Tricuspid Regurgitation Follow-up

  • Author: Mary C Mancini, MD, PhD; Chief Editor: Richard A Lange, MD   more...
 
Updated: Sep 27, 2011
 

Further Inpatient Care

Inpatient care of patients with tricuspid regurgitation requires control of the following:

  • Heart failure
  • Treatment of any infectious process that may have affected the valve
  • Control of arrhythmias that may be present (For related information, see Medscape's Cardiac Rhythm Management Resource Center.)

Anticoagulation is generally in order if atrial fibrillation is present or valve replacement has been undertaken. The international normalized ratio (INR) should be maintained between 3.0-4.0 following valve replacement, because of the associated low flow state.

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Further Outpatient Care

Patients should be carefully monitored for control of any heart failure. Repeat echocardiography is indicated at 6-month intervals for patients in whom the valve has been removed. Annual echocardiography should be considered in patients whose valve has been replaced.

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Inpatient & Outpatient Medications

Digitalis, diuretics (including potassium-sparing agents), ACE inhibitors, and anticoagulants are all indicated in the care of these patients. Antiarrhythmics are added as needed to control atrial fibrillation.

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Deterrence/Prevention

Prevention of tricuspid regurgitation from bacterial endocarditis can be undertaken by securing good dental care and avoiding the use of illicit drugs, particularly by the intravenous route.

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Complications

Complications of tricuspid regurgitation include cardiac cirrhosis, ascites, thrombus formation, and embolization. Complications of operative intervention can include heart block, arrhythmias, thrombosis of the prosthetic valve, and infection.

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Prognosis

Prognosis in these patients is generally good. If the cause of the regurgitation is infection, removal of the valve generally cures the problem, provided that the inciting cause is removed (eg, poor dentition, illicit drug use). For patients with accompanying pulmonary hypertension or cardiac dilatation, the prognosis is directly associated with the prognosis for these problems.

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Patient Education

Patients should be instructed to reduce their intake of salt. Elevation of the head of the bed may improve symptoms of shortness of breath. Careful instruction in the use of anticoagulants must be given.

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Contributor Information and Disclosures
Author

Mary C Mancini, MD, PhD  Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Martin Keane, MD, FACC, FAHA  Associate Professor, Cardiovascular Medicine Division, Department of Medicine, University of Pennsylvania School of Medicine

Martin Keane, MD, FACC, FAHA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Society of Echocardiography, Pennsylvania Medical Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald J Oudiz, MD, FACP, FACC, FCCP  Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society

Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria; Lilly Grant/research funds Clinical Trials + honoraria; LungRx Clinical Trials + honoraria; Bayer Grant/research funds Consulting

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Richard A Lange, MD  Professor and Executive Vice Chairman, Department of Medicine, Director, Office of Educational Programs, University of Texas Health Science Center at San Antonio

Richard A Lange, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and Association of Subspecialty Professors

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Frank Sheridan, MD to the development and writing of this article.

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