Etiology of pure tricuspid regurgitation based on anular circumference and leaflet area: Analysis of 45 necropsy patients with clinical and morphologic evidence of pure tricuspid regurgitation

B. F. Waller, A. T. Moriarty, John Eble, D. M. Davey, D. A. Hawley, J. E. Pless

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Abstract

Despite recent renewed interest in the detection of tricuspid valve regurgitation by echocardiographic and Doppler techniques, little morphologic information is available on dysfunctioning tricuspid valves. This report describes 45 necropsy patients with clinical and morphologic evidence of pure (no element of stenosis) tricuspid regurgitation and provides morphometric observations (anular circumference, leaflet area) of the tricuspid valve useful in determining the etiology of pure tricuspid regurgitation. Of 45 patients, 24 (53%) had pure tricuspid regurgitation resulting from an anatomically abnormal valve (prolapse in 7, papillary muscle dysfunction in 6, rheumatic disease in 5, Ebstein's anomaly in 3, infective endocarditis in 2, carcinoid tumor in 1), and 21 (47%) had an anatomically normal valve with systolic pulmonary artery hypertension (cor pulmonale in 12, mitral stenosis in 9). Anular circumference was dilated (>12 cm) in patients with various causes of pulmonary hypertension, floppy valve and Ebstein's tricuspid anomaly. Leaflet area was increased in floppy valve and Ebstein's anomaly. Of the 45 patients, 24 had pulmonary systolic artery pressure measurements available for correlation with tricuspid valve morphology. Pulmonary artery pressures accurately predicted morphologically normal from abnormal valves in 16 patients (89%). Morphologic overlap occurred in six patients with pulmonary pressures of 41 to 54 mm Hg. Of these six, the additional knowledge of normal or dilated anular circumference correctly separated valves with normal and abnormal leaflets.

Original languageEnglish
Pages (from-to)1063-1074
Number of pages12
JournalJournal of the American College of Cardiology
Volume7
Issue number5
StatePublished - 1986

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Tricuspid Valve Insufficiency
Tricuspid Valve
Ebstein Anomaly
Pulmonary Artery
Pulmonary Hypertension
Pressure
Pulmonary Heart Disease
Papillary Muscles
Mitral Valve Stenosis
Prolapse
Carcinoid Tumor
Endocarditis
Rheumatic Diseases
Pathologic Constriction
Blood Pressure
Lung

ASJC Scopus subject areas

  • Nursing(all)

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Etiology of pure tricuspid regurgitation based on anular circumference and leaflet area : Analysis of 45 necropsy patients with clinical and morphologic evidence of pure tricuspid regurgitation. / Waller, B. F.; Moriarty, A. T.; Eble, John; Davey, D. M.; Hawley, D. A.; Pless, J. E.

In: Journal of the American College of Cardiology, Vol. 7, No. 5, 1986, p. 1063-1074.

Research output: Contribution to journalArticle

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abstract = "Despite recent renewed interest in the detection of tricuspid valve regurgitation by echocardiographic and Doppler techniques, little morphologic information is available on dysfunctioning tricuspid valves. This report describes 45 necropsy patients with clinical and morphologic evidence of pure (no element of stenosis) tricuspid regurgitation and provides morphometric observations (anular circumference, leaflet area) of the tricuspid valve useful in determining the etiology of pure tricuspid regurgitation. Of 45 patients, 24 (53{\%}) had pure tricuspid regurgitation resulting from an anatomically abnormal valve (prolapse in 7, papillary muscle dysfunction in 6, rheumatic disease in 5, Ebstein's anomaly in 3, infective endocarditis in 2, carcinoid tumor in 1), and 21 (47{\%}) had an anatomically normal valve with systolic pulmonary artery hypertension (cor pulmonale in 12, mitral stenosis in 9). Anular circumference was dilated (>12 cm) in patients with various causes of pulmonary hypertension, floppy valve and Ebstein's tricuspid anomaly. Leaflet area was increased in floppy valve and Ebstein's anomaly. Of the 45 patients, 24 had pulmonary systolic artery pressure measurements available for correlation with tricuspid valve morphology. Pulmonary artery pressures accurately predicted morphologically normal from abnormal valves in 16 patients (89{\%}). Morphologic overlap occurred in six patients with pulmonary pressures of 41 to 54 mm Hg. Of these six, the additional knowledge of normal or dilated anular circumference correctly separated valves with normal and abnormal leaflets.",
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