Defects of the three-leaved valve
The infectious endocarditis at addicts or a heart attack of a right ventricle can be the reason of the isolated acute tricuspid insufficiency.
Chronic tricuspid insufficiency — sometimes in combination with a tricuspid stenosis, meets at rheumatism against defeat of mitral and aortal valves, and occasionally — at a carcinoid syndrome.
In rare instances tumors (a myxoma of the right auricle) can serve as the reason of a tricuspid stenosis.
Clinical picture of tricuspid insufficiency
At rheumatic defect the picture of defeat of the left half of heart dominates, however the defect decompensation in case of defeat of the three-leaved valve comes quicker. Complaints to an asthma, fatigue, feeling of a pulsation of cervical vessels are typical. Emergence of feeling of weight in right hypochondrium, abdominal pains, feeling of fast saturation because of hypostasis of an intestinal wall, anorexia is possible.
Objectively the Crocq's disease, sometimes yellowness of skin and mucous membranes, a pulsation of veins of a neck, a liver pulsation, expansion of borders of heart to the right, ascites comes to light. If defect forms at the patient with a mitral stenosis, then an asthma can weaken, the patient transfers horizontal position easier. Heavy tricuspid insufficiency often is followed by emergence of systolic trembling.
The I tone is weakened or not changed. Systolic noise with a maximum over a xiphoidal shoot or in the fifth mezhreberye to the right of a breast is listened. Most often noise irradiates to the right, sometimes reaching the right front axillary line, its distribution and to the left to a heart top is sometimes possible. Noise often amplifies on a breath — Rivero-Corvallo's phenomenon.
Fast development of stagnation in a big circle of blood circulation with fast accession of a ciliary arrhythmia is characteristic of a tricuspid stenosis. Cyanosis and yellowness of skin is expressed. The liver is increased, the jugular veins which bulked up, borders of heart are expanded to the right.
Auskultativno a tricuspid stenosis is shown by the clapping I tone, click of opening of the tricuspid valve which, unlike mitral click, is better listened over a xiphoidal shoot of a breast on a breath on the right side. However these sound phenomena are changeable. The phonocardiographic analysis is submitted to more reliable — the diastolic noise with presystolic strengthening having a maximum over a xiphoidal shoot or in the fifth mezhreberye at the left and not merging with the I tone that distinguishes it from noise of a mitral stenosis is registered. Noise amplifies upon transition from vertical to a prone position on the right side, can extend to the front axillary line to the left.
Treatment of tricuspid defect
Along with causal treatment, in conservative treatment of tricuspid insufficiency diuretics and venous vazodilatator (nitrates, angiotensin-converting enzyme inhibitors) are used. At a tricuspid stenosis and heavy pulmonary hypertensia they should be applied with care owing to need of maintenance at this defect of higher, than usually, the central venous pressure and limited ability to increase in cordial emission in response to decrease in peripheric resistance. At heavy dysfunction of a right ventricle inotropic means (Dobutaminum) are shown. Prevention of an infectious endocarditis is carried out.
As the indication to balloon valvuloplasty, prosthetics or plastics of the tricuspid valve serves defect, refractory to conservative therapy. At relative tricuspid insufficiency the annuloplasty can be used.