small amount of heart muscle tissue is removed for examination. […] Radiation therapy. Rarely, radiation therapy for cancer that is focused on the chest area can cause tricuspid valve regurgitation.

• #5 Tricuspid Regurgitation: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/158484-overview

  Tricuspid regurgitation may result from structural alterations of any or all of the components of the tricuspid valve apparatus. The lesion may be classified as primary when it is caused by an intrinsic abnormality of the valve apparatus or as secondary when it is caused by right ventricular (RV) dilatation or other conditions (eg, left ventricular [LV] dysfunction). […] The pathophysiology of tricuspid regurgitation focuses on the structural incompetence of the valve. The incompetence can result from primary structural abnormalities of the leaflets and chordae or, more often, be secondary to myocardial dysfunction and dilatation. […] Tricuspid valve insufficiency due to leaflet abnormalities may be secondary to endocarditis or rheumatic heart disease. […] When due to the latter, it generally occurs in combination with tricuspid stenosis.

• #5 Tricuspid Regurgitation: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/158484-overview

  Ebstein anomaly is the most common congenital form of tricuspid regurgitation. […] Inspiration increases the severity of tricuspid regurgitation. […] Chronically, tricuspid regurgitation leads to RV volume overload, which results in right-sided congestive heart failure (CHF). This manifests as hepatic congestion, peripheral edema, and ascites. […] Pure tricuspid regurgitation can be caused by at least 10 conditions, as follows: Rheumatic heart disease, Endocarditis, Ebstein anomaly, Tricuspid valve prolapse, Carcinoid, Papillary muscle dysfunction, Trauma, Connective-tissue diseases, Medications, RV dilatation. […] Tricuspid regurgitation secondary to rheumatic involvement is usually associated with mitral and aortic valve pathology. […] The valve develops diffuse fibrous thickening without commissural fusion, fused chordae, or calcific deposits.

• #6 Tricuspid valve regurgitation: no longer the “forgotten valve”

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Tricuspid-valve-regurgitation-no-longer-the-forgotten-valve

  Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease. […] In general, the aetiology of TR is classified according to the presence of primary tricuspid valve pathology (primary TR), the presence of associated left-sided heart disease (secondary TR) or the presence of atrial fibrillation without any associated left-sided heart disease (isolated TR). […] Primary TR is caused by an abnormality of the tricuspid valve and/or its subvalvular apparatus (tricuspid leaflets, chordae, papillary muscles, or annulus), due to congenital or acquired causes. […] In secondary TR, the underlying mechanism is characterised by RV dilation and dysfunction, leading to leaflet tethering, tricuspid annulus dilation and leaflet malcoaptation. […] Finally, isolated TR is a novel entity most frequently seen in elderly patients with a high prevalence of atrial fibrillation, in the absence of concomitant pulmonary hypertension or co-existing left-sided heart disease. The underlying mechanism is pronounced right atrial and tricuspid annular dilation, leading to leaflet malcoaptation, in the absence of any pronounced RV remodelling. […] The advent of advanced imaging techniques has provided novel insights into the important role of right heart remodelling in the pathophysiology of TR which may lead to improved risk stratification and more timely intervention in the near future.

• #7 The tricuspid valve in review: anatomy, pathophysiology and echocardiographic assessment with focus on functional tricuspid regurgitation – Yucel – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/38028/html

  Tricuspid valve (TV) disease, mostly seen as tricuspid regurgitation (TR) in adults, is the most common right-sided valvular heart lesion. […] Primary (organic) TR can be inherited or acquired, and accounts for 10% of cases of TR in adults. […] Functional (secondary) TR constitutes approximately 90% of TR and is due to a heterogenous group of etiologies that cause right atrial (RA) or right ventricular (RV) dilation. This results in annular dilation and tethering of the TV leaflets. […] The causes of functional (secondary) TR (FTR) are typically related to RV or RA dilation. […] More recently, epidemiological studies point to the high prevalence of FTR in the absence of PH. […] A new entity, idiopathic FTR, has been described, where significant TR is identified without an overt cause (LV dysfunction, pacemaker lead impingement, primary TR) or any other significant concomitant valve disease. […] The role of ventricular-valvular interaction was also apparent, where PH-related FTR and RV remodeling led to a larger, longer, and more elliptical ventricle with more valve tenting and a larger effective orifice area.

