Is there a treatment for tricuspid valve closure?

It is common in obvious mitral valve disease and chronic pulmonary heart disease. According to the typical murmur, right ventricle and right atrium enlargement, systemic congestion and other symptoms and signs, it is generally not difficult to make a diagnosis. Echocardiography, contrast-enhanced ultrasound and Doppler ultrasound can make a definite diagnosis and help to diagnose the cause. The treatment is simple tricuspid insufficiency without pulmonary hypertension, such as secondary to infective endocarditis or trauma, which generally does not require surgical treatment. Active treatment of heart failure caused by other causes can improve the severity of functional tricuspid regurgitation. When mitral valve disease is accompanied by pulmonary hypertension and the right ventricle is significantly enlarged, tricuspid insufficiency can be gradually reduced or disappeared without special treatment after correcting mitral valve abnormality and reducing pulmonary artery pressure. Patients with severe organic tricuspid valve disease, especially those with rheumatic diseases without severe pulmonary hypertension, can undergo valvuloplasty or artificial heart valve replacement. Etiology Tricuspid insufficiency is mostly caused by pulmonary hypertension and tricuspid dilatation. Common in obvious mitral valve disease and chronic cor pulmonale, inferior myocardial infarction involving right ventricle, rheumatic or congenital heart disease and pulmonary hypertension caused by late heart failure, ischemic heart disease and cardiomyopathy; Rare cases, such as rheumatic tricuspid valve shortening and deformation, are often complicated with tricuspid valve stenosis; Congenital Ebstein malformation; Valve damage caused by infective endocarditis; Tricuspid valve prolapse, such patients are often accompanied by mitral valve prolapse, which is common in Marfan syndrome; Right atrial myxoma, right ventricular myocardial infarction and chest trauma can also be seen. Carcinoid syndrome can cause acquired tricuspid regurgitation, because carcinoid plaque is often deposited on the ventricular surface of tricuspid valve, and the apex of tricuspid valve adheres to the right ventricular wall, thus causing tricuspid regurgitation. Most of these patients have pulmonary valve lesions at the same time. Tricuspid insufficiency often leads to a marked enlargement of the right heart. Clinically, the pathophysiological changes of the right heart caused by tricuspid insufficiency are similar to those of the left heart caused by mitral insufficiency, but the compensation period is longer. If the disease progresses gradually, it will eventually lead to hypertrophy of the right ventricle and right atrium and right ventricular failure. Patients with obvious pulmonary hypertension develop rapidly. (1) Symptoms When tricuspid insufficiency is complicated with pulmonary hypertension, symptoms of decreased cardiac output and systemic congestion may occur. In patients with tricuspid insufficiency complicated with mitral valve disease, the symptoms of pulmonary congestion can be alleviated due to the development of tricuspid insufficiency, but other symptoms of fatigue and decreased cardiac output can be more serious. (2) The main sign is systolic murmur of the left lower sternum, which can be enhanced after inhaling and compressing the liver; However, if the failed right ventricle cannot increase the stroke volume, it is difficult to enhance the murmur. Only when the flow is very large, the tricuspid valve area has a third heart sound and a low-key mid-diastolic murmur. V wave of jugular vein pulse graph (also called reflux wave, which is caused by blood flowing back to the right atrial vein when the right ventricle contracts) increases; I can feel the liver pulse. When the valve is prolapsed, non-ejection sound can be heard in the tricuspid valve area. The symptoms of congestion are the same as those of right heart failure. Auxiliary examination (1) X-ray examination showed that the right ventricle and right atrium were enlarged. In patients with elevated right atrial pressure, azygos vein dilatation and pleural effusion can be seen; If there is ascites, you should lift the diaphragm. The contraction pulse of the right atrium can be seen in fluoroscopy. (2) ECG examination can show right ventricular hypertrophy and strain and right atrial hypertrophy; And there is often right bundle branch block. (3) Echocardiography showed that the right ventricle and atrium were enlarged, and the superior and inferior vena cava were widened and pulsated; Flail tricuspid echocardiography can confirm reflux, and Doppler ultrasound can judge the degree of reflux and pulmonary hypertension. Differential diagnosis should be differentiated from low ventricular septal defect with mitral insufficiency. Mitral regurgitation: a typical wind-blown systolic murmur in apical region, accompanied by enlargement of left atrium and left ventricle. Tricuspid insufficiency: A localized wind-blown systolic murmur is heard at the lower end of the left sternum, which can be enhanced when inhaling and weakened when exhaling due to the increase of cardiac blood volume. When pulmonary hypertension occurs, the second heart sound of pulmonary valve is hyperactive and the V wave of jugular vein is increased. There may be liver pulsation and swelling. Electrocardiogram and X-ray examination showed right ventricular hypertrophy. Echocardiography can make a definite diagnosis.