11th May 2024

A 7-year-old girl presents to the paediatric outpatient clinic with fatigue and occasional palpitations.

A 7-year-old girl presents to the paediatric outpatient clinic with fatigue and occasional palpitations. On examination, the paediatric cardiologist notes a mild jugular venous distention and a palpable liver edge. Auscultation reveals a pansystolic murmur heard best at the lower left sternal border, which increases in intensity with inspiration. An echocardiogram confirms moderate tricuspid regurgitation (TR) without evidence of other structural heart defects. The girl’s echocardiogram also shows mild right ventricular dilation but normal function. The family is concerned about the long-term impact of this condition on their child’s health.

Which is the most appropriate next step in management?