• #8 Transcatheter treatment for tricuspid valve disease | EuroIntervention

  https://eurointervention.pcronline.com/article/transcatheter-treatment-for-tricuspid-valve-disease

  Primary TR results from anatomical abnormality of the TV apparatus and is observed in only 8-10% of patients with TV disease. Secondary TR (STR) is more common and arises as a result of annular dilation caused by RV enlargement and dysfunction due to pressure/volume overload as a consequence of pulmonary hypertension (PHT), often caused by left-sided heart disease, or atrial fibrillation (AF) with normal RV pressures (atrial/atriogenic or isolated TR). STR may also develop after left-sided valve surgery, probably due to silent ischaemic RV damage. […] Definition of different TR groups is prognostically important since disease aetiology determines long-term outcomes. Accordingly, we propose a novel integrative classification of TR that accounts for the pathophysiology, imaging characteristics, clinical management and outcome, while recognising that differentiation of the initial aetiology based on valve and chamber morphology/function may be challenging as TV disease progresses.

• #8 Transcatheter treatment for tricuspid valve disease | EuroIntervention

  https://eurointervention.pcronline.com/article/transcatheter-treatment-for-tricuspid-valve-disease

  Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid valve apparatus and is observed in only 8-10% of the patients with tricuspid valve disease. Secondary TR is more common and arises as a result of annular dilation caused by right ventricular enlargement and dysfunction as a consequence of pulmonary hypertension, often caused by left-sided heart disease or atrial fibrillation. […] Chronic severe TR leads to volume overload and increased wall stress of the right ventricle (RV), which negatively contribute to detrimental remodelling and worsening TR. This vicious circle translates into impaired survival and increased heart failure (HF) symptoms in patients with and without reduced left ventricular ejection fraction.

• #9 Tricuspid Regurgitation – Tricuspid Valve Disease – Valvular Heart Disease – Cardiovascular Diseases – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.2.10.2.

  Tricuspid regurgitation (TR) is a reversal of blood flow from the right ventricle to the right atrium due to an incomplete closure of tricuspid valve leaflets. Patients with isolated TR (without tricuspid stenosis) usually have functional TR related to pulmonary hypertension (secondary or primary) or coexisting mitral valve disease, particularly stenosis. […] […] 1) Structural (organic) TR: Rheumatic fever, infective endocarditis, carcinoid syndrome, Marfan syndrome, Fabry disease, Whipple disease, tricuspid valve prolapse, rheumatoid arthritis, systemic lupus erythematosus, congenital heart disease (Ebstein anomaly and other conditions), papillary muscle dysfunction, drugs (methysergide, fenfluramine). […] 2) Functional TR (most frequent in patients with acquired valvular disease): Dilation of the tricuspid annulus of an anatomically normal valve secondary to the altered right ventricular geometry most commonly caused by pulmonary hypertension, mitral valve disease, right ventricular myocardial infarction, or congenital heart disease (eg, right ventricular outflow obstruction).

• #9 Tricuspid Regurgitation – Tricuspid Valve Disease – Valvular Heart Disease – Cardiovascular Diseases – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.2.10.2.

  3) TR associated with intracardiac devices: Pacemaker and defibrillator leads can interfere with function of the tricuspid valve and lead to varying degrees of regurgitation, which may be progressive. […] […] Regardless of the underlying condition, severe TR is associated with a poor long-term prognosis due to the progressive right ventricular dysfunction and systemic venous congestion.

• #10 Isolated tricuspid regurgitation: outcomes and therapeutic interventions | Heart

  https://heart.bmj.com/content/104/10/798

  Isolated tricuspid regurgitation (TR) can be caused by primary valvular abnormalities such as flail leaflet or secondary annular dilation as is seen in atrial fibrillation, pulmonary hypertension and left heart disease. […] The aetiology of TR is divided into primary and secondary causes. […] Primary valvular disease accounts for 10% of cases of TR in adults. […] Acquired primary conditions include endocarditis, rheumatic disease, carcinoid or flail leaflet caused by trauma. […] Secondary TR results from annular dilation and leaflet tethering leading to malcoaptation. […] Secondary TR commonly develops in response to right ventricular (RV) remodelling due to PH, which is the final common pathway of both intrinsic pulmonary vascular disease and left-sided myocardial or valvular disease.

