Lancisi’s Sign: Giant C-V waves with Severe Tricuspid Regurgitation in
Isolated Tricuspid Valve Prolapse
Abstract
IIntroduction Isolated tricuspid valve prolapse (TVP) is a rare finding
on transthoracic echocardiography. Right atrial enlargement or prominent
” v ” waves as a consequence of hemodynamic changes in severe tricuspid
regurgitation (TR) are rarely seen with isolated TVP. Here is a case of
isolated prolapse of anterior tricuspid leaflet presenting with giant
C-V waves also known as Lancisi’s sign. Case Report A 66-year-old male
presented with increasing exercise limitation and leg edema in recent
months and was complaining about the persistent pulsation at his neck
and elevated jugular venous pulse with prominent systolic pulsation that
represents giant C-V waves, also known as ‘Lancisi’s sign’ consequence
of severe TR due to isolated prolapse of the anterior leaflet.The
patients’ symptoms resolved completely after tricuspid valve
replacement. Discussion TVP is best defined at parasternal short axis
view with more than 2 mm atrial displacement (AD) of leaflet/leaflets.
TVP can also be detected from four chamber view with more than 2 mm AD
or in right ventricular inflow view with more than 4 mm AD. As a
consequence of TVP, the physiological jugular venous waveform alters due
to severe TR.During severe TR; retrograde blood flow through right
atrium during ventricular systole restrains x descent and produces a
fusion of c and v waves that appears as a large pulsation in physical
examination called as ‘Lancisi’s sign’ Conclusion ‘Lancisi’s sign’ is
defined as a large visible systolic neck pulsation as a consequence of
the c-v waves fusion by preventing x descent during severe TR.