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JACC. Cardiovascular Imaging Mar 2019An appreciation of the complex and variable anatomy of the tricuspid valve is essential to unraveling the pathophysiology of tricuspid regurgitation. A greater... (Review)
Review
An appreciation of the complex and variable anatomy of the tricuspid valve is essential to unraveling the pathophysiology of tricuspid regurgitation. A greater appreciation of normal and abnormal anatomy is important as new methods of treating the tricuspid regurgitation are developed. This review of tricuspid valve and right heart anatomy is followed by a discussion of the possible pathophysiology of secondary (functional) tricuspid regurgitation.
Topics: Hemodynamics; Humans; Risk Factors; Tricuspid Valve; Tricuspid Valve Insufficiency; Ventricular Function, Right
PubMed: 30846121
DOI: 10.1016/j.jcmg.2018.07.032 -
Methodist DeBakey Cardiovascular Journal 2019Ebstein's anomaly is a malformation of the tricuspid valve with myopathy of the right ventricle (RV) that presents with variable anatomic and pathophysiologic... (Review)
Review
Ebstein's anomaly is a malformation of the tricuspid valve with myopathy of the right ventricle (RV) that presents with variable anatomic and pathophysiologic characteristics, leading to equally variable clinical scenarios. Medical management and observation is often recommended for asymptomatic patients and may be successful for many years. Tricuspid valve repair is the goal of operative intervention; repair also typically includes RV plication, right atrial reduction, and atrial septal closure or subtotal closure. Postoperative functional assessments generally demonstrate an improvement or relative stability related to degree of RV enlargement, RV dysfunction, RV fractional area change, and tricuspid valve regurgitation.
Topics: Cardiac Surgical Procedures; Cardiovascular Agents; Ebstein Anomaly; Hemodynamics; Humans; Recovery of Function; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency; Ventricular Function, Right
PubMed: 31384377
DOI: 10.14797/mdcj-15-2-138 -
JACC. Cardiovascular Imaging Mar 2019Tricuspid regurgitation (TR) is an independent predictor of death. Lately, emerging technologies for the treatment of TR have increased the interest of physicians. Due... (Review)
Review
Tricuspid regurgitation (TR) is an independent predictor of death. Lately, emerging technologies for the treatment of TR have increased the interest of physicians. Due to the complex 3-dimensional (3D) geometry of the tricuspid valve (TV) and its anterior position in the mediastinum, conventional 2D echocardiography is unsuitable to study the anatomy and pathophysiologic mechanisms of the regurgitant TV. 3D echocardiography has emerged as a very cost-effective imaging modality with which to: 1) visualize the TV anatomy; 2) define the mechanism of TR; 3) measure the size and geometry of the tricuspid annulus; 4) analyze the anatomic relationships between TV apparatus and surrounding cardiac structures; 5) assess volumes and function of the right atrium and ventricle; and 6) plan surgical repair or guide and monitor transcatheter interventional procedures.
Topics: Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Hemodynamics; Humans; Predictive Value of Tests; Prognosis; Reproducibility of Results; Severity of Illness Index; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 30846124
DOI: 10.1016/j.jcmg.2018.10.035 -
JACC. Cardiovascular Imaging Mar 2019Tricuspid regurgitation (TR) is classified according to different morphologic types based on the underlying mechanisms: primary, secondary, and isolated TR. Primary TR... (Review)
Review
Tricuspid regurgitation (TR) is classified according to different morphologic types based on the underlying mechanisms: primary, secondary, and isolated TR. Primary TR is caused by an anatomical abnormality of the tricuspid valve apparatus. Secondary TR is caused by dilation of the tricuspid valve annulus, related to right ventricular (RV), or right atrial remodeling and increased RV pressures (often secondary to left-sided heart disease). Isolated TR can exist in patients without increased RV pressures and is frequently associated with atrial fibrillation. Two-dimensional echocardiography plays a pivotal role in the assessment of the etiology and severity of TR. Views from 3-dimensional techniques have significantly increased the understanding of the pathophysiology of each morphologic type of TR (leaflet damage, annular dilation, and distinct patterns of right-heart remodeling). The following review will describe the etiology, anatomical and functional characteristics, and outcomes of each morphologic type of TR, and furthermore addresses challenging pitfalls in the referral for tricuspid valve intervention.
