Images in Clinical Medicine
Jugular Venous C-V Wave in Severe Tricuspid Regurgitation
N Engl J Med 2012; 366:e5January 12, 2012
- Article
Video
Jugular Venous C-V Wave in Severe Tricuspid Regurgitation.
An 18-year-old man presented with a 2-year history of progressive anasarca and exertional dyspnea. On examination, his jugular venous pressure was elevated and showed prominent systolic pulsations that were eliminated with the application of gentle pressure at the base of the neck (Panel A, arrow; Video 1). Cardiac auscultation revealed a loud first heart sound, a loud pulmonary component of the second heart sound, an apical mid-diastolic rumble, and a holosystolic murmur at the left lower sternal border that increased with inspiration. The patient was jaundiced and had an enlarged, pulsatile liver. Transthoracic echocardiography confirmed the presence of severe rheumatic mitral stenosis and severe tricuspid regurgitation (Video 2). Ventricularization of the right atrial waveform was evident on cardiac catheterization (Panel B). Prominent systolic pulsations of the jugular veins, known as C-V waves, are a manifestation of severe tricuspid regurgitation. For this patient, mitral-valve replacement and tricuspid-valve repair could not be performed because of progressive hepatic failure. Despite the performance of percutaneous balloon mitral valvotomy as a bridge to mitral-valve replacement, his clinical status continued to worsen, and he died 20 days after the balloon valvotomy and 30 days after presentation.
Nagendra Boopathy Senguttuvan, M.D.
Ganesan Karthikeyan, M.D., D.M.
All India Institute of Medical Sciences, New Delhi, India
