Tricuspid Valve Disease

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Tricuspid Valve Stenosis

The tricuspid valve may become stenotic as a result of rheumatic fever, or it may be narrow at birth (Fig. 10.5). Tricuspid valve stenosis from rheumatic fever, particularly that which is severe enough

Myxoid Degeneration:

Degeneration of the middle layer of tissue in blood vessels and heart valves.

The mitral valve is attached to the ventricular wall by chordae. If these rupture, the mitral valve becomes incompetent. The surgeon removes that portion of the valve where the ruptured chordae is located (above), then sews the valve together and places a supporting ring (below).

Ascites:

An abnormal accumulation of serum-like fluid in the abdomen.

This illustration shows four possible valve disorders. The pulmonary valve (top) suffers from congenital stenosis. The aortic valve (middle) suffers from stenosis and incompetence resulting from rheumatic fever. The tricuspid valve (far right) suffers from stenosis and incompetence. The mitral valve (near right) suffers from incompetence due to bacterial infection. The growths on the valve's surface are clumps of bacteria, and a hole has been eaten through the valve leaflet.

to require heart surgery, is relatively uncommon.

If the valve is severely stenotic, blood returning from the veins to the heart will have difficulty getting into the right ventricle. As a result, the liver may become engorged, and fluid can build up in the abdomen. This fluid buildup is known as ascites. The legs and ankles may swell. If there's a small hole in the heart between the right and the left atrium, some unoxygenated blood may pass through this hole, and a patient may appear blue (cyanotic). Heart surgery may be required to correct this problem.

Tricuspid Valve Incompetence

Tricuspid valve incompetence is relatively common and usually related to dilatation of the tricuspid valve annulus, or the ring around the tricuspid valve that anchors the valve. This is commonly related to either long-standing mitral valve disease or pulmonary arterial and/ or pulmonary venous hypertension, meaning the pressure in the pulmonary arteries and veins is elevated, forcing the right ventricle to work harder.

Over time, the right ventricle enlarges and begins to fail. As it does, the annulus may dilate and cause the tri-cuspid valve to leak blood back into the right atrium, causing similar signs and symptoms as in tricuspid valve stenosis (narrowed valve).

During an episode of endocarditis, bacteria or fungi can destroy the leaflets of the tricuspid valve. Depending on the severity of the condition, heart surgery may be required, and the valve may be repaired or replaced.

Pulmonary Valve, Congenital Stenosis

Mitral Valve, Incompetent due to Bacterial Endocarditis

Stenotic and Incompetent Aortic Valve

Stenotic and Incompetent Tricuspid Valve

Dr. Agustin Arbulu, a heart surgeon at Wayne State University in Detroit, has shown that when a tricuspid valve is severely damaged because of antibiotic-resistant infection and the infection is the result of illicit intravenous drug abuse, a good method of treatment is to remove the infected tricuspid valve and not replace it. This removes the source of the infection. If an artificial valve is put in, it too will likely become infected since the patient frequently resumes the illicit drug use.

Tricuspid Valve Stenosis and Incompetence

This combination is usually related to rheumatic heart disease, and the problem is similar to mitral and aortic valve incompetence/stenosis in which the valve is both leaky and narrow. Depending on its severity, this condition may require heart surgery.

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