The Tricuspid Valve

Abstract

Abstract-Cardiovascular specialists have entered an era of renewed interest and enthusiasm surrounding the diagnosis and treatment of valvular heart disease, driven in part by emerging percutaneous therapies for the treatment of aortic, pulmonic, and mitral valve disease. Despite this wave of investigation, little or no attention has been given to the treatment of tricuspid valve disease. Tricuspid regurgitation (TR) occurs mainly from tricuspid annular dilation, which can result from left-sided heart failure from myocardial or valvular causes, right ventricular volume and pressure overload, or dilation of cardiac chambers. If untreated at the time of surgical mitral valve repair, significant residual TR negatively impacts perioperative outcomes, functional class, and survival. TR does not reliably resolve after successful mitral valve surgery. If present at the time of mitral valve surgery, TR can usually be effectively addressed with ring annuloplasty. Because reoperations for recurrent TR carry high mortality rates, few patients are offered reoperation for redo tricuspid repair or replacement. As transcatheter therapies for mitral regurgitation arise, parallel percutaneous approaches for TR may be necessary. In this article, we review the anatomy, pathophysiology, and value of mechanical correction of TR, including potential transcatheter therapies for TR.

Isolated Severe Tricuspid Regurgitation in a Post Pneumonectomy Patient with Chronic Atrial Fibrillation

“…5) In conclusion chronic atrial fibrillation in some rare instances through incompletely understood mechanisms, despite the absence of pulmonary hypertension appears to be associated with annular dilatation and subsequent severe primary TR. Consideration should be given for early intervention when right heart failure develops and is refractory to standard optimal medical management.…”

“…3,4) In the absence of any other known etiology, we suspect that the chronic atrial fibrillation may possibly be the cause or at least a contributing factor for the primary severe tricuspid regurgitation in all these reported cases with refractory heart failure despite optimal medical management. Rogers et al 5) had stated that TR occurs mainly from tricuspid annular dilatation, which can result from left-sided failure from myocardial or valvular causes, right ventricular volume and pressure overload or dilatation of the cardiac chambers. We wonder if chronic atrial fibrillation in certain patient subsets through right heart remodeling from volume overload can result in annular dilatation with TR and initiation of a vicious cycle with more volume overload and more regurgitation.…”

Clinical Outcomes After Tricuspid Valve Annuloplasty in Addition to Mitral Valve Surgery

“…15 Historically, it was thought that MVP ⁄ MVR would lead to a reduction in functional TR. 1 However, increasing evidence has shown that functional TR does not always disappear but can progress or even appear de novo if the tricuspid valve is left untreated at the time of left-sided surgery.…”

Tricuspid Valve Regurgitation After Antiarrhythmic Device Implantation

“…Обычно для диагностики степени выражен-ности ТР используется трансторакальная 2D-эхокардиография с функцией цветового доппле-ровского картирования [7]. Данный вид эхокар-диографического исследования достаточно чувствителен как для выявления, так и для опре-деления степени выраженности ТР [8].…”