Competence of the Tricuspid Valve in Pulmonary Heart Disease (cor Pulmonale).

THE alleged occurrence of tricuspid regurgitation in association with, and as a physiologic consequence of, right ventricular failure in cases of cor pulmonale has been reported during the past decade. -3 Emphasis has been laid upon hepatic pulsations, distended or pulsating neck veins, and a systolic murmur of appropriate timing and placement as evidence of this phenomenon. It has been suggested that the appearance of these findings should alert the clinician to the presence of this lesion.2 It has also been reported that in patients with cardiac failure a progressive change in the form of the right atrial pulse suggesting tricuspid incompetence occurred at a right atrial mean pressure of approximately 5 mm. Hg.3 Several methods have been employed to detect regurgitant flow across the atrioventricular valves. Most depend upon changes in the contour of the atrial pressure curve,4 6 or upon the demonstration of regurgitation by indicator technics,7-11 or visualization of reflux of radiopaque material.12 Impairment of the X descent on the right atrial pressure curve has long been utilized as an index of tricuspid regurgitation. The absence of the X descent is presumably produced by the transmission