Tricuspid regurgitation causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2] Fatimo Biobaku M.B.B.S [3]


Most cases of significant tricuspid regurgitation are due to tricuspid annular dilation and leaflet tethering secondary to right ventricular remodeling from volume and/or pressure overload. Such dilation leads to derangement of the normal anatomy and mechanics of the tricuspid valve and the muscles governing its proper function. The result is incompetence of the tricuspid valve. Common causes of right ventricular dilation include left heart failure, pulmonary hypertension, and right ventricular infarction.


Life Threatening Causes

Life-threatening causes of TR, which encompass conditions which may result in death or permanent disability within 24 hours if left untreated, include:[1][2][3]

Common Causes

Common causes of primary tricuspid regurgitation may include:[4][5][6][7][8]

Congenital disease

Genetic causes

Some genetic conditions may cause TR which includes the following:[9][10]

Acquired disease

  1. Right ventricular endomyocardial biopsy
  2. Blunt chest wall trauma[13]
  • Degenerated bioprosthesis

Common causes of secondary tricuspid regurgitation may include:[4][14]

  1. Left-sided valvular and/or myocardial disease
  2. Pulmonary hypertension independent of left-sided cardiac pathology
  3. Right ventricular infarction with remodeling

Causes by Organ System

Cardiovascular Acute coronary syndrome, anomalous pulmonary venous return, atrial fibrillation, atrial septal defect, cardiac sarcoidosis, congenital heart disease, congestive heart failure, coronary artery disease, dilated cardiomyopathy, Ebstein's anomaly, Eisenmenger syndrome, endomyocardial fibrosis, infective endocarditis, ischemic heart disease, left heart failure, Marantic endocarditis, mitral annular calcification, mitral regurgitation, mitral stenosis, myocardial rupture, papillary muscle rupture, pulmonary atresia, pulmonary regurgitation, pulmonary stenosis, restrictive cardiomyopathy, rheumatic heart disease, right ventricular dilation, right ventricular tumors, Takotsubo cardiomyopathy, tetralogy of Fallot, transposition of the great arteries, truncus arteriosus, ventricular septal defect
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Cabergoline, dexfenfluramine, ergotamine, fenfluramine, fluoxetine, indomethacin, methysergide, paroxetine, pergolide, phentermine, sertraline
Ear Nose Throat No underlying causes
Endocrine Carcinoid syndrome, hyperthyroidism
Environmental No underlying causes
Gastroenterologic Primary intestinal lymphangiectasia, protein-losing gastroenteropathy
Genetic Aneuploidy, congenital nephrotic syndrome, Downs syndrome, Ehlers-Danlos syndrome, Holt-Oram syndrome, Marfan's syndrome, osteogenesis imperfecta, polycystic kidney disease, Turner syndrome, X-linked dilated cardiomyopathy
Hematologic No underlying causes
Iatrogenic Acute cardiac allograft rejection, balloon valvuloplasty of the tricuspid valve, cardiac catheterization, cardiac transplant, cardiopulmonary resuscitation, cathether ablation for arrhythmias, endomyocardial biopsy, heart surgery, implantable cardioverter-defibrillator, pacemaker syndrome, percutaneous coronary intervention, permanent pacemaker, postpericardiotomy syndrome, prosthetic valve dysfunction, pulmonary artery catheterization
Infectious Disease Chagas disease, HIV, infective endocarditis, myocarditis, rheumatic fever
Musculoskeletal/Orthopedic Ehlers-Danlos syndrome, Marfan's syndrome, osteogenesis imperfecta
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic Peripartum cardiomyopathy, twin-to-twin transfusion syndrome
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Takotsubo cardiomyopathy
Pulmonary Cor pulmonale, interstitial lung disease, Loefflers syndrome, pulmonary embolism, pulmonary hypertension, pulmonary veno-occlusive disease
Renal/Electrolyte Congenital nephrotic syndrome, end stage renal disease, polycystic kidney disease
Rheumatology/Immunology/Allergy Cardiac sarcoidosis, Ehlers-Danlos syndrome, Marfan's syndrome, osteogenesis imperfecta, rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis
Sexual No underlying causes
Trauma Blunt or penetrating chest trauma
Urologic No underlying causes
Miscellaneous Functional tricuspid regurgitation

Causes in Alphabetical Order


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  14. Waller BF, Moriarty AT, Eble JN, Davey DM, Hawley DA, Pless JE (1986) 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. J Am Coll Cardiol 7 (5):1063-74. DOI:10.1016/s0735-1097(86)80224-8 PMID: 3958362
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