ISSN 2398-2969      

Heart: tricuspid valve degenerative disease

icanis
Contributor(s):

Serena Brownlie

Liz Bode

Synonym(s): Myxomatous tricuspid valve disease (MMVD), Degenerative tricuspid valve disease, Chronic valvular disease, Endocardiosis of tricuspid valve


Introduction

  • Usually concurrent left-sided degenerative valve disease, rarely tricuspid degenerative valve disease with right-sided heart failure predominates over left-sided lesion. Can also be seen with degeneration of the aortic and/or pulmonic valves. 
  • Insufficiency can be exacerbated by concurrent pulmonary hypertension. 
  • Cause: insufficient right atrioventricular valve due to degenerative changes of the valve and associated structures.
  • Signs: right-sided heart failure, murmur auscultated over the right apex can sometimes be appreciated.
  • Diagnosis: signs, echocardiography.
  • Treatment: symptomatic.

Pathogenesis

Etiology

Predisposing factors

General

Specific

Pathophysiology

  • Myxomatous degeneration of tricuspid valve is almost always less severe than mitral valve.
  • Valvular incompetence resulting in tricuspid regurgitation → volume overloading of right atrium and right ventricle, consequently right atrial and right ventricular enlargement.
  • Development of right-sided heart failure is associated with raised end-diastolic right ventricular pressure and right atrial pressure → raised right atrial pressure causes backwards failure with increased systemic pressures.
  • Hepatic venous drainage is compromised leading to hepatomegaly and hepatocellular damage → leaky hepatic sinusoids and raised, central venous pressure causes ascites.
  • See also congestive heart failure Heart: congestive heart failure.
  • Degenerative tricuspid valve disease → tricuspid regurgitation → right-sided volume overload → slow development of right atrial and right ventricular enlargement → right ventricular eccentric hypertrophy → further tricuspid incompetence.
  • Increased right ventricular end-diastolic pressure and right atrial pressure → systemic venous congestion → increased central venous pressure → chronic hepatic venous congestion and hepatocellular cell damage (increased alanine transferase) → hepatic sinusoids are leaky → fluid extravasation into abdomen (ascites).
  • Ascites and gastrointestinal edema may result in compromised absorption of nutrients (and drugs) and lead to signs like diarrhea.
  • Pleural effusion may result from compromised pleural drainage into the systemic circulation.
  • Hypoproteinemia Hypoproteinemia may result due to poor absorption, hepatic sinusoidal loss of protein, compromised liver function and inappetence.
  • With severe long-standing right-sided congestive heart failure associated with ascites and hypoproteinemia, subcutanenous edema may occasionally be recognized due to altered capillary homeostasis (Starlings law).

Timecourse

  • Development of right-sided heart failure is a poor prognostic sign and death (often euthanasia) usually follows within weeks or months.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Borgarelli M et al (2020) DELay of Appearance of sYmptoms of Canine Degenerative Mitral Valve Disease Treated with spironolactone and Benazepril: the DELAY Study. J Vet Cardiol 27, 34-53 PubMed.
  • Wess G et al (2020) Efficacy of adding ramipril (VAsotop) to the combination of furosemide (Lasix) and pimobendan (VEtmedin) in dogs with mitral valve degeneration: The VALVE trial. JVIM 34(6), 2232-2241 PubMed.
  • Packer M (1998) Neurohormonal interactions and adaptations in congestive heart failure. Circulation 77 (4), 721-730 PubMed.
  • The COVE Study Group (1995) Controlled clinical evaluation of enalapril in dogs with heart failure - results of the Cooperative Veterinary Enalapril Study Group. JVIM 9 (4), 243-252 PubMed
  • The IMPROVE Study Group (1995) Acute and short-term hemodynamic, echocardiographic and clinical effects of enalapril maleate in dogs with naturally acquired heart failure - results of the Invasive, Multicenter, PROspective Veterinary evaluation of Enalapril study. JVIM 9 (4), 234-242 PubMed.
  • Francis G S & Chu C (1994) Compensatory and maladaptive responses to cardiac dysfunction. Current Opinion in Cardiology 9 (3), 280-288 PubMed.
  • Schlesinger D P & Rubin S I (1994) Potential adverse effects of angiotensin converting enzyme inhibitors in the treatment of congestive heart failure. Comp Cont Educ Pract Vet 16 (3), 275-283 VetMedResource.

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