• #11 Anatomy of the Tricuspid Valve and Pathophysiology of Functional Tricuspid Regurgitation | Thoracic Key

  https://thoracickey.com/anatomy-of-the-tricuspid-valve-and-pathophysiology-of-functional-tricuspid-regurgitation/

  Functional tricuspid regurgitation (FTR) occurs due to loss of leaflet coaptation as a result of two pathologies: dilatation of the tricuspid annulus and/or leaflet tethering, both of which occur due to right ventricular remodeling and dilatation as a result of raised pulmonary artery pressures from left sided heart valve disease. […] Tricuspid annular dilatation can also be caused by long standing atrial fibrillation. […] It is referred to as functional as the leaflets are normal in morphology but their function is impaired due to dilatation of the tricuspid annulus which pulls them apart, or right ventricular dilatation, elongation and altered geometry which displaces the papillary muscles laterally and apically, tethering the leaflets and preventing adequate leaflet coaptation. […] Raised pulmonary artery pressures due to left sided heart valve disease contribute to these pathologies and exacerbates the severity of FTR.

• #11 Anatomy of the Tricuspid Valve and Pathophysiology of Functional Tricuspid Regurgitation | Thoracic Key

  https://thoracickey.com/anatomy-of-the-tricuspid-valve-and-pathophysiology-of-functional-tricuspid-regurgitation/

  The severity of TR is greatest when both tricuspid annular dilatation and leaflet tethering are present. […] Dilatation of the tricuspid annulus is the most common cause of FTR. […] Functional TR ensues once the annulus is dilated by more than 40 % its normal size. […] Tethering of the tricuspid leaflet is another cause of FTR. […] As the right ventricle dilates due to raised pulmonary artery pressures, it can assume a more elongated or eccentric geometry, thereby pulling the anterior papillary muscle apically and laterally, and tethering the tricuspid valve leaflets as a result, preventing adequate leaflet coaptation. […] This pathology is distinct from tricuspid annular dilatation although the two can co-exist, with tricuspid annular dilatation progressing to leaflet tethering with progressive RV dilatation and eccentricity. […] Inadequate leaflet enlargement in response to annular dilatation may be another mechanism of functional tricuspid regurgitation.

• #12 Etiology, epidemiology, pathophysiology and management of tricuspid regurgitation: an overview

  https://www.imrpress.com/journal/rcm/22/4/10.31083/j.rcm2204122

  Significant tricuspid regurgitation (TR) is a common finding, affecting about one in twenty-five subjects among the elderly and presenting more frequently in women than in men. […] FTR is a multifactorial disorder, resulting from maladaptive right ventricular remodeling secondary to pulmonary hypertension or from atrial fibrillation leading to dilation of the right atrium, tricuspid annulus and base of the right ventricle, with pathological TV coaptation. […] Thus two main types of FTR can be identified: pulmonary hypertension-FTR and idiopathic-FTR, depending on which factor, ventricular or atrial respectively, is the primum movens of the disease. […] Appreciable evidence suggests that significant TR leads to worsening prognosis regardless of the underlying etiology and should be addressed as a separate therapeutic target.

• #13 Isolated tricuspid regurgitation in the community: phenotyping the patients

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/isolated-tricuspid-regurgitation-in-the-community-phenotyping-the-patients

  The recent Tricuspid Valve Academic Research Consortium (TVARC) document recommended to use the term A-STR for any STR in which atrial/annular dilatation is the main mechanism of regurgitation and separately classify it from the more prevalent form of STR in which RV dilatation/dysfunction is the main mechanism of regurgitation (ventricular STR, V-STR). […] Data from the European Society of Cardiology (ESC) Heart Failure Long-Term Registry showed that isolated TR was associated with an unexpectedly poor outcome, and HFpEF was one of the main drivers of isolated TR. […] Notably, severe isolated TR is linked to an excess in cardiac events and mortality, independently of cardiac rhythm or other cardiovascular or comorbid conditions. […] The severity of the clinical presentation before surgery has a greater impact on patient outcome than the TR mechanism/aetiology.