Topics: Echocardiography; Echocardiography, Doppler, Color; Echocardiography, Three-Dimensional; Hemodynamics; Humans; Predictive Value of Tests; Prognosis; Severity of Illness Index; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 30846123
DOI: 10.1016/j.jcmg.2018.09.027 -
Reviews in Cardiovascular Medicine Dec 2021Significant tricuspid regurgitation (TR) is a common finding, affecting about one in twenty-five subjects among the elderly and presenting more frequently in women than... (Review)
Review
Significant tricuspid regurgitation (TR) is a common finding, affecting about one in twenty-five subjects among the elderly and presenting more frequently in women than in men. This review summarizes data concerning etiology, epidemiology, pathophysiology and management strategies of TR. The tricuspid valve (TV) has a broad anatomical variability. Classically, TR has been distinguished as primary and secondary or functional TR (FTR), with the latter being the most prevalent. FTR is a multifactorial disorder, resulting from maladaptive right ventricular remodeling secondary to pulmonary hypertension or from atrial fibrillation leading to dilation of the right atrium, tricuspid annulus and base of the right ventricle, with pathological TV coaptation. Thus two main types of FTR can be identified: pulmonary hypertension-FTR and idiopathic-FTR, depending on which factor, ventricular or atrial respectively, is the of the disease. Appreciable evidence suggests that significant TR leads to worsening prognosis regardless of the underlying etiology and should be addressed as a separate therapeutic target. The treatment of TR in patients undergoing left-sided cardiac surgery is well established. Isolated surgical repair of TR is instead rarely performed because patients are often deemed inoperable due to prohibitive risk. Besides, perioperative mortality remains higher than for any other valve. Several transcatheter TV replacement and repair systems, the latter mostly borrowed from percutaneous treatment systems of mitral regurgitation or from TV repair surgical techniques, have shown efficacy and safety when used on the TV. These could provide an effective treatment option for patients not eligible for surgery.
Topics: Aged; Female; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve Insufficiency; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency; Ventricular Remodeling
PubMed: 34957757
DOI: 10.31083/j.rcm2204122 -
EuroIntervention : Journal of EuroPCR... Nov 2021Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid...
Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid valve apparatus and is observed in only 8-10% of the patients with tricuspid valve disease. Secondary TR is more common and arises as a result of annular dilation caused by right ventricular enlargement and dysfunction as a consequence of pulmonary hypertension, often caused by left-sided heart disease or atrial fibrillation. Irrespective of its aetiology, TR leads to volume overload and increased wall stress, both of which negatively contribute to detrimental remodelling and worsening TR. This vicious circle translates into impaired survival and increased heart failure symptoms in patients with and without reduced left ventricular ejection fraction. Interventions to correct TR are underutilised in daily clinical practice owing to increased surgical risk and late patient presentation. The recently introduced transcatheter tricuspid valve interventions aim to address this unmet need. Dedicated expertise and an interdisciplinary Heart Team evaluation are essential to integrate these new techniques successfully and select patients. The present article proposes a standardised approach to evaluate patients with TR who may be candidates for transcatheter interventions. In addition, a state-of-the-art review of the available transcatheter therapies, the main criteria for patient and device selection, and information concerning the remaining uncertainties are provided.
Topics: Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Stroke Volume; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency; Ventricular Function, Left
PubMed: 34796878
DOI: 10.4244/EIJ-D-21-00695 -
JACC. Cardiovascular Imaging Jul 2021The purpose of this study was to introduce a novel clinically relevant nomenclature system for the TV and determine the relative incidence of each morphological type.
