DOI QR코드

DOI QR Code

Revisit of Functional Tricuspid Regurgitation; Current Trends in the Diagnosis and Management

  • Muraru, Denisa (Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, School of Medicine) ;
  • Surkova, Elena (Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, School of Medicine) ;
  • Badano, Luigi Paolo (Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, School of Medicine)
  • Received : 2016.02.11
  • Accepted : 2016.03.08
  • Published : 2016.07.30

Abstract

Current knowledge of functional tricuspid regurgitation (FTR) as a progressive entity, worsening the prognosis of patients irrespective of its aetiology, has led to renewed interest in the pathophysiology and assessment of FTR. For the proper management of FTR, not only its severity, but also the mechanisms, the mode of leaflet coaptation, the degree of tricuspid annulus enlargement and leaflet tenting, and the haemodynamic consequences for right atrial and right ventricular morphology and function have to be taken into account. A better assessment of the anatomy and function of tricuspid apparatus and tricuspid regurgitation severity should help with the appropriate selection of patients who will benefit from either surgical tricuspid valve repair/replacement or a percutaneous procedure, especially among patients who are to undergo or have undergone primary left-sided valvular surgery. In this article, we review the anatomy, pathophysiology and the use of imaging techniques to assess patients with FTR, as well as the various treatment options for FTR, including emerging transcatheter procedures. The limitations affecting the current approach to FTR patients and the unmet clinical needs for their management have also been discussed.

Keywords

References

  1. Braunwald NS, Ross J, Jr, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation 1967;35(4 Suppl):I63-9.
  2. Sade RM, Castaneda AR. The dispensable right ventricle. Surgery 1975;77:624-31.
  3. Kim JB, Yoo DG, Kim GS, et al. Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes. Heart 2012;98:24-30. https://doi.org/10.1136/heartjnl-2011-300403
  4. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 2004;43:405-9. https://doi.org/10.1016/j.jacc.2003.09.036
  5. Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol 2009;53:401-8. https://doi.org/10.1016/j.jacc.2008.09.048
  6. Jeong DS, Park PW, Mwambu TP, et al. Tricuspid reoperation after left-sided rheumatic valve operations. Ann Thorac Surg 2013;95:2007-13. https://doi.org/10.1016/j.athoracsur.2013.03.007
  7. Kim YI, Kwon DA, Kim HK, et al. Determinants of surgical outcome in patients with isolated tricuspid regurgitation. Circulation 2009;120:1672-8. https://doi.org/10.1161/CIRCULATIONAHA.109.849448
  8. Zhu TY, Wang JG, Meng X. Does concomitant tricuspid annuloplasty increase perioperative mortality and morbidity when correcting left-sided valve disease? Interact Cardiovasc Thorac Surg 2015;20:114-8. https://doi.org/10.1093/icvts/ivu326
  9. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012;33:2451-96. https://doi.org/10.1093/eurheartj/ehs109
  10. Sutton JP 3rd, Ho SY, Vogel M, Anderson RH. Is the