• #14 Tricuspid Valve Disease | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/tricuspid-valve-disease

  Tricuspid valve disease can be caused by: […] Dilated right ventricle: When the right ventricle dilates (expands), the tricuspid valves ringlike base stretches out and the leaflets dont close. Examples of conditions that cause dilated right ventricle include heart failure, mitral valve disease and coronary artery disease. […] Infections: Rheumatic fever and infective endocarditis (an infection of the heart lining that can also involve the valves) can damage the leaflets of the tricuspid valve. These diseases can also damage the aortic and mitral valves. […] Pulmonary hypertension: This is an increase in blood pressure in the lungs. Pulmonary hypertension can lead to increased pressure in the right ventricle and subsequent damage to the tricuspid valve.

• #15 Mitral & Tricuspid Valve Disease

  https://ikch.lfhk.cuni.cz/en/mitral-tricuspid-valve-disease

  Tricuspid valve stenosis is a rare disease. It may be caused by rheumatic process, carcinoid or cardiac tumors. By restriction of transtricuspid blood flow the blood stagnates and the pressure in the right atrium rises. The signs of right heart failure are present – systemic venous congestion (increased filling of the jugular veins, pleural effusion, hepatic enlargement, ascites and peripheral edema), low cardiac output (weakness, fatigue). In auscultation we find a mesodiastolic murmur above the bottom part of the sternum, opening snap may be present. […] Tricuspid valve regurgitation is mostly of secondary etiology in pulmonary hypertension. A result of pressure- or volume-overload of the right ventricle is its hypertrophy and dilation, including the dilation of tricuspid valve anulus. The primary reason for this is mostly left-heart valve disease, pulmonary stenosis or regurgitation, congenital anomalies with left-to-right shunting, chronic obstructive pulmonary disease or pulmonary thrombembolism. A myocardial infarction or other right ventricular myocardial damage can lead to secondary tricuspid valve regurgitation, too.

• #16 Tricuspid regurgitation: Etiology, clinical features, and evaluation – UpToDate

  https://www.uptodate.com/contents/tricuspid-regurgitation-etiology-clinical-features-and-evaluation

  Tricuspid regurgitation (TR) is a relatively common abnormality. […] This topic will review the etiology, pathophysiology, and clinical features associated with regurgitation of the tricuspid valve. […] Abnormal degrees of TR in adults are largely secondary (ie, related to tricuspid annular dilation and/or leaflet tethering in the setting of right ventricular [RV] pressure and/or volume overload) and much less often due to primary disorders of the valve apparatus. […] The causes of pacer-associated TR include: effects of chronic RV pacing on RV geometry and systolic function, direct impingement on leaflet motion, foreign body inflammation and fibrosis of the leaflets, thrombosis, and endocarditis.

• #17 Pulsenotes | Tricuspid regurgitation

  https://app.pulsenotes.com/medicine/cardiology/notes/tricuspid-regurgitation

  Tricuspid regurgitation (TR) is the most common right-sided heart valve disease. […] The underlying problem is backflow of blood from the right ventricle into the right atrium during systole. Although TR can be due to a problem with the tricuspid valve itself, it is most commonly caused by a problem elsewhere in the cardiovascular system, which has a knock-on effect on tricuspid valve function. […] The main underlying problem in tricuspid regurgitation is the backflow of blood from the right ventricle into the right atrium during systole. […] There are three key pathological changes in TR: […] Rise in right atrial pressure: Initially, a small degree of TR doesnt cause many problems. This is because the right atrium is relatively compliant (stretchy), and so can cope with the increase in volume. However, as TR progresses, and more blood regurgitates with each heartbeat, right atrial pressure will start to rise.

