Isolated tricuspid regurgitation: outcomes and therapeutic interventions

Abstract

Isolated tricuspid regurgitation (TR) can be caused by primary valvular abnormalities such as flail leaflet or secondary annular dilation as is seen in atrial fibrillation, pulmonary hypertension and left heart disease. There is an increasing recognition of a subgroup of patients with isolated TR in the absence of other associated cardiac abnormalities. Left untreated isolated TR significantly worsens survival. Stand-alone surgery for isolated TR is rarely performed due to an average operative mortality of 8%–10% and a paucity of data demonstrating improved survival. When surgery is performed, valve repair may be preferred over replacement; however, there is a risk of significant recurrent regurgitation after repair. Existing society guidelines do not fully address the management of isolated TR. We propose that patients at low operative risk with symptomatic severe isolated TR and no reversible cause undergo surgery prior to the onset of right ventricular dysfunction and end-organ damage. For patients at increased surgical risk novel percutaneous interventions may offer an alternative treatment but further research is needed. Significant knowledge gaps remain and future research is needed to define operative outcomes and provide comparative data for medical and surgical therapy.

Enlarged coronary sinus thrombosis after repair of Ebstein's anomaly

“…The choice of biological vs mechanical prosthesis for tricuspid valve replacement is debatable. A few authors have reported no statistically significant differences in survival and reoperation rates between patients undergoing bioprosthetic and mechanical valve implantation 7 . We prefer a bioprosthetic valve for tricuspid valve replacement because compared to patients undergoing mechanical valve implantation, those undergoing bioprosthetic valve placement show a lower risk of valve thrombosis.…”

Analyses for Prevalence and Outcome of Tricuspid Regurgitation in China: An Echocardiography Study of 134,874 Patients

“…Some researchers indicated that severe TR was mainly related to pacemaker lead induction [9, 19, 20], whereas our study indicated that the rate of severe TR in subjects with implantation of a postoperative pacemaker was only 6.9%. Reasons for this might be the types of pacemakers used and the varied proficiency of the operators for pacemaker implantation procedures [13]. …”

“…PAH was defined as pulmonary systolic pressure more than 40 mm Hg, which was confirmed by the Bernoulli equation (ΔP  =  4 × v 2 ), the maximal velocity of the TR jet area, allowing calculation of the pressure gradient between the right atrium and the right ventricle [12]. Idiopathic TR meant that no cause of the regurgitation could be identified [13]. The diagnosis of the etiology was based on the echocardiographic database recording the major clinical diagnosis of patients and was rechecked by the echocardiography report of the patients; this could provide tremendous information about the etiology.…”

Congenital tricuspid valve disease can masquerade as primary idiopathic tricuspid regurgitation

“…We read with interest the excellent and timely article on increasingly detected cases of isolated tricuspid valve regurgitation 1. The authors rightly note that there is an emerging population of adult patients without left-sided heart disease, pulmonary hypertension or congenital abnormalities who develop symptomatic isolated tricuspid regurgitation.…”