Tricuspid Regurgitation Medication
- Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Richard A Lange, MD, MBA more...
The medical therapy used in the treatment of tricuspid regurgitation is directed toward the control of heart failure that is causing or contributing to the problem. Drugs used include diuretics, digoxin, and angiotensin-converting enzyme (ACE) inhibitors. Patients who have atrial fibrillation or who have received a prosthetic valve require anticoagulation.
Diuretics are used to control the fluid overload associated with tricuspid regurgitation.
Furosemide increases excretion of water by interfering with the chloride-binding cotransport system, which in turn inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. The dose must be individualized to the patient. Depending on response, administer at increments of 20-40 mg, no sooner than 6-8 h after the previous dose, until desired diuresis occurs. When treating infants, titrate with 1 mg/kg/dose increments until a satisfactory effect is achieved.
These drugs (primarily digoxin) are used to control atrial fibrillation and to increase myocardial contractility.
Digoxin (Lanoxin, Digox)
Digoxin is a cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. This agent acts directly on cardiac muscle, increasing myocardial systolic contractions. Its indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.
Angiotensin-Converting Enzyme Inhibitors
ACE inhibitors are used to provide afterload reduction, thereby decreasing the volume load on the right ventricle.
Captopril prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in increased levels of plasma renin and a reduction in aldosterone secretion.
Enalapril is a competitive ACE inhibitor that reduces angiotensin II levels and decreases aldosterone secretion.
Lisinopril prevents conversion of angiotensin I to angiotensin II, resulting in decreased aldosterone secretion.
In patients who have undergone valve replacement for treatment of severe tricuspid regurgitation, anticoagulants are used to prevent thrombosis and embolization from the prosthetic valve.
Warfarin interferes with hepatic synthesis of vitamin K–dependent coagulation factors. It is used for prophylaxis and treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders. Tailor the dose to maintain an international normalized ratio (INR) in the range of 2-3.
Frater R. Tricuspid insufficiency. J Thorac Cardiovasc Surg. 2001 Sep. 122(3):427-9. [Medline].
Topilsky Y, Tribouilloy C, Michelena HI, Pislaru S, Mahoney DW, Enriquez-Sarano M. Pathophysiology of tricuspid regurgitation: quantitative Doppler echocardiographic assessment of respiratory dependence. Circulation. 2010 Oct 12. 122(15):1505-13. [Medline].
Khan IA. Ebstein's anomaly of the tricuspid valve with associated mitral valve prolapse. Tex Heart Inst J. 2001. 28(1):72. [Medline].
Simula DV, Edwards WD, Tazelaar HD, et al. Surgical pathology of carcinoid heart disease: a study of 139 valves from 75 patients spanning 20 years. Mayo Clin Proc. 2002 Feb. 77(2):139-47. [Medline].
Luo GH, Ma WG, Sun HS, et al. Correction of traumatic tricuspid insufficiency using the double orifice technique. Asian Cardiovasc Thorac Ann. 2005 Sep. 13(3):238-40. [Medline].
Topilsky Y, Khanna AD, Oh JK, et al. Preoperative factors associated with adverse outcome after tricuspid valve replacement. Circulation. 2011 May 10. 123(18):1929-39. [Medline].
Sugimoto T, Okada M, Ozaki N, et al. Long-term evaluation of treatment for functional tricuspid regurgitation with regurgitant volume: characteristic differences based on primary cardiac lesion. J Thorac Cardiovasc Surg. 1999 Mar. 117(3):463-71. [Medline].
[Guideline] Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2012 Oct. 33(19):2451-96. [Medline].
Ha JW, Chung N, Jang Y, Rim SJ. Tricuspid stenosis and regurgitation: Doppler and color flow echocardiography and cardiac catheterization findings. Clin Cardiol. 2000 Jan. 23(1):51-2. [Medline].
Shah PM, Raney AA. Tricuspid valve disease. Curr Probl Cardiol. 2008 Feb. 33(2):47-84. [Medline].
Vlahos AP, Feinstein JA, Schiller NB, Silverman NH. Extension of Doppler-derived Echocardiographic Measures of Pulmonary Vascular Resistance to Patients with Moderate or Severe Pulmonary Vascular Disease. J Am Soc Echocardiogr. 2008 Jan 8. [Medline].
Yang WI, Shim CY, Kang MK, et al. Vena contracta width as a predictor of adverse outcomes in patients with severe isolated tricuspid regurgitation. J Am Soc Echocardiogr. 2011 Sep. 24(9):1013-9. [Medline].
Anderson C, Filsoufi F, Farivar RS, Adams DH. Optimal management of severe tricuspid regurgitation in cardiac transplant recipients. J Heart Lung Transplant. 2001 Feb. 20(2):247. [Medline].
DeLeon MA, Gidding SS, Gotteiner N, Backer CL, Mavroudis C. Successful palliation of Ebstein's malformation on the first day of life following fetal diagnosis. Cardiol Young. 2000 Oct. 10(4):384-7. [Medline].
Filsoufi F, Anyanwu AC, Salzberg SP, et al. Long-term outcomes of tricuspid valve replacement in the current era. Ann Thorac Surg. 2005 Sep. 80(3):845-50. [Medline].
Gatti G, Maffei G, Lusa AM, Pugliese P. Tricuspid valve repair with the Cosgrove-Edwards annuloplasty system: early clinical and echocardiographic results. Ann Thorac Surg. 2001 Sep. 72(3):764-7. [Medline].
Roberts PA, Boudjemline Y, Cheatham JP. Percutaneous Tricuspid Valve Replacement in Congenital and Acquired Heart Disease. JACC. 2011. 58:117-22.