OBJECTIVES
The purpose of this study was to introduce a novel clinically relevant nomenclature system for the TV and determine the relative incidence of each morphological type.
BACKGROUND
With the rapid development of transcatheter tricuspid valve (TV) repair techniques, there is a growing recognition of the variability in leaflet morphology and a need for a unified nomenclature, which could aid in procedural planning and execution.
METHODS
Patients from 4 medical centers (2 in Europe, 2 in the United States) referred for transesophageal echocardiography (TEE) to assess native TV function, were retrospectively analyzed for leaflet morphology with the use of a novel classification scheme. Four morphological types were identified: type I, 3 leaflets; type II, 2 leaflets; type IIIA, 4 leaflets with 2 anterior; type IIIB, 4 leaflets with 2 posterior; type IIIC, 4 leaflets with 2 septal; and type IV, >4 leaflets.
RESULTS
A total of 579 patients were analyzed: mean age 78.1 ± 8.0 years, 50.4% female, 70.9% in atrial fibrillation, and 32.2% with previous left heart surgery or transcatheter intervention. Tricuspid regurgitation was moderate or less in 9.4%, severe in 40.5%, massive in 32.3%, and torrential in 17.7%. The etiology of tricuspid regurgitation was primary in 9.4%, mixed in 10.8%, and secondary in all of the other patients (18.6% atriogenic/isolated). The incidence of type I morphology was 312 of 579 (53.9%), type II was 26 of 579 (4.5%), type IIIA was 15 of 579 (2.6%), type IIIB was 186 of 579 (32.1%), type IIIC was 22 of 579 (3.8%), and type IV was 14 of 579 (2.4%).
CONCLUSIONS
A novel TV leaflet nomenclature classification scheme can be used to identify 4 types of TV morphologies with the use of TEE imaging. From this multinational retrospective study, the TV has 3 well defined leaflets in only ∼54% of patients and 4 functional leaflets in ∼39% of patients, with type IIIB (2 posterior leaflets) being the most common of the latter. The utility of this classification scheme deserves further study.
Topics: Aged; Aged, 80 and over; Echocardiography; Europe; Female; Humans; Male; Predictive Value of Tests; Retrospective Studies; Tricuspid Valve
PubMed: 33744134
DOI: 10.1016/j.jcmg.2021.01.012 -
Current Cardiology Reports Aug 2021New transcatheter techniques to perform tricuspid annuloplasty are evolving and are introduced into the clinical routine. Yet, clinical experience is limited. (Review)
Review
PURPOSE OF REVIEW
New transcatheter techniques to perform tricuspid annuloplasty are evolving and are introduced into the clinical routine. Yet, clinical experience is limited.
RECENT FINDINGS
Currently, 3 different techniques for tricuspid annuloplasty have been used in larger clinical cohorts. They can be divided into direct annuloplasty techniques and suture plication techniques. The largest clinical evidence is related to direct annuloplasty techniques. It has been shown that annular dimensions can be effectively reduced. This translates into an improvement of the degree of tricuspid regurgitation and improvement of clinical symptoms. Due to the newness of this type of therapy, long-term data is limited, but for one of the described techniques, published data show that the positive effects persist over a 2-year period. Transcatheter approaches are safe and are able to treat tricuspid regurgitation effectively. There are still differences in the efficacy of the different techniques. Clinical experience varies among the different approaches.
Topics: Cardiac Valve Annuloplasty; Heart Valve Prosthesis Implantation; Humans; Time Factors; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 34410518
DOI: 10.1007/s11886-021-01570-8 -
The Journal of Thoracic and... Dec 2020
Topics: Cardiac Surgical Procedures; Catheters; Heart Valve Prosthesis Implantation; Humans; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 32711975
DOI: 10.1016/j.jtcvs.2020.05.044 -
JACC. Cardiovascular Interventions Jun 2021
Topics: Heart Valve Prosthesis Implantation; Humans; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 34112461
DOI: 10.1016/j.jcin.2021.04.008