Which of the following is a functional tricuspid regurgitation manifestation associated with mitral stenosis?

• A. Functional TR
• B. Aortic regurgitation
• C. Mitral valve prolapse
• D. Pulmonary embolism

Answer: (A)

Mitral stenosis causes a rise in left atrial pressure that backs up into the pulmonary circulation, leading to pulmonary hypertension. The increased pressure and chronic right-sided loading promote dilation of the right atrium and ventricle, which enlarges the tricuspid annulus. When the annulus dilates, the valve leaflets can no longer coapt properly, producing tricuspid regurgitation that is functional in nature—originating from right heart remodeling rather than from a primary tricuspid valve abnormality. This is the typical TR seen with mitral stenosis. Other options don’t fit because aortic regurgitation is not a direct consequence of MS, mitral valve prolapse is a separate valvular condition, and pulmonary embolism is a thromboembolic event rather than a inherent TR manifestation associated with MS.