Case of An Isolated Tricuspid Valve Regurgitation Presenting as Right Sided Heart Failure

Abstract

Trivial to mild tricuspid regurgitation is commonly seen in patients with a normal right heart. It is usually asymptomatic and when severe enough may cause symptoms of right-sided heart failure such as ascites, edema and congestive hepatopathy. We present a case of a 46-year-old female who presented with progressive bipedal edema. Transthoracic echocardiography showed dilated right atrium and right ventricle with severe tricuspid regurgitation. Patient then underwent tricuspid valve replacement with a 29mm bioprosthetic valve. Final histopath report showed myxomatous degeneration of valve leaflets. Post-operatively, patient developed increasing shortness of breath and orthopnea. A repeat transthoracic echo revealed decompensation of right ventricle with decline in right ventricular systolic function. Patient was then given inotropic support with milrinone and norepinephrine and adequate diuresis with IV furosemide. She was gradually weaned off the inotropes. Prior to discharge, a repeat transthoracic echocardiogram done showed improvement of right ventricular systolic function and she was discharged on oral furosemide and spironolactone.