Diagnosis and Treatment of Tricuspid Valve Disease
- Rodés-Cabau J, Taramasso M, O’Gara PT.
- Diagnosis and Treatment of Tricuspid Valve Disease: Current and Future Perspectives. Lancet 2016;Apr 2:[Epub ahead of print].
The following are 10 key points to remember from this review on the diagnosis and treatment of tricuspid valve disease:
- The assessment and management of tricuspid valve disease have evolved substantially during the past several years.
- Whereas tricuspid stenosis is uncommon, tricuspid regurgitation (TR) is frequently encountered and is most often secondary in nature and caused by annular dilatation and leaflet tethering from adverse right ventricular remodeling in response to any of several disease processes.
- Noninvasive assessment of TR must define its cause and severity; advanced three-dimensional echocardiography, magnetic resonance imaging, and computed tomography are gaining in clinical application. Whereas cardiac magnetic resonance is not widely available and often contraindicated by the presence of indwelling device leads or inability of the patient to tolerate the magnet, automated advanced transthoracic echocardiography imaging of the right ventricle and tricuspid valve is becoming more widespread.
- The indications for tricuspid valve surgery to treat TR are related to the cause of the disorder, the context in which it is encountered, its severity, and its effects on right ventricular function.
- Most operations for TR are done at the time of left-sided heart valve surgery. The threshold for restrictive ring annuloplasty repair of secondary TR at the time of left-sided valve surgery has decreased over time with recognition of the risk of progressive TR and right heart failure in patients with moderate or lesser degrees of TR and tricuspid annular dilatation, as well as with appreciation of the high risks of reoperative surgery for severe TR late after left-sided valve surgery.
- Furthermore, there is growing consensus on the basis of observational data that moderate or lesser degrees of TR should also be managed at the time of left-sided valve surgery with restrictive ring annuloplasty when tricuspid annular dilatation is present.
- However, many patients with unoperated severe TR are also deemed at very high or prohibitive surgical risk.
- There is a clinical need for less invasive therapies for treating severe TR. However, the anatomical features of the tricuspid valve apparatus and right heart chambers have made transcatheter treatment of tricuspid valve quite challenging.
- Several transcatheter therapies have recently emerged that are aimed to reduce caval reflux, shorten the dimensions of the tricuspid annulus, or improve leaflet coaptation. However, few data on safety and feasibility are available.
- Continued refinement of transcatheter techniques offers hope for the development of less invasive means to treat severe TR in many patients deemed at prohibitive or high surgical risk.
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