概述

三尖瓣反流是是一种心脏瓣膜病,指两个右心腔(右心室和右心房)之间的瓣膜不能正确闭合。这会导致血液回流进入右上腔室(右心房)。

有人可能生来就患有三尖瓣反流(先天性心脏病)。有时,三尖瓣反流是由其他健康问题引起的瓣膜问题所致。

轻度三尖瓣反流不会引起症状,或无需治疗。如果病情严重并引起体征和症状,可能需要药物或手术治疗。

渗漏的三尖瓣

三尖瓣负责让从体内流入心脏的血液流向右心室,血液在右心室被泵送到肺部以获取氧气。如果三尖瓣存在渗漏,血液可能会回流,导致心脏需要更用力地泵送血液。随着时间的推移,这会导致心脏变大和功能异常。

儿童瓣膜疾病和三尖瓣下移畸形

症状

在病情严重之前,三尖瓣反流往往不会引起体征或症状。可能会在因其他原因进行检查时发现该病。

三尖瓣反流的体征和症状可能包括:

  • 疲劳
  • 心律不齐(心律失常)
  • 颈部跳动
  • 活动性气短
  • 腹部、腿部或颈部静脉肿胀

何时就诊

如果您在活动后容易感到疲劳或气短,请与医务人员约诊。医务人员可能会将您转诊给在心脏病方面训练有素的医生(心脏科医生)。

病因

要了解导致三尖瓣反流的原因,了解心脏和心脏瓣膜通常的工作方式可能会有帮助。

正常心脏有四个腔室。两个上心腔(心房)接收血液。两个下心腔(心室)泵送血液。四片瓣膜通过开合确保血液的流动方向正确。这四片心脏瓣膜分别是:

  • 主动脉瓣
  • 二尖瓣
  • 三尖瓣
  • 肺动脉瓣

风险因素

一些因素会增加三尖瓣反流的风险,包括:

  • 先天性心脏缺陷,例如三尖瓣下移畸形
  • 心脏病发作
  • 心力衰竭
  • 血压高(高血压)
  • 肺部高血压(肺动脉高压)
  • 影响心脏的感染,例如风湿热和感染性心内膜炎
  • 曾经接受过胸部放射
  • 曾使用某些用于治疗帕金森病和偏头痛的兴奋剂和药物
  • 心肌衰弱(心肌病)

并发症

三尖瓣反流的潜在并发症可能包括:

  • 房颤(A-fib)。部分患有严重三尖瓣反流的患者也可能出现 A-fib,这是一种常见的心律失常。
  • 心力衰竭。严重的三尖瓣反流可能导致右下腔(心室)压力升高。右心室会随着时间而增大、功能减弱,最终导致心力衰竭。

在 Mayo Clinic 治疗

March 12, 2024
  1. Ferri FF. Tricuspid regurgitation. In: Ferri's Clinical Advisor 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed Feb. 7, 2024.
  2. Otto CM, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2021; doi:10.1016/j.jacc.2020.11.018.
  3. Otto CM. Etiology, clinical features, and evaluation of tricuspid regurgitation. https://www.uptodate.com/contents/search. Accessed Feb. 6, 2024.
  4. Phillips KA, et al. Contemporary early postoperative cone repair outcomes for patients with Ebstein anomaly. Mayo Clinic Proceedings. 2023; doi: 10.1016/j.mayocp.2022.06.009.
  5. What are heart valve diseases? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/heart-valve-diseases. Accessed Feb. 6, 2024.
  6. Libby P, et al., eds. Tricuspid, pulmonic, and multivalvular disease. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed Feb. 7, 2024.
  7. Patlolla SH, et al. Incidence and burden of tricuspid regurgitation in patients with atrial fibrillation. Journal of the American College of Cardiology. 2021; doi:10.1016/j.jacc.2022.09.045.
  8. Otto CM. Management and prognosis of tricuspid regurgitation. https://www.uptodate.com/contents/search. Accessed Aug. 31, 2021.
  9. Ami TR. Allscripts EPSi. Mayo Clinic. Feb. 23, 2024.
  10. AskMayoExpert. Tricuspid regurgitation (adults). Mayo Clinic. 2023.
  11. Silversides C, et al. Pregnancy and valve disease. https://www.uptodate.com/contents/search. Accessed Feb. 7, 2024.
  12. Phillips, SD (expert opinion). Mayo Clinic. Sept. 24, 2021.
  13. Tricuspid valve repair and tricuspid valve replacement. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/tricuspid-valve-repair-tricuspid-valve-replacement/about/pac-20385087. Feb. 6, 2024.
  14. Lloyd-Jones DM, et al. Life's essential 8: Updating and enhancing the American Heart Association's construct of cardiovascular health: A presidential advisory from the American Heart Association. Circulation. 2022; doi:10.1161/CIR.0000000000001078.
  15. Wilson WR, et al. Prevention of Viridans group streptococcal infective endocarditis: A scientific statement from the American Heart Association. Circulation. 2021; doi:10.1161/CIR.0000000000000969.
  16. Robert P. Frantz (expert opinion). Mayo Clinic. Sept. 17, 2023.
  17. Health Education & Content Services. Tricuspid valve regurgitation (insufficiency). Mayo Clinic; 2013.
  18. Heart valve disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-valve-disease/diagnosis-treatment/drc-20353732. Accessed Feb. 7, 2024.
  19. Fortier JH, et al. Drug-associated valvular heart diseases and serotonin-related pathways: A meta-analysis. Heart. 2019; doi:10.1136/heartjnl-2018-314403.
  20. Rowse PG (expert opinion). Mayo Clinic. Feb. 8, 2024.
  21. Risk factor. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/risk-factor. Accessed Feb. 8, 2024.
  22. Cancer causes and risk factors. VCU Massey Comprehensive Cancer Center. https://www.masseycancercenter.org/patients-and-families/patient-resources-and-support-services/cancer-causes-and-risk-factors. Accessed Feb. 9, 2024.