• #17 Pulsenotes | Tricuspid regurgitation

  https://app.pulsenotes.com/medicine/cardiology/notes/tricuspid-regurgitation

  Back pressure in the vena cava: Increased right atrial pressure leads to back pressure into the SVC and IVC. This pressure causes the signs and symptoms of right-sided heart failure (e.g. raised JVP, peripheral oedema, ascites, liver impairment) […] Right ventricular dilatation: As TR becomes more severe, the right ventricle has to work harder. This is because it has to continue to pump blood into the pulmonary artery, whilst also pumping a significant volume of blood into the right atrium. Initially, the right ventricle copes with this by undergoing hypertrophy. However, eventually the right ventricle becomes unable to fully compensate for the regurgitation, leading to reduced forward flow into the pulmonary circulation and right ventricular dilatation. […] Right ventricular dilatation is particularly problematic since as we saw in secondary causes of TR above right ventricular dilatation is also a cause of TR. This can lead to a vicious cycle of ventricular dilatation, valvular annular stretch and improper closing, increased work of the ventricle due to an ineffective tricuspid valve, which subsequently leads to more stretching, overload, and dilatation of the right ventricle.

• #18 Tricuspid Valve Disease (Types, Causes, Symptoms and Treatment)

  https://patient.info/doctor/tricuspid-valve-disease

  In primary tricuspid regurgitation, specific abnormalities of the valve can be identified. In secondary tricuspid regurgitation, annular dilatation, along with right ventricular and right atrium dimensions, as well as right ventricular function should be measured in view of their prognostic relevance. […] Severe tricuspid regurgitation is associated with impaired survival and worsening heart failure. Appropriate timing of intervention is essential to avoid irreversible right ventricular damage and organ failure with subsequent increased surgical risk.

• #19 Tricuspid Stenosis – Tricuspid Valve Disease – Valvular Heart Disease – Cardiovascular Diseases – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.2.10.1.

  Tricuspid stenosis (TS) is a reduction of the tricuspid valve orifice area, which causes impaired right ventricular filling. […] Etiology: Rheumatic fever; other, very rare etiologies include carcinoid syndrome. Right atrial myxoma or other tumors of the right atrium, tricuspid valve vegetations, and right atrial thrombus can cause tricuspid inflow stenosis not related to the valve but with similar physiologic consequences. Tricuspid atresia is a rare congenital anomaly affecting the tricuspid valve with other associated lesions. Patients with previous tricuspid valve replacement can develop prosthetic valve stenosis. The majority of patients have mixed TS and tricuspid regurgitation (TR), such as those with carcinoid syndrome.

• #20 Tricuspid stenosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Tricuspid_stenosis_pathophysiology

  Tricuspid stenosis (TS) is characterized by structural changes in the tricuspid valve. The pathophysiology of tricuspid valve depends on the underlying etiology. In rheumatic heart disease which is the most common cause of tricuspid stenosis, there is fibrous thickening of the valve leaflets and chordae tendineae with/without fusion of the commissures as a result of inflammation. The obstruction to right ventricular filling due to the stenotic tricuspid valve can result in systemic venous hypertension and congestion. […] The tricuspid disease is characterized by diffuse fibrous thickening of the leaflets and fusion of 2 or 3. Leaflet thickening usually occurs in the absence of calcific deposits, and the anteroseptal commissure is most commonly involved. Incompletely developed leaflets, shortened or malformed chordae, a small annulus, or an abnormal number or size of papillary muscles may result in TS. The valves consist of an outer layer of valve endothelial cells (VECs) surrounding three layers of the extracellular matrix each with specialized function and interspersed with interstitial valve cells (VICs). Genetic or acquired/environmental causes that disrupt the normal organization and composition of the extracellular matrix and communication between VECs and VICs alter valve mechanics and interfere with the valve leaflet function, culminating in heart failure.

• #20 Tricuspid stenosis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Tricuspid_stenosis_pathophysiology

  As a result of valvular stenosis, there is a persistent diastolic pressure gradient between the right atrium and right ventricle. This gradient increases when blood flow across the tricuspid valve increases, as occurs with inspiration and exercise, and decreases when blood flow decreases, such as with expiration. The primary result of TS is right atrial pressure elevation and consequent right-sided congestion. During sinus rhythm, the right atrial „a” wave is increased and may approach the level of right ventricular systolic pressure. The resting cardiac output may be reduced and fails to increase with exercise. This may contribute to the only modestly elevated left atrial and pulmonary arterial pressures seen when mitral valve disease is also present. As a result, most patients with significant tricuspid stenosis have systemic venous congestion with jugular venous distension, ascites, and peripheral edema. […] The pathophysiology of tricuspid stenosis depends on the underlying etiology.

