Right heart valve disease

Medicine > Cardiovascular

Background knowledge 🧠

Definition

Right heart valve disease refers to dysfunction of the tricuspid or pulmonary valves.
Can lead to right-sided heart failure due to valve stenosis or regurgitation.
Most common types include tricuspid regurgitation and pulmonary stenosis.

Epidemiology

Less common than left-sided valve disease.
Tricuspid regurgitation is the most prevalent right-sided valve disease.
Can be secondary to left-sided heart disease, pulmonary hypertension, or carcinoid syndrome.
Pulmonary valve disease often congenital.

Aetiology and pathophysiology

Tricuspid regurgitation: Functional (due to right ventricular dilation) or structural (due to infective endocarditis or trauma).
Tricuspid stenosis: Rare, usually rheumatic or congenital.
Pulmonary stenosis: Typically congenital, but can occur from rheumatic disease or carcinoid syndrome.
Pulmonary regurgitation: Often secondary to pulmonary hypertension or prior valve surgery.

Types

Tricuspid regurgitation
Tricuspid stenosis
Pulmonary stenosis
Pulmonary regurgitation

Clinical Features 🌡️

Symptoms

Fatigue
Dyspnoea
Abdominal discomfort or bloating (due to hepatic congestion)
Peripheral oedema
Palpitations

Signs

Jugular venous distention (JVD)
Hepatomegaly (pulsatile in tricuspid regurgitation)
Peripheral oedema
Ascites (in severe cases)
Murmurs: holosystolic murmur at left sternal edge in tricuspid regurgitation; ejection systolic murmur in pulmonary stenosis.

Investigations 🧪

Tests

ECG: May show right atrial enlargement, right ventricular hypertrophy.
Chest X-ray: May show cardiomegaly or pulmonary artery enlargement.
Echocardiography: Essential for diagnosis, assesses valve morphology and function.
Cardiac MRI: May be used for detailed anatomical assessment.
Cardiac catheterisation: Invasive, for haemodynamic assessment.

Management 🥼

Management

Medical: Diuretics for fluid overload, vasodilators for pulmonary hypertension.
Surgical: Valve repair or replacement for severe cases.
Percutaneous interventions: E.g., balloon valvuloplasty for pulmonary stenosis.
Treat underlying causes: E.g., treating infective endocarditis or managing left-sided heart disease.

Complications

Right-sided heart failure
Hepatic congestion (chronic)
Arrhythmias (e.g., atrial fibrillation)
Infective endocarditis
Embolic events

Prognosis

Depends on underlying cause and severity.
Severe untreated disease has poor outcomes.
Post-surgery outcomes generally good if performed early.
Better prognosis if underlying condition (e.g., pulmonary hypertension) is well managed.

Key points

Right heart valve disease is less common but clinically significant.
Prompt identification and management are essential to prevent right-sided heart failure.
Echocardiography is the diagnostic cornerstone.
Surgical intervention may be required for severe cases.
Regular follow-up is key to monitor progression and complications.

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