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Right heart valve disease

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 stenosisΒ 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 hypertensionΒ 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 πŸ§ͺ

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 πŸ₯Ό

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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