• #21 Pulsenotes | Tricuspid stenosis

  https://app.pulsenotes.com/medicine/cardiology/notes/tricuspid-stenosis

  Tricuspid stenosis is usually caused by rheumatic fever. […] Rheumatic fever damages the heart valves in the following ways: In response to the infection, autoantibodies develop which target the heart valves. Autoantibodies lead to chronic inflammation of the heart valves. Chronic inflammation leads to thickening and calcification of the valves. Thickening and calcification lead to narrowing of the valve orifice and relatively fixed and stiff valves. […] Tricuspid stenosis can lead to increased back pressure in the venous system. Tricuspid stenosis creates resistance to blood flow from the right atrium to the right ventricle. This leads to three problems: Turbulent blood flow across the valve. This is the cause of the murmur. Increased right atrial pressure. This back pressure is passed on to the vena cava, which can lead to a raised JVP, ascites, hepatomegaly, and occasionally peripheral oedema. Reduced right ventricular blood flow. This means there is also a reduction in onward blood flow to the lungs.

• #22 Cellular and Molecular Mechanisms Underlying Tricuspid Valve Development and Disease

  https://www.mdpi.com/2077-0383/12/10/3454

  Tricuspid valve (TV) disease is highly prevalent in the general population. […] Comprehensive knowledge of molecular and cellular mechanisms underlying TV development, TV disease, and tricuspid regurgitation-related right-ventricle cardiomyopathy is necessary to enhance TV disease understanding to improve the ability to risk stratify TR patients, while also predicting valve dysfunction and/or response to tricuspid regurgitation treatment. […] Scientific efforts are still needed to eventually decipher the complete picture describing the etiopathogenesis of TV and TV-associated cardiomyopathy, and future advances to this aim may be achieved by combining emerging diagnostic imaging modalities with molecular and cellular studies. […] Dysfunction or failure of some of the molecular and morphogenetic mechanisms underlying tricuspid and right structures development have been proven to be associated with tricuspid disease.

• #22 Cellular and Molecular Mechanisms Underlying Tricuspid Valve Development and Disease

  https://www.mdpi.com/2077-0383/12/10/3454

  The pathogenesis of TR in mitral valve disease is complex and multifactorial. […] Mechanisms underlying TR are strongly related to the RV remodeling pattern that may occur in the development of this valve disease, demonstrating the wide variety of this phenomenon. […] TR-induced right ventricular cardiomyopathy has a molecular and cellular basis which is still not completely clear.

• #23 The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options – Professional Heart Daily | American Heart Association

  https://professional.heart.org/en/science-news/the-tricuspid-valve-a-review-of-pathology-imaging-and-current-treatment-options

  Tricuspid valve disease is often underrecognized and is associated with high morbidity and mortality. […] If not diagnosed properly, and if it progresses to a late course of the disease, patients often present with severe right sided heart failure, pulmonary hypertension, and quality of life limiting symptoms. […] This paper highlights important background information, anatomical considerations, therapeutic options, and future directions regarding tricuspid valve disease.

• #24 Tricuspid valve regurgitation: epidemiology and pathophysiology – Minerva Cardioangiologica 2018 December;66(6):673-9 – Minerva Medica – Journals

  https://www.minervamedica.it/en/journals/minerva-cardiology-angiology/article.php?cod=R05Y2018N06A0673

  Compared with the vast literature concerning the prevalence, pathophysiology, and outcome of left valvular disease, the data concerning tricuspid regurgitation (TR) is very limited. […] We review the present knowledge concerning the pathogenesis of TR, focusing on functional TR. […] We show that functional TR is multifactorial, resulting from both RV remodeling and pulmonary hypertension, and/or atrial fibrillation resulting in right atrial dilatation. […] We demonstrate that RV remodeling, mostly in the mid segment, will result in tethering. […] On the other side, right atrial remodeling will mostly result in pure annular dilatation and loss of valvular/annular coverage reserve. […] Finally, due to the heterogeneous nature of TR we review the outcome data for each presentation of TR and show that in most contexts TR is associated with very poor outcome, even when adjusted for left ventricular systolic, and diastolic function, pulmonary pressure, and RV dysfunction.

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