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Tricuspid Regurgitation
Published in Takahiro Shiota, 3D Echocardiography, 2020
Denisa Muraru, Luigi P. Badano
Tricuspid regurgitation (TR) has an important impact on patient prognosis, as demonstrated in large epidemiology studies,1,2 in various disease states,3–7 and after left heart surgical and transcatheter therapies.8–11 Awareness of the dramatic impact on patient survival and morbidity has raised significant interest in TR pathophysiology, imaging diagnosis, and percutaneous treatment solutions.12,13
Congenital Heart Disease in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
A common sequela of these congenital heart defects is heart block, which occurs at a rate of approximately 2% per year. The tricuspid valve may be abnormal, with Ebstein-like malformation and associated regurgitation, or may be initially competent but develop secondary regurgitation due to tricuspid annular dilation. Tricuspid valve replacement should be considered for patients with severe tricuspid regurgitation, though the optimal timing of this surgery is subject to debate. With increasing age, right ventricular dysfunction also becomes more prevalent, and significant systemic ventricular dysfunction leading to heart failure symptoms often presents in the fourth or fifth decade of life.
Epidemiology and the natural history of mitral stenosis
Published in Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi, Mitral Stenosis, 2018
Pulmonary hypertension: In a series of 586 patients with MS, 48 patients (8.2%) had severe pulmonary hypertension with resting systolic pulmonary artery pressure of >80 mmHg and pulmonary vascular resistance of 10 Wood units or more.58 The mean survival of patients with severe pulmonary hypertension who did not undergo surgery was 2.4 ± 0.5 years. One-fourth of these patients had died within 6 months and half by 12 months after catheterization, indicating the markedly poor prognosis in this subgroup. These patients often develop functional tricuspid regurgitation and, subsequently, right-ventricular failure.
Transcatheter tricuspid valve repair and replacement: a landscape review of current techniques and devices for the treatment of tricuspid valve regurgitation
Published in Expert Review of Cardiovascular Therapy, 2021
Kusha Rahgozar, Edwin Ho, Ythan Goldberg, Mei Chau, Azeem Latib
Tricuspid regurgitation is most often diagnosed by echocardiography. The size and direction of regurgitant jet, size of vena contracta width, and flow convergence are all used to evaluate TR. The most common echocardiographic findings of severe TR include vena contracta width >0.7 cm, effective regurgitant orifice area >40 mm, PISA >0.9 cm, right ventricular dilation, right atrium dilation, inferior vena cava dilation, and systolic flow reversal in the hepatic veins [6]. Most guidelines use a tricuspid annular threshold of >40 mm as the cutoff for combined tricuspid valve repair. Electrocardiogram (EKG) findings of severe TR include peaked p-waves in v1 and q-waves in v1. Physical exam findings are nonspecific and reflect clinical manifestations of right heart failure. Jugular venous dilation, peripheral edema, and ascites can all be seen in patients with severe TR (Table 2).
Tricuspid regurgitation: when is it time for surgery?
Published in Expert Review of Cardiovascular Therapy, 2021
Ana Paula Tagliari, Daniel Perez-Camargo, Maurizio Taramasso
Right-sided cardiac diseases have traditionally been considered less relevant than mitral and aortic valve pathologies. Particularly in the last years, however, the concept of early tricuspid regurgitation (TR) intervention and the trends for transcatheter structural heart interventions led to a growing interest in the tricuspid valve (TV) diseases. Tricuspid regurgitation surgical indication is most often considered at the time of mitral or aortic valve surgery. Correction of symptomatic severe primary TR is preferentially performed before the onset of significant right ventricular (RV) dysfunction. In contrast, the optimal timing of TV surgery for asymptomatic or minimally symptomatic severe primary TR has not been established [1,2]. In this review, we discuss the broad spectrum of TR intervention, highlighting current evidence and bringing some future perspectives.
Contemporary review of percutaneous therapy for tricuspid valve regurgitation
Published in Expert Review of Cardiovascular Therapy, 2020
Vinayak Nagaraja, Samir R. Kapadia, Rhonda Miyasaka, Serge C. Harb, Amar Krishnaswamy
The specific anatomic details used for procedural planning are beyond the scope of this manuscript. Briefly, pre-procedural imaging with echocardiography continues to be the fundamental imaging modality in the assessment of tricuspid regurgitation. This provides valuable information regarding right ventricular size and function, pulmonary pressure, inferior vena cava dimensions, mechanism of TR, TA, and valve morphology. Further multimodality imaging with computed tomography and magnetic resonance imaging can be beneficial about screening for percutaneous device applicability and provides a precise characterization of RV size, TV annulus (TA) dimensions, and annular distance from the RCA and RV apex. A hostile course of the RCA (≤2 mm from the TA) is seen in nearly 40% of individuals with severe TR [29,30]. A CT also provides the venous anatomical course and dimensions for subclavian and axillary veins as well as fluoroscopic angles for procedural planning [31]. Understanding the mechanism of TR is essential for planning a transcatheter tricuspid procedure and device selection. The specific devices are discussed below, and in broad terms include 1) leaflet approximation to restore coaptation, 2) annuloplasty, and 3) TV replacement. Figures 2 and 3 depict the devices available in the transcatheter tricuspid intervention.