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Tricuspid Valve Regurgitation Manifesting in Gastrointestinal Symptoms
Ninoshka Pérez-Soto1, Angélica Fregoso-Sánchez2, Jorge Javier Miguel-González2
1Research Department, Instituto Cardiovascular de Mínima Invasión, Zapopan, Jalisco, México; Research Department, Universidad Autónoma de Guadalajara - School of Medicine, International Program.
Background:
Tricuspid regurgitation has a typical presentation coexisting with right heart failure symptoms and is challenging to diagnose, with extracardiac manifestations often overlooked.
Case Summary:
A 35-year-old woman had a history of mixed neurocardiogenic syncope. She received a pacemaker at age 11; 13 years later, she developed lead dysfunction. As pacing was no longer required, the leads were removed. She subsequently developed asymptomatic tricuspid regurgitation and experienced gastrointestinal symptoms, which were initially attributed to irritable bowel syndrome, with a low Gastrointestinal Quality of Life Index (GIQLI) score. Biological valve replacement improved gastrointestinal symptoms and GIQLI score. Later, a mechanical valve was implanted owing to bioprosthesis deterioration, resulting in further clinical and GIQLI score improvement.
Discussion:
Severe tricuspid regurgitation may cause visceral venous congestion, intestinal edema, dysbiosis, hypoperfusion, and inflammation, producing gastrointestinal symptoms.
Take-Home Message:
This case emphasizes the importance of considering visceral venous congestion symptoms, such as gastrointestinal manifestations, in the assessment and management of severe tricuspid regurgitation.
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