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Tricuspid valve prolapse.

Tricuspid valve prolapse is an infrequent echocardiographic finding that is most commonly associated with mitral valve prolapse. When compared with patients exhibiting isolated prolapse of the mitral valve, patients with tricuspid valve prolapse are somewhat older individuals with a slightly higher frequency of neurologic symptoms, fatigue, weakness, supraventricular arrhythmias (especially atrial fibrillation) and skeletal deformities. Tricuspid valve prolapse may serve as a marker of more-diffuse connective tissue abnormalities, and its identification also should prompt an echocardiographic search for evidence of prolapse and regurgitation of the other heart valves.

Adult↗

Isolated tricuspid valve prolapse.

Tricuspid valve prolapse is commonly associated with mitral valve prolapse or other heart abnormalities and is rarely found as an isolated finding. A patient with isolated tricuspid valve prolapse is described which was discovered on routine examination of an asymptomatic pilot.

Adult↗

[Incidence of tricuspid valve prolapse].

The incidence of tricuspid valve prolapse and its association with mitral valve prolapse was studied in 100 patients with right- and left-ventricular angiography. Coronary artery disease was present in 81 patients (pts), a dilative cardiomyopathy in 6 pts, and a hypertrophic cardiomyopathy in 2 pts. 11 pts were angiographically normal. A total of 27 pts had a tricuspid valve prolapse, and 15 pts had a mitral valve prolapse. In 19 pts prolapse of the tricuspid valve was isolated, and in 8 pts it was associated with a mitral valve prolapse. The associated finding of a prolapse of the tricuspid and mitral valve was statistically significant (p less than 0.02). Patients with a tricuspid valve prolapse experienced a higher right-ventricular ejection fraction (58 + 10 vs 53 +/- 10%; p less than 0.05) and smaller end-systolic right ventricular volume indices (39 +/- 16 vs 47 +/- 17 ml/m2; p less than 0.05) compared to those without tricuspid valve prolapse. There was no further difference in clinical and hemodynamic parameters between those with and those without tricuspid valve prolapse. The clinical significance of a tricuspid valve prolapse is still undefined.

Adolescent↗

Tricuspid regurgitation in tricuspid valve prolapse demonstrated with contrast cross-sectional echocardiography.

To determine the prevalence of tricuspid regurgitation in patients with tricuspid valve prolapse and to define further the criteria for the diagnosis of tricuspid regurgitation on contrast echocardiography, evaluation was made of 45 patients who had adequate contrast studies. There were four groups of patients: Group A, 10 healthy control subjects with no evidence of structural heart disease on cardiac catheterization; group B, 10 patients with classic clinical evidence of tricuspid regurgitation; group C, 10 patients with cross-sectional echocardiographic evidence of mitral valve prolapse without tricuspid valve prolapse; and group D, 15 patients with both mitral and tricuspid valve prolapse on cross-sectional echocardiography. Tricuspid regurgitation was sought in each group by using the subxiphoid echocardiographic approach with peripheral venous injection of saline solution. The diagnosis required the presence of microcavitations in both the inferior vena cava and hepatic veins for at least three consecutive cardiac cycles. Tricuspid regurgitation was observed in no patients in group A, 10 of 10 patients in group B, 0 of 10 in groups C and 6 of 15 (40 percent) in group D. Contrast cross-sectional echocardiography proved to be a reliable technique for identifying tricuspid regurgitation with a high degree of specificity and sensitivity. Patients with tricuspid valve prolapse had a 40 percent prevalence rate of tricuspid regurgitation. This finding may identify a subgroup that requires particularly careful clinical follow-up care.

Adolescent↗

[The tricuspid valve prolapse. Clinical significance and diagnostic problems (author's transl)].

Systolic prolapse of the tricuspid valve is a relatively unknown anatomo-clinical entity. In this communication etiology, clinical significance and diagnostic problems of this condition are reported and discussed. The frequent association with mitral valve prolapse and the coexistence of skeletal and cardiac anomalies strongly suggest the role of congenital factors and the degenerative nature of this valvular abnormality. Pathophysiology of leaflets prolapse remains unexplained for those few reported cases of isolated tricuspid invovlement. The clinical diagnosis of tricuspid valve prolapse is difficult, since the characteristic physical signs of tricuspid incompetence are uncommon, while apical mid-systolic click-late systolic murmur may indicate mitral valve prolapse, tricuspid valve prolapse, or a combination of the two. In the reported cases selective right ventriculography (R.A.O.) has shown pansystolic or late systolic prolapse of anterior and inferior leaflets (without or with varying degree of tricuspid incompetence) or isolated late systolic prolapse of the inferior cusp. M-mode echocardiography has shown great value in the diagnosis of tricuspid valve prolapse. On the echocardiogram several types of abnormalities have been noted which correlated well to angiocardiographic data. Tricuspid valve prolapse is of clinical importance, since this condition may be associated with significant tricuspid incompetence, a high incidence of cardiac arrhythmias, and possibly with bacterial endocarditis.

Adolescent↗

Tricuspid valve prolapse diagnosed by cross-sectional echocardiography.

Cross-sectional echocardiography utilizing the apical and longitudinal right ventricular inflow tract views was used to investigate the tricuspid valve in 64 patients with mitral valve prolapse and 16 controls who had no angiographic or echocardiographic evidence of mitral valve prolapse. The tricuspid valve leaflets and their coaptation point in systole were found to be below (towards the right ventricular apex) the level of the tricuspid valve ring in systole in all controls. Tricuspid valve prolapse, defined as the leaflet(s) of the tricuspid valve lying above the tricuspid valve ring level within the right atrium, was seen in 31/64(48 percent) of patients with mitral valve prolapse. The right ventricular inflow tract view demonstrated tricuspid valve prolapse most readily compared to the apical view, and 29 of the 31 patients with tricuspid valve prolapse had prolapse of at least two leaflets of the tricuspid valve. The 31 patients with both mitral and tricuspid valve prolapse, when compared to the 33 patients with mitral valve prolapse alone, had more symptomatology and abnormal physical findings.

