Tricuspid valve regurgitation: current diagnosis and treatment

Tricuspid regurgitation (TR) is present in 1.6 million individuals in the United States and 3.0 million people in Europe. Functional TR, the most common form of TR, is caused by cardiomyopathies, LV valve disease, or pulmonary disease. The five-year survival with severe TR and HFrEF is 34%. Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease. Management includes diuretics, ACE inhibitors, and aldosterone antagonists. Surgical annuloplasty or valve replacement should be considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension. Transcatheter repair/replacement is possible in patients with a LVEF <40%, dilated annuli, and impaired RV function. The diagnosis and treatment of TR, including coaptation, annuloplasty devices and prosthetic valves, success rates, morbidity/mortality, and trials are discussed. Transcatheter tricuspid valve repair/replacement is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis.

Specific Anatomic Considerations for Tricuspid Interventions

PURPOSE OF REVIEW

This review discusses the normal anatomy and pathology of the tricuspid valve (TV) and right side of the heart. Emphasis is on those anatomic and pathologic features relevant to interventions intended to restore normal function to the TV in disease states.

RECENT FINDINGS

TV pathology is less common than aortic and mitral valve pathology, and treatment and outcomes for interventions face considerable hurdles. New innovations and early data showing safety and efficacy in transcatheter interventions have transformed TV interventions into the next frontier in cardiac valve disease treatment. Certain features of the TV and right heart have presented themselves as potential targets, as well as impediments, for TV intervention. The causes of TV pathology and the anatomy of the TV and right heart bring unique challenges to intervention. Approaches to intervention will continue to progress and change the way we view and treat TV pathology.