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Mangieri A, Montalto C, Pagnesi M, Jabbour RJ, Rodés-Cabau J, Moat N, Colombo A, Latib A. Mechanism and Implications of the Tricuspid Regurgitation. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005043. [DOI: 10.1161/circinterventions.117.005043] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/15/2017] [Indexed: 01/28/2023]
Abstract
The tricuspid valve was virtually ignored for a long time in the past. However, significant tricuspid regurgitation (TR) often accompanies left-side heart valve pathology and does not always reverse with its correction. If left untreated, TR can progress and result in progressive right ventricular failure. Current guideline recommendations still hold minor differences. Nevertheless, there is a consensus to operate on patients with severe TR undergoing left-sided valve surgery (class I) or those with mild to moderate TR with a dilated annulus (≥40 or ≥21 mm
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, Class IIa). However, in case of the primary TR, surgical options is limited by a relatively high risk of mortality and morbidity. For these patients, new percutaneous approaches are becoming available but no long-term data are still available. In this review, we provide a comprehensive overview of the epidemiological and pathophysiological aspects of TR, and the current and future directions of therapy.
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Affiliation(s)
- Antonio Mangieri
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Claudio Montalto
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Matteo Pagnesi
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Richard J. Jabbour
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Josep Rodés-Cabau
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Neil Moat
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Antonio Colombo
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
| | - Azeem Latib
- From the Interventional Cardiology Unit, Cardiology and Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy (A.M., C.M., M.P., A.C., A.L.); Department of Cardiology, Imperial College, London, United Kingdom (R.J.J.); Department of Cardiology, Quebec Heart & Lung Institute, Laval University, QC, Canada (J.R.-C.); and Department of Thoracic Surgery, Royal Brompton & Harefield NHS Trust, London, United Kingdom (N.M.)
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Ramakrishna H, Augoustides JGT, Gutsche JT, Stein E, Weiss SJ, Vernick WJ. Incidental tricuspid regurgitation in adult cardiac surgery: focus on current evidence and management options for the perioperative echocardiographer. J Cardiothorac Vasc Anesth 2014; 28:1414-20. [PMID: 25319991 DOI: 10.1053/j.jvca.2014.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erica Stein
- Department of Anesthesiology, Ohio State University, Columbus, OH
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - William J Vernick
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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