Adult↗

Echocardiographic evaluation of normal and prolapsed tricuspid valve leaflets.

The tricuspid valve was examined by 2-dimensional (2-D) echocardiography in 14 patients with tricuspid valve prolapse (TVP) and in 16 normal subjects. Individual leaflets were identified anatomically and for frequency of prolapse. Maximal and minimal anular sizes were measured. Multiple tomograms of the tricuspid anulus were recorded at 30 degrees intervals around the tricuspid anulus with the transducer placed at the right ventricular apex. Anuli were reconstructed from the 6 planes and corrected for body surface area. Three leaflets of the tricuspid valve could be anatomically identified in all patients. Prolapse of all 3 leaflets was observed in 6 patients, 2 leaflets in 5 and 1 in 3. Frequency of individual leaflet prolapse was 93% for the septal cusp, 86% for the anterior and 43% for the posterior. Maximal anular circumference and area in TVP were 7.9 +/- 0.6 and 8.9 +/- 1.3 cm2/m2, respectively--significantly larger than values in normal subjects (6.4 +/- 0.5 cm/m2 and 6.1 +/- 0.9 cm2/m2, respectively) (p less than 0.001). Percent reductions in circumference and area in TVP were 14 +/- 3 and 25 +/- 5%, respectively--significantly smaller values than in normal subjects (19 +/- 4 and 33 +/- 4%, respectively). Tricuspid regurgitation (TR) was detected by contrast echocardiography in 7 of 14 patients with TVP. The severity of TR appeared to be minimal in 6 of the 7 patients, and was not associated with an increase in anular size. Thus, TVP is associated with anular dilatation irrespective of associated TR, probably as a primary pathologic characteristic.

Adult↗

[A clinicopathologic study of morphologic tricuspid valve prolapse in the aged: comparison with color Doppler evaluation].

Similar morphologic abnormalities have often been observed in the leaflets of tricuspid valve in patients with mitral valve prolapse. In the present study, morphologic tricuspid valve prolapse was analyzed in 500 consecutive autopsies of the aged over 60 years (mean 78.5 yrs, 266 men, 234 women). Additionally, the sensitivity and specificity of the color Doppler technique applied before death were assessed in 61 autopsy cases. The results were as follows: 1. The incidence of morphologic tricuspid valve prolapse was 22.2% at autopsy in 500 cases of the aged, however, tricuspid regurgitation had not clinically been detected in any of them. 2. The prolapse of 2- or 3-leaflets was common (78.5%). Among the 3 leaflets, the prolapse was more frequently observed in the anterior or posterior leaflet than in the septal leaflet. Combined tricuspid and mitral valve prolapses were observed in 22 cases (19.8%). 3. Among 61 cases examined by color Doppler echocardiography, autopsy showed that 16 cases had tricuspid valve prolapse and 14 cases tricuspid regurgitant flow signals (87.5%). 4. Regurgitant flow signals were also detected in 4 of 12 morphologically normal cases (33.3%). 5. In autopsy cases of the aged, generally, the incidence of morphologic tricuspid valve prolapse and tricuspid regurgitant flow signal were high, however, hemodynamically significant regurgitation due to prolapse was very rare.

Aged↗

Isolated tricuspid valve prolapse diagnosed by echocardiography.

Isolated tricuspid valve prolapse in the absence of mitral valve prolapse or other cardiac defects has not been previously noted. This report describes a patient who on both M-mode and two-dimensional echocardiography demonstrated tricuspid prolapse without other associated abnormalities. The implications of this finding are discussed.

Aged↗

Occurrence and significance of echocardiographically demonstrated tricuspid valve prolapse.

Echocardiograms from 562 patients were examined for evidence of the pattern of tricuspid valve prolapse. Criteria for the diagnosis can be established similar to those applicable to mitral prolapse. In 500 consecutive patients without mitral valve prolapse, there were no cases of isolated tricuspid valve prolapse. Eleven of 53 (21%) patients with mitral valve prolapse also had tricuspid valve prolapse. Four of six (67%) patients with Marfan's syndrome and mitral valve prolapse also had tricuspid valve prolapse. The occurrence of this echocardiographic pattern as an isolated finding as well as associated with mitral valve prolapse was significantly less than previous angiographic reports. Patients with both these findings tended to be older than those with mitral valve prolapse alone, but clinically differed in no other way. Use of standardized technique can minimize errors in diagnosis.

Adolescent↗

Echocardiographic detection of tricuspid valve prolapse.

The echocardiographic findings in 12 patients with tricuspid valve prolapse are presented. Eight of these patients had associated mitral valve prolapse. Only one of the above patients had the characteristic physical signs of tricuspid incompetence. Two types of abnormality were noted on the echocardiogram of the tricuspid valve. In eight patients, the systolic segment of the tricuspid valve showed an initial horizontal motion followed by a posterior motion in midsystole. Four patients exhibited posterior motion of the tricuspid valve in early systole, which reached a maximum in midsystole, and this was followed by an anterior motion, thus producing a hammock-like configuration. We conclude that echocardiography is useful in the diagnosis of tricuspid valve prolapse. Since this condition may be associated with clinically significant tricuspid incompetence or bacterial endocarditis, its recognition is of clinical importance.

Adolescent↗