Acquired tricuspid regurgitation

Tricuspid regurgitation can be either relative or organic. In the relative type, the valve itself is not diseased; rather, right ventricular hypertrophy and corresponding dilatation of the atrioventricular ring cause poor coaptation of the tricuspid valve leaflets, resulting in regurgitation. Patients with severe rheumatic mitral stenosis or regurgitation often have associated relative tricuspid regurgitation. Organic tricuspid regurgitation is a sequela of rheumatic fever and is uncommon clinically; it is usually accompanied by mitral and aortic valve disease. Pathological changes include fibrous thickening and retraction of the leaflets, shortening of the chordae tendineae, and annular dilatation, so that the leaflets cannot coapt completely during systole. It is often combined with fusion of the commissures, and therefore is also associated with stenosis.