Although tricuspid regurgitation (TR) is a common finding, primary disease of the
tricuspid valve (TV) is an uncommon lesion in developed countries.
1
The more common “functional” TR, is a consequence of annular dilatation and distortion
of the subvalvular apparatus, often resulting from right ventricular (RV) dilation
and dysfunction.
- Cohen SR
- Sell JE
- McIntosh CL
- Clark RE
Tricuspid regurgitation in patients with acquired, chronic, pure mitral regurgitation.
I. Prevalence, diagnosis, and comparison of preoperative clinical and hemodynamic
features in patients with and without tricuspid regurgitation.
J Thorac Cardiovasc Surg. 1987; 94: 481-487
2
These features are most often driven by left heart disease, pulmonary hypertension,
and atrial fibrillation. The unproven assumption that TR would improve or resolve
when the left-sided lesion has been treated lead to a very conservative approach to
anything less than severe TR.
3
Furthermore, the excessive morbidity and mortality associated with TV surgeries supported
this approach, although untreated significant TR itself carries a poor long-term prognosis.
4
,
5
Evidence generated over the past 15 years has led to a more aggressive approach to
tricuspid repair in patients undergoing left heart valvular surgery.
6
,
7
,
8
In many instances of mitral regurgitation, particularly secondary to ischemic or
nonischemic cardiomyopathy, the base disease might impair left and RV function progressing
to significant tricuspid annular dilatation and leaflet tethering. Worsening of TR
might continue despite correction of the mitral disease. Because this patient population
is heterogeneous, disease progression is variable, being dependent on the baseline
lesion, where early correction of degenerative mitral regurgitation shows the least
TR progression.
9
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References
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Article info
Publication history
Published online: May 06, 2021
Footnotes
See article by Muntané-Carol et al., pages 1094-1102 of this issue.
See page 951 for disclosure information.
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© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- Transcatheter Tricuspid Valve Intervention in Patients With Previous Left Valve SurgeryCanadian Journal of CardiologyVol. 37Issue 7
