Tricuspid regurgitation during pregnancy: two-dimensional and pulsed Doppler echocardiographic observations

Although precordial murmurs occur frequently during pregnancy, their origin is rarely known. To investigate the nature of these murmurs, 2-dimensional (2-D) and pulsed Doppler echocardiography was performed in 81 asymptomatic pregnant women who had new systolic precordial murmurs. End-systolic right atrial dimensions, early diastolic tricuspid anular diameters, and end-diastolic right ventricular diameters were measured from the apical 4-chamber view and compared with measurements from 26 young nonpregnant women without known heart disease. Tricuspid regurgitation (TR) was detected by pulsed Doppler echocardiography in 35 of 81 pregnant women. Thirty-two pregnant women had normal 2-dimensional and pulsed Doppler echocardiographic findings. Other valvular or congenital lesions were detected in 14 pregnant women. The right-sided intracardiac diameters were larger in all groups of pregnant women than in non-pregnant control subjects (p less than 0.001). The tricuspid anular diameter was larger in the pregnant women with TR than in pregnant women with normal pulsed Doppler echocardiographic findings (24 +/- 2 vs 22 +/- 3 mm, p less than 0.015). No patient had clinical difficulty associated with a murmur. Functional TR, therefore, often occurs in pregnancy and appears to be a result of dilation of the tricuspid anulus. TR may contribute to the development of murmurs in pregnant women.