Epidemiology, anatomy, pathophysiology and clinical evaluation of functional tricuspid regurgitation

Sun, Yee-Ping; O’Gara, Patrick T.

doi:10.23736/s0026-4725.17.04398-5

Cited by 7 publications

(1 citation statement)

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“…[1][2][3][4] There are three types of TR, each with different etiologies: primary, secondary, and cardiac electric implantable device-related (CEID). 5 Primary TR is congenital or acquired and occurs when there is a problem with the tricuspid valve itself, such as Ebstein's anomaly, damage from infection, carcinoid, or trauma. Secondary TR is due to conditions that increase the volume or pressure on the right side of the heart or change the morphology of the right-sided chambers 6 ; this includes pulmonary hypertension, leftsided heart failure, or right atrial enlargement with annular dilation.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Tricuspid Interventions: Past, Present, and Future

Barker¹,

Goel

2023

Methodist DeBakey Cardiovascular Journal

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Tricuspid regurgitation (TR) etiologies include primary valve pathology or secondary (functional) regurgitation from increased hemodynamic pressure or volume on the right side of the heart. Patients with severe TR have a worse prognosis independent of all other variables. Surgical treatment for TR has mostly been limited to patients undergoing concomitant left-sided cardiac surgery. The results and durability of surgical repair or replacement are not well defined. For patients with significant and symptomatic TR, transcatheter techniques would be beneficial, but these techniques and devices have been slow to develop. Much of the delay is a result of neglect and challenges in defining the symptoms associated with TR. In addition, the anatomic and physiological aspects of the tricuspid valve apparatus present unique challenges. Several devices and techniques are in various phases of clinical investigation. This review highlights the current landscape of transcatheter tricuspid interventions and future opportunities. It is imminent that these therapies become commercially available and widely adopted to have a significant positive impact on millions of patients that have been neglected.

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Section: Introductionmentioning

confidence: 99%

Transcatheter Tricuspid Interventions: Past, Present, and Future

Barker¹,

Goel

2023

Methodist DeBakey Cardiovascular Journal

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A pilot in silico modeling‐based study of the pathological effects on the biomechanical function of tricuspid valves

Laurence

Johnson

Hsu

et al. 2020

Numer Methods Biomed Eng

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Current clinical assessment of functional tricuspid valve regurgitation relies on metrics quantified from medical imaging modalities. Although these clinical methodologies are generally successful, the lack of detailed information about the mechanical environment of the valve presents inherent challenges for assessing tricuspid valve regurgitation. In the present study, we have developed a finite element‐based in silico model of one porcine tricuspid valve (TV) geometry to investigate how various pathological conditions affect the overall biomechanical function of the TV. There were three primary observations from our results. Firstly, the results of the papillary muscle (PM) displacement study scenario indicated more pronounced changes in the TV biomechanical function. Secondly, compared to uniform annulus dilation, nonuniform dilation scenario induced more evident changes in the von Mises stresses (83.8‐125.3 kPa vs 65.1‐84.0 kPa) and the Green‐Lagrange strains (0.52‐0.58 vs 0.47‐0.53) for the three TV leaflets. Finally, results from the pulmonary hypertension study scenario showed opposite trends compared to the PM displacement and annulus dilation scenarios. Furthermore, various chordae rupture scenarios were simulated, and the results showed that the chordae tendineae attached to the TV anterior and septal leaflets may be more critical to proper TV function. This in silico modeling‐based study has provided a deeper insight into the tricuspid valve pathologies that may be useful, with moderate extensions, for guiding clinical decisions.Novelty StatementThe novelties of the research are summarized below: A comprehensive in silico pilot study of how isolated functional tricuspid regurgitation pathologies and ruptured chordae tendineae would alter the tricuspid valve function; An extensive analysis of the tricuspid valve function, including mechanical quantities (eg, the von Mises stress and the Green‐Lagrange strain) and clinically‐relevant geometry metrics (eg, the tenting area and the coaptation height); and A developed computational modeling pipeline that can be extended to evaluate patient‐specific tricuspid valve geometries and enhance the current clinical diagnosis and treatment of tricuspid regurgitation.

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Multi-Modality Imaging in the Evaluation and Treatment of Tricuspid Regurgitation

Kim

Singh

Nati

et al. 2018

Curr Treat Options Cardio Med

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The evaluation and management of TR is a rapidly growing field with significant advances in both imaging and interventions. Important advances have been made to understand TV anatomy and physiology in 3D echo, CT, and MRI. Additional understanding of the abnormal outcomes in both primary TR and secondary TR have been appreciated. Multiple transcatheter devices have reached the stage of early trials in high surgical risk cohorts with favorable initial findings. TR is a significant cardiovascular problem and vastly undertreated in the present era. There has been tremendous growth in knowledge of mechanisms of TR, its prognostic implications, timing of intervention, and development of novel treatment strategies. Multimodality imaging plays a key role in evaluation and treatment of this condition.

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Epidemiology, anatomy, pathophysiology and clinical evaluation of functional tricuspid regurgitation

Cited by 7 publications

References 0 publications

Transcatheter Tricuspid Interventions: Past, Present, and Future

Transcatheter Tricuspid Interventions: Past, Present, and Future

A pilot in silico modeling‐based study of the pathological effects on the biomechanical function of tricuspid valves

Multi-Modality Imaging in the Evaluation and Treatment of Tricuspid Regurgitation

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