Tricuspid valve down

Introduction The tricuspid valve is displaced to the right ventricle, mainly the septal and posterior lobes, which are often attached to the right ventricular wall of the proximal apex rather than the fibrous ring of the tricuspid valve. The position of the anterior leaflet is normal, so right The ventricle is divided into two cavities. The ventricular wall above the deformed valve is thin, and the right atrium is connected to a large heart chamber. It is the "atrialized right ventricle" and its function is the same as that of the right atrium. The heart chamber below the malformed valve includes The apex and outflow tract are "functional right ventricles", which function as the usual right ventricle, but the heart chamber is relatively small. Often accompanied by atrial septal defect, ventricular septal defect, patent ductus arteriosus, pulmonary stenosis or atresia. An increase in right atrial pressure may occur, at which time an atrial septal defect or open foramen ovale may result in a right-to-left shunt and purpura.

Cause

The primary lesion is tricuspid valve leaflet and right ventricular dysplasia with the valvular and posterior lobes descending to the right ventricle, attached to the right ventricular wall below the tricuspid annulus by the chordae papillary muscle. The tricuspid valve leaflets enlarge or shrink, and the thickening deformation is often shortened. The lesions most often involve the lobes, followed by the posterior leaflets, and the lobes and posterior lobes may be partially absent. Lesions involving the anterior leaflet are rare. The anterior leaflet originates from the normal tricuspid annulus, which can be enlarged, such as a sail, and sometimes has many small holes that are attached to the ventricular wall by shortening and underdeveloped chordae and papillary muscles. The downwardly moving leaflet divides the right ventricle into two parts. The enlarged ventricle above the leaflet is called the ventricular ventricle, and its function is similar to that of the right atrium; the lower part of the leaflet is the functional right ventricle. The right atrium is enlarged and the fibrosis of the wall is thickened. The right atrium and the highly enlarged thin-walled right ventricle connect into a large heart chamber, which acts to store blood, while the functional right ventricle below the leaflets functions to discharge blood. Cases of tricuspid valvular dislocation often show a dysfunction due to the enlargement of the tricuspid annulus and the right ventricle and the abnormality of the leaflet. If the free edge of the leaflet is partially adhered, the enlarged anterior leaflet may cause different degrees of tricuspid stenosis due to blood flow obstruction between the atrial ventricle and the functional right ventricle. The anatomy of the atrioventricular node and the atrioventricular bundle is normal, but the right bundle branch may be thickened by endocardial compression to produce a right bundle branch block. In about 5% of cases, the abnormal Kent conduction bundle presents a pre-excitation syndrome. About 50-60% of patients with tricuspid valvular disease have a patent foramen ovale or atrial septal defect. The atrial level shows a right-to-left shunt, arterial oxygen saturation decreases, and purpura appears clinically. Other malformations include pulmonary stenosis, ventricular septal defect, patent ductus arteriosus, tetralogy of Fallot, aortic dislocation, aortic coarctation, and congenital mitral stenosis.

an examination

Related inspection

Electrocardiogram selective angiography

(A) X-ray examination performance: typical cases showed right atrial enlargement and right ventricular outflow tract moved to the outside, the upper mediastinum narrowed, pulmonary vascular texture was normal or reduced. In a few cases, the heart shadow can be free of abnormal signs.

(B) ECG examination: typical manifestations of right atrial hypertrophy, P wave high tip, incomplete or complete right bundle branch block. The right axis of the electric axis is biased, the R-wave voltage of the chest lead is lowered, the PR interval is prolonged, and there is often a supraventricular rhythm disorder. About 5% of the patients show type B pre-excitation syndrome.

(C) section echocardiography and Doppler examination: showed that the tricuspid valve anterior leaflet increased, the range of activity is large. The leaflets and posterior leaflets are obviously moved down, dysplasia, and poor mobility. The tricuspid valve is closed, the valve position is shifted to the left, and the interventricular septum is abnormal. The right atrium and the right atrium of the room show a large right atrium cavity, and the functional right ventricular cavity is shortened. Doppler examination can show atrial horizontal right to left shunt and tricuspid regurgitation.

(4) Right heart catheter and selective angiography: the right atrium cavity is huge, the pressure is increased, and the pressure curve a wave and V wave are both high. The right ventricle of the room is atrial pressure curve, the intracardiac electrocardiogram is right ventricular type, and the atrial septal defect can enter the left atrium from the right atrium. Atrial level can present right to left shunt, right ventricular systolic pressure increases normal diastolic pressure, and in some cases tricuspid valve transvalvular pressure difference can be measured. Right heart angiography showed that the right atrium was significantly enlarged to occupy the left ventricle position, and the right ventricle was located in the right ventricular outflow tract. The valve port is moved to the left edge of the spine, and the lower edge of the right ventricle shows a tricuspid annulus and another notch between the ventricular and functional ventricles. The total trunk and branches of the pulmonary artery are small, and the left atrium is developed in advance with a right to left shunt at the atrial level.

Differential diagnosis

The disease needs to be differentiated from other valvular diseases. The most important clinical identification is tricuspid dysplasia and tricuspid half-valve deficiency:

Most of the tricuspid valvular deformities are accompanied by a large number of tricuspid regurgitation, while other diseases such as tricuspid dysplasia, tricuspid prolapse, trauma, right ventricular dysplasia, endocarditis, tricuspid annulus expansion Can cause a large number of tricuspid regurgitation, but these diseases have their own characteristics easily identified. However, the absence of tricuspid valve and tricuspid dysplasia have many similarities with tricuspid valvular deformity and need to be carefully identified. The main point of differentiation is the absence of right ventricular dilatation rather than hypoplasia in the absence of the right; the absence of leaflet morphology and flap effect in the right chamber helps to identify. This differential diagnosis is important for surgically determining the surgical procedure. Tricuspid regurgitation, in some cases, severely enlarged right atrium and leaflet and right ventricular wall adhesions cause the illusion of annulus or leaflet down, but multiple sections carefully identify the non-valve lower, the right ventricular is not narrow Conversely, the contradictory movement of the enlarged and non-roomized right ventricle can be differentiated from the downward dislocation. X-ray examination showed that the majority of patients showed less pulmonary blood and a marked increase in right atrium and right ventricle. A small number of patients have normal lung blood and a slight increase in right heart. However, neither the X-ray nor the cardiac catheter can show the leaflets, so the diagnostic accuracy of the Ebstein malformation is limited.

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