Right sided valvular lesions

Question 1

Overview of Rt sided valvular lesions

Answer 1

=>Less frequently encountered & less often the primary cause of critical illness in the CICU compared with left-sided disease.
* Most commonly identified lesion: tricuspid regurgitation (TR), but usually secondary (functional or secondary to pulmonary hypertension, RV dilatation, pacing leads, etc.).

Question 2

Tricuspid Regurgitation

Answer 2

=>Even acute severe TR (e.g., due to infective endocarditis or lead extraction)-> often well tolerated, (low-pressure right heart circuit accommodates regurgitant flow).
=>Etiologies in the CICU:
* Functional TR (RV dilatation from LV failure, PH, or RV infarction).
* Infective endocarditis (especially in IVDU or intracardiac devices).
* Post-lead extraction or trauma.

=>Endocarditis management:
* Recurrent septic emboli → percutaneous mechanical debulking of vegetations ± definitive valve surgery.

Question 3

Pulmonic Valve Lesions

Answer 3

->Pulmonic stenosis or regurgitation may be seen in adult congenital heart disease (ACHD) -»Often secondary to repaired congenital lesions (e.g., tetralogy of Fallot, prior valvotomy).
->Manifest as RV failure, systemic congestion, and low output.
->Management:
*Multidisciplinary input (cardiology, cardiothoracic surgery, ACHD team).
* Transcatheter valve replacement or surgical correction

Question 4

Key Points for the CICU

Answer 4

• Right-sided lesions rarely precipitate shock but often complicate management of other cardiac diseases.
• Optimize preload and RV function; avoid excessive diuresis or high PEEP.
• Treat underlying cause (e.g., pulmonary hypertension, LV dysfunction, endocarditis).
• Early ACHD or valve-team consultation for structural interventions when indicated.