Study of the Right Atrial Pressure Pulse in Functional Tricuspid Regurgitation and Normal Sinus Rhythm

Abstract

Six patients having mitral stenosis, functional tricuspid regurgitation, and normal sinus rhythm were studied. All patients had a systolic murmur at the lower left sternal border that increased with inspiration. Five patients had right heart catheterization while all six had right atrial pressure-pulses obtained by direct puncture of the right atrium with a 20-gage needle during right thoracotomy. Functional tricuspid regurgitation was proved by subsequent digital exploration of the tricuspid valve. The right atrial pressure pulses obtained were analyzed. The curves taken with the needle-puncture of the right atrium were comparable to those obtained at right heart catheterization. The X descent was well preserved in all six cases. In five patients the X descent was deeper than the Y descent, while in only one patient was the X descent equal to the Y descent. There was no exaggeration of the V wave in any of the curves. The role played by the compliance of the right atrium in preserving the normal contour of the right atrial curve, in spite of tricuspid regurgitation, is discussed. It is concluded that in functional tricuspid regurgitation with normal rhythm the normally preserved X descent followed by a normal V wave may persist in the right atrial curve. The application of this finding to the clinical study of the jugular venous pulse in functional tricuspid regurgitation and normal rhythm is evident.