Idiopathic annular dilation: A rare cause of isolated severe tricuspid regurgitation

The management of patients with severe tricuspid regurgitation (TR) require s the clinician to clarify the mechanism of regurgitation. Primary disorder s of the tricuspid valve, either congenital or acquired, may be readily ide ntified by echocardiography. Severe TR most often results from left-sided h eart disease and secondary pulmonary hypertension. Cardiomyopathic processe s may also cause right ventricular failure and functional TR. We report thr ee patients with severe TR dire to idiopathic annular dilation. The tricusp id valves were otherwise normal on surgical inspection, and the pulmonary p ressures were not significantly elevated. Each patient was aged over 65 yea rs and had chronic atrial fibrillation with preserved left ventricular syst olic function. Surgical treatment was associated with marked clinical impro vement. Clinicians should recognize this unusual but treatable cause of rig ht-sided congestive heart failure.