Functional Regurgitation of Atrioventricular Valves and Atrial Fibrillation: An Elusive Pathophysiological Link Deserving Further Attention

Functional Tricuspid Regurgitation and Atrial Fibrillation: Which Comes First, the Chicken or the Egg?

“…Our cases reinforce the concept of the atriogenic FTR. 4 In addition, we showed that, in some patients, restoring the normal sinus rhythm is associated with reverse remodeling of both the RA and the TA with improvement of the FTR severity. This finding has important clinical implications since aggressive rhythm control strategies in patients with AF seem to be beneficial not only for symptom relief but also to prevent RA and TA remodeling.…”

“…1,2,8 The role of the remodeling of the RA in the pathophysiology of TA dilation and development of FTR has been largely neglected until recently. 4,9 Contemporary three-dimensional echocardiography allows a comprehensive assessment of the tricuspid valve, 10,11 the RA, 12 and the right ventricle 13 to clarify the pathophysiology of FTR. However, it remains to be clarified whether it is a preexisting FTR that, through a dilation of the RA, triggers the AF onset or, conversely, whether it is the chronic AF that, through the dilation of the RA, causes the dilation of the TA and leads to FTR.…”

“…Our cases demonstrate that RA dilatation is the major determinant of TA remodeling, which leads to FTR in AF patients. 4 Even more, persistent restoration of the sinus rhythm can lead to RA and TA reverse remodeling with significant reduction in RA volume and TA area and improvement of FTR.…”

“…[1][2][3] The pathophysiology of FTR in AF patients involves the interplay among tricuspid annulus (TA) remodeling, right atrium (RA) dilatation, and loss of function. 4 However, the temporal relationship between FTR and AF remains to be clarified. Accordingly, we report two cases of severe FTR in patients with AF that may help to address this issue.…”

Surgical treatment for valvular heart disease: a single centre experience from Sri Lanka

“…Congenital valvular disease can involve all four valves and can present at any age, but the congenital bicuspid aortic valve is the commonest type and is present in 1% of the world population [8]. Dilatation of the annulus is the key mechanism of functional regurgitation [9]. Coronary artery disease that causes ischemic changes of the mitral papillary muscles can cause ischemic mitral regurgitation [10].…”