# Isolated rheumatic tricuspid valve regurgitation: it is only rare not just a myth: rare case report

## TL;DR

A rare case of isolated rheumatic tricuspid valve regurgitation is reported, highlighting diagnostic challenges and treatment approaches.

## Contribution

This case report emphasizes the importance of echocardiography in diagnosing rare rheumatic heart disease affecting the tricuspid valve.

## Key findings

- Echocardiography revealed significant tricuspid valve thickening and severe regurgitation in a patient with latent rheumatic heart disease.
- Medical therapy provided only temporary relief, leading to surgical tricuspid valve replacement due to persistent symptoms.
- Isolated tricuspid valve regurgitation is rare, with limited treatment options and uncertain long-term outcomes.

## Abstract

Isolated rheumatic tricuspid regurgitation (IRTR) is a rare condition that can manifest as right heart failure (RHF) and pulmonary hypertension (PH) symptoms. Diagnosing and treating IRTR in cases of latent RHD can be a challenge and crucial for future research to establish new guidelines for echocardiography in RHD that focus not only on the mitral and aorta but also the tricuspid valve.

A young female patient with clinical symptoms of RHF suspected IRTR due to latent RHD from echocardiography. Echocardiography revealed significant thickening and calcification of all tricuspid valve (TV) leaflets, with partial prolapse posterior leaflet and severe tricuspid regurgitation (TR) with a high probability of PH, no significant anatomical and functional abnormality pulmonary valve (PV), mitral valve (MV), and aortic valve (AV). She was administered daily doses of Ramipril, bisoprolol, spironolactone, and furosemide. Although she received therapy, she persisted in suffering dyspnea when doing mild physical activity (NYHA functional class III). She was admitted to the surgical conference, due to our center’s limitation of percutaneous intervention for valve replacement, and she was approved to undergo tricuspid valve replacement (TVR) surgery.

Echocardiography plays a crucial role in identifying latent RHD. Isolated rheumatic TR shows echocardiographic results similar to rheumatic mitral regurgitation, except for the presence of a high-velocity jet. Diuretics temporarily slow symptoms, but disease progression remains uncertain. TV surgery is effective for severe symptoms, but isolated TVR is rare and has a poor prognosis.