Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US.
Methodist Debakey Cardiovasc J. 2022 Jun 3;18(3):87-88. doi: 10.14797/mdcvj.1095. eCollection 2022.
A 73-year-old male with a history of dilated cardiomyopathy and paroxysmal atrial fibrillation underwent transthoracic echocardiography (TTE) to evaluate for endocarditis due to fever and gram-positive cocci in chains on blood cultures. TTE revealed a 3 × 8 mm mass on the ventricular aspect of the tricuspid valve ( ). Subsequent transesophageal echocardiography (TEE) showed that the mass in question was actually myxomatous degeneration of the tricuspid valve (TV) and redundant chordae with significant valve prolapse. shows the prolapsing TV leaflets at the same level as the mitral valve. and show the valve at the level of the annulus in early systole and then prolapsing 8 mm in mid-late systole, respectively. Tricuspid valve prolapse (TVP) is uncommon, and one study of 118,000 patients reported an incidence of 0.3%. Since diagnostic parameters are not clearly defined, diagnosis is often determined subjectively. One objective criteria, > 2 mm atrial displacement of the TV leaflets in the TEE parasternal short-axis view, is noted to have high diagnostic accuracy. TVP is commonly associated with mitral valve prolapse. Patients with TVP have more severe tricuspid regurgitation and right-sided chamber enlargement compared to patients with no TVP. Due to the lack of significant tricuspid regurgitation in this case, the patient was reassured, and no further intervention was recommended.
一位 73 岁男性，有扩张型心肌病和阵发性心房颤动病史，因发热和血培养阳性球菌而行经胸超声心动图（TTE）检查以评估心内膜炎。TTE 显示三尖瓣心室面有一个 3×8mm 的肿块（图 1）。随后的经食管超声心动图（TEE）显示，有问题的肿块实际上是三尖瓣（TV）粘液瘤样变性和多余的腱索，伴有明显的瓣膜脱垂。图 2 显示脱垂的 TV 瓣叶与二尖瓣在同一水平。图 3 和图 4 显示瓣叶在收缩早期处于瓣环水平，然后在收缩中期晚期脱垂 8mm。三尖瓣脱垂（TVP）并不常见，一项对 118000 例患者的研究报告发病率为 0.3%。由于诊断参数未明确界定，诊断通常是主观确定的。一个客观标准，即 TEE 胸骨旁短轴切面 TV 瓣叶的>2mm 心房移位，被认为具有较高的诊断准确性。TVP 通常与二尖瓣脱垂相关。与无 TVP 的患者相比，TVP 患者的三尖瓣反流更严重，右侧心腔扩大。由于本例中三尖瓣反流不明显，患者得到了安抚，不建议进一步干预。
