Pathophysiology of Tricuspid Regurgitation

Abstract

Background-Respiratory dependence of tricuspid regurgitation (TR), a long-held concept suggested by murmur variation, remains unproven and of unclear mechanisms. PϽ0.0001), increased systolic annular diameter (Pϭ0.003), valve tenting height (PϽ0.0001) and area (PϽ0.0001), and reduced valvular-to-annular ratio (Pϭ0.006). Effective regurgitant orifice during inspiration was independently determined by inspiratory valvular-to-annular ratio (Pϭ0.026) and inspiratory change in right ventricular length-towidth ratio (Pϭ0.008) and valve tenting area (Pϭ0.015). Conclusions-TR is dynamic with almost universal respiratory changes of large magnitude and complex pathophysiology. Methods and Results-InDuring inspiration, a large increase in effective regurgitant orifice causes, despite a decline in regurgitant gradient, a notable increase in regurgitant volume. Effective regurgitant orifice changes are independently linked to inspiratory annular enlargement (decreased valvular coverage) and to inspiratory right ventricular shape widening with increased valvular tenting. These novel physiological insights into TR respiratory dependence underscore right-side heart plasticity and are important for clinical TR severity evaluation. (Circulation. 2010;122:1505-1513.)

Pulmonary Acceleration Time to Optimize the Timing of Lung Transplant in Cystic Fibrosis

“…Systolic PAP estimation by echocardiography may be difficult in CF because of lung hyperinflation, absence of tricuspid regurgitation in some patients and variations in TRV depending on respiration time and regurgitation severity. [1720] Interestingly, a strong inverse relationship between PAT and mean PAP has been reported,[8] and we found a strong association between PAT and sPAP. A weaker association was reported previously between echocardiographic PAT and both diastolic and sPAP in children.…”

Leaflet Area as a Determinant of Tricuspid Regurgitation Severity in Patients With Pulmonary Hypertension

“…Strengths of this study include a prospective two-center design, measurement of 3-D leaflet area using a specialized software tool which has been validated against explanted valves 7 and computed tomography 34 , and gradation of TR severity according to VC, which has been shown to be more accurate and reproducible compared to jet area or visual assessment 15,35 and the most prognostic indicator of TR severity 36 . By integrating TLA with annulus area and tenting volume, a more complete understanding of the pathophysiology of functional TR is obtained.…”

Clinical Context and Mechanism of Functional Tricuspid Regurgitation in Patients With and Without Pulmonary Hypertension

“…Recent advances in noninvasive Doppler echocardiography allow consistent measurement of regurgitant volume (RVol) and ERO, [27][28][29] providing important insights into TR pathophysiology. 27,30 Quantification of valvular-ventricular complex deformation, which provided crucial information in functional mitral regurgitation, 31 can also be obtained in FTR simultaneously to TR quantitation. 26 Thus, to gain mechanistic insights specific to each FTR type, we analyzed our prospectively quantified TR population in whom comprehensive imaging of RV, right atrial (RA), and tricuspid valvular complex had also been performed.…”