Functional tricuspid regurgitation, related right heart remodeling, and available treatment options: good news for patients with heart failure?

Abstract

Significant functional tricuspid regurgitation (FTR) represents a poor prognostic factor independent of right ventricular (RV) function. It is usually the consequence of left-sided cardiac diseases that induce RV dilatation and dysfunction, but it can also resulted from right atrial (RA) enlargement and consequent tricuspid annular dilatation. FTR is very frequent among patients with heart failure, particularly in those with reduced LVEF and concomitant functional mitral regurgitation. The development of three-dimensional echocardiography enabled detailed assessment of tricuspid valve anatomy, subvavlular apparatus, and RA and RV changes, as well as accurate evaluation of FTR etiology. Due to high in-hospital mortality risk in patients who were operatively treated for isolated FTR, it has been treated only medically for a long time. Percutaneous approach considers mainly transcatheter tricuspid valve repair (edge-to-edge and annuloplasty) and represents a very attractive option for the high-risk patients. Studies that investigated the effects of different devices showed excellent feasibility and safety, followed by significant reduction in FTR grade, improvement in functional capacity and NYHA class, quality of life, and reduction in hospitalization due to heart failure. Some investigations also reported a decreased mortality in FTR patients. Nevertheless, the results of these investigations should be interpreted with cautious due to the small number of participants and relatively short follow-up. The aim of this review was to summarize the existing data about the clinical importance of FTR and FTR-induced right heart remodeling and currently existing therapeutic approaches for treatment of FTR.

Right/Left Ventricular Blood Pool T2 Ratio as an Innovative Cardiac MRI Screening Tool for the Identification of Left‐to‐Right Shunts in Patients With Right Ventricular Disease

“…9 Several other diseases such as advanced left heart failure, pulmonary and tricuspid valve regurgitation, and arrhythmogenic right ventricular cardiomyopathy (ARVC) may lead to right heart dilatation in the absence of L-R shunts. 10,11 Patients with suspected L-R shunts typically undergo phase-contrast MRI to compare the flow between the pulmonary and systemic circulation (Qp and Qs respectively). 9 Phase-contrast acquisitions require extensive planning leading to prolonged examination times, reduced patient comfort, and limited scanner efficiency.…”

“…In addition, MRI is considered useful in adults with nonspecific findings such as murmurs and RV dilatation, potentially caused by shunts, that are otherwise difficult to diagnose by echocardiography 9 . Several other diseases such as advanced left heart failure, pulmonary and tricuspid valve regurgitation, and arrhythmogenic right ventricular cardiomyopathy (ARVC) may lead to right heart dilatation in the absence of L‐R shunts 10,11 . Patients with suspected L‐R shunts typically undergo phase‐contrast MRI to compare the flow between the pulmonary and systemic circulation (Qp and Qs respectively) 9 .…”

Transcatheter tricuspid valve replacement for functional tricuspid regurgitation after left‐sided valve surgery: A single‐center experience

“…31 Patients with FTR typically present with advanced disease progression at the time of referral, often accompanied by significant TA dilatation or large leaflet gaps. 32 Additionally, these patients may have a larger right heart or a pacemaker lead impinging on the valve leaflet. 18 To minimize surgical complexity and reduce the risk of short-term recurrence, transcatheter replacement is often considered a more suitable approach compared to transcatheter repair, considering the anatomical factors and maneuverability involved.…”

“…29,30 Moreover, TTVR with the LuX-Valve can effectively induce right heart reverse remodeling, providing long-term benefits for patients with advanced FTR. 5,29,32 This approach underscores the substantial impact of TTVR in improving the overall hemodynamic status and alleviating the burden on vital organs. 33…”

“…However, it is worth noting that the patient population enrolled in this study reflects the characteristics commonly seen in TV surgery 31 . Patients with FTR typically present with advanced disease progression at the time of referral, often accompanied by significant TA dilatation or large leaflet gaps 32 . Additionally, these patients may have a larger right heart or a pacemaker lead impinging on the valve leaflet 18 .…”