Tricuspid Valve Regurgitation

My six year old son went in for a check-up and a heart murmur was discovered. The PA ordered an ECHO to be done. I just got a call from the office saying that the Tricuspid Valve has trival regurgitation with RV pressure at 21. They left a message that I can just have it watched or that I could have the office send my son to a specialist. I am at awe at what to do. I left a message for someone to call me back so I could ask questions about this.
What does all this mean.
I

[kenkeith]

If the diagnoses was for an adult there wouldn't be any concern because terms that relate to valve leakage such as trivial, mild, trace is considered medically insignificant and it almost never progresses nor cause a medical problem. And normal RV pressure is 15-25 mmHg for an adult.  

I don't believe a stethoscope that hears a murmur qualifies as a diagnosis for determining the degree of leakage or whether there is or is not a leakage.  Sometimes a murmur is heard and a follow-up indicates it is an innocent murmur.  Not uncommon with children to hear an innocent murmur.
Are there any symptoms such as unusual shortness of breath, chest pain, easily fatigued...?

An echocardiogram would be the test to determine a valve disorder. Regardless it is not a condition of urgency, especially if your son does not have symptoms.  Hope the helps give you an insight for consultation with your son's doctor.  Take care and thanks for sharing, and if you have any follow-up questions you are welcome to post.

[skippyjones]

Thank you for replying! :)

We had the ECHO done yesterday and today they called me with the message about the Tricuspid Valve has trival regurgitation with RV pressure at 21.
I called back and left a message b/c I really wanted to talk to someone...I have questions.
If the result of the valve is trivial why did they give me the option of monitoring over time or seeing a specialist?

He was a "strep" carrier in our family for close to a year; he was asymptomatic and we finally had everyone tested in the household and discovered that it was him giving strep to everyone. So, this makes me concerned.

I know he does complain that he is so tired and exhausted but to be honest I thought he was just being lazy.

You mentioned that normal RV pressure is 15-25 mmHg for an adult is this the same for a child?

So, I am not sure if I should a specialist look at him and the results.

Any suggestions?

[kenkeith]

QUOTE: You mentioned that normal RV pressure is 15-25 mmHg for an adult is this the same for a child?

>>>>Until one becomes an adult their organs and body system is growing, and whether that is an issue or not and what influence if any that has may be better answered by a pediatric cardiologist.  

For instance in children, blood pressure and heart rate normally vary with age. While blood pressure tends to get higher with age, heart rate tends to get lower with age. In addition, a taller person tends to have a higher blood pressure because more "pressure" is needed to pump the blood around the body. And it is not clear how that would effect right side pressures.

Pediatrics involves the effects of heart rate and right ventricular pressure on right coronary arterial flow and its systolic (pumping) versus diastolic (filling) distribution in a variety of congenital heart diseases in children.

QUOTE: If the result of the valve is trivial why did they give me the option of monitoring over time or seeing a specialist?

>>>>Trivial valve leakage should not cause any symptoms. Symptoms usually occur when the leakage is moderate to severe.  The right ventricle will enlarge and right ventricle pressure will rise. No comment so apparently, the right ventricle is normal size (for a child?!), and pressure appears to be within the normal range (for adult, child?).

What may guide you for further evaluation with a cardiologist may depend on any relevant symptoms.  I don't know what a cardiologist can do as it has been determined there is trivial valve leakage, and that shouldn't cause any symptoms and no treatment available nor is it necessary. If you were to see a cardiologist, and based on the information given, (s)he would wait and watch.

Hope this helps, and I understand the stress that you are under and the difficulty to make a decision.

Take care.

[grendslori]

I can understand about you being concerned over this news. Usually a trivial leakage isn't much to worry about. If it sets your mind to ease, ask to see the pediatric cardiologist, it isn't going to hurt. Most understand the fears of the parents and will take the time to answer your questions. My one daughter is also a strep carrier; I don't think that will be an issue for you. Strep issues usually affect the joints. if can affect the heart but as far as I know if affects the muscle more than the valves. Don't quote me on that one, but I think that is acurate. Things that would fall into that catagory would be things like Rhuematic Fever. While I can agree with ken on pretty much everything he has written, I would like to say that listening to the heart can detect certain types of heart disease. That happened in the case of my own daughter who had Hypertrophic Cardiomyopathy. There is a very specific type of murmur heard with this type of heart disease. Most murmurs heard in children are functional murmurs which are of no significance. Again, see the pediatric cardiologist if it will help ease your mind. Take care.  

[kenkeith]

QUOTE: While I can agree with ken on pretty much everything he has written, I would like to say that listening to the heart can detect certain types of heart disease.

>>>>There is no disagreement that a murmur heard can indicate a heart issue, but many child murmurs are innocent (functional if wish), and has said disappears as a child ages.  It is true different sounds are specific for different conditions and are associated with the sound produced as blood flows through the heart.  What is the specific sound heard for HCM (hypertrophy myocardiomyopathy) and if there is a sound, isn't it related to blood flow through the mitral valve (left side valve) not the tricuspid (right side)?

True a murmur can be heard when there is dynamic outflow obstruction (when present in HCM) and almost always due to systolic anterior motion of the anterior leaflet of the mitral valve and left side of the heart. The child's heart issue, if any, appears to be with the right side of the heart.

Lets not unduly alarm with a very serious condition of HCM when there is no evidence :)....

[grendslori]

Ken, I agree. I wasn't trying to alarm, only to say that when listening to the heart, certain types of murmurs lead to a diagnosis of a form of certain heart disease. Without going back through my daughter's records, I think she had a Grade V/VI systolic ejection murmur. I remember them saying it was a rare murmur and because of that all the interns/residences were always brought in to see her and listen to the murmur. The murmur would have been related to the mitral valve. You do not have to have an obstruction to hear this type of murmur. You ae absolutely right about most murmurs in children are classified as 'functional'. They have no significance whatsoever. :)
BTW.... it's cardiomyopathy, not myocardiomyopathy........:):)  

[kenkeith]

You ae!? :)  

[grendslori]

okay Ken....I see a smiley face so I'm guessing your reply was a funny one........trouble is, I don't know what it means so can you enlighten me once again???:):)

[grendslori]

Okay........could 'ae' possibably mean: 'anything else'? LOLs!  


(I cheated and looked it up on Google!)


If so, to answer your question.......no, but please let me have my fun. I find it difficult to EVER find ANYTHING you write to be in error! You are one SMART guy!!

My best to you!

[kenkeith]

"You ae" is from your post!  I'm sorry,  thought you would pickup on YOUR error as you commented on my misspelling! Didn't mean to distress!  Take care and thanks for your input.

[grendslori]

LOLs!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! That's just TOO funny!!!!

[skippyjones]

Thankl you so much for all your input. I did finally talk to a cardiologist. They are not concerned at this point but they are going to do a follow up in six months just to evaulate.

I appreciate all you and Ken had to offer!!!

Thank you,
Skippy :)

[skippyjones]

Thank you so much for all you had to offer and making me feel better. As you can see in grendslori's post...I did get a cardiologist to see him and give me more info.

Thank you for everything.

Skippy :)

[kenkeith]

You are welcome.  Hope it goes well for your son, and you son is fortunate to have such a caring mother.