Woman in her seventh decade with huge heart in thorax

This article reports a case of a 70-year-old female patient with severe tricuspid regurgitation (TR), aiming to supplement clinical data on isolated severe tricuspid insufficiency in elderly patients and provide references for etiological exploration and clinical decision-making (Writing Committee Members in J Am Coll Cardiol 77(4):e25-197, 2021). The patient had an 18-year history of recurrent bilateral lower extremity edema and a 3-year history of exertional fatigue and shortness of breath. Clinical examinations included echocardiography and enhanced chest computed tomography (CT). Echocardiography showed right atrial and ventricular enlargement, severe tricuspid regurgitation, and normal left ventricular systolic function; enhanced chest CT indicated significant enlargement of the heart (predominantly right atrium and ventricle), calcification of the aorta and coronary arteries, and a mass in the lower lobe of the right lung. The final diagnosis was severe tricuspid regurgitation (secondary to right heart dilation and tricuspid annulus dilatation), sinus rhythm, grade III cardiac function, and a right lower lung mass (nature to be determined) (Coisne et al. in J Am Coll Cardiol 82(8):721-34, 2023). Due to poor lung function and elevated arterial carbon dioxide partial pressure, the patient could not tolerate surgical treatment and was discharged with medication and follow-up recommendations. This case highlights the complexity of etiological diagnosis in elderly patients with isolated severe tricuspid insufficiency and the importance of comprehensive clinical assessment for treatment strategy formulation.