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Etiology, clinical features, and evaluation of tricuspid regurgitation

Catherine M Otto, MD
Section Editor
William H Gaasch, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Tricuspid regurgitation (TR) is a relatively common abnormality. Since this lesion is frequently asymptomatic and may not be detected on physical examination, it is often diagnosed solely by echocardiography. This topic will review the etiology, pathophysiology, and clinical features associated with regurgitation of the tricuspid valve.

Management and prognosis of tricuspid regurgitation and Ebstein's anomaly of the tricuspid valve are discussed separately. (See "Management and prognosis of tricuspid regurgitation" and "Clinical manifestations and diagnosis of Ebstein anomaly".)


A small degree of tricuspid regurgitation (TR) is present in approximately 70 percent of normal adults. On echocardiography, this "normal" or physiological degree of regurgitation is localized to a small region adjacent to valve closure, often does not extend throughout systole, and has a low signal strength [1].

Abnormal degrees of TR in adults are largely functional (ie, related to tricuspid annular dilation and/or leaflet tethering in the setting of right ventricular pressure and/or volume overload) and much less often due to primary disorders of the valve apparatus [2-4]. The frequency of TR as well as valvular pathology was evaluated in a study of 5223 adults (predominantly male with a mean age of 67) who underwent echocardiography at three Veterans Affairs medical centers [2]. Moderate to severe TR was present in 819 (15.7 percent), but only 8 percent had primary tricuspid valve pathology.

Functional TR — TR in adults is most commonly functional, defined as regurgitation with apparently anatomically normal leaflets and chords. The cause of functional TR most likely is dilatation of the right atrium and right ventricle with dilation of the tricuspid annulus [5] and tethering of the tricuspid valve leaflets [6], although the mechanism of valve dysfunction has not been fully defined. Right ventricular dilatation, tricuspid annular dilatation, and tricuspid leaflet tethering may result from any condition that directly involves the right ventricle or causes elevation in right ventricular systolic pressure often with pulmonary hypertension.

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Literature review current through: Nov 2017. | This topic last updated: Aug 11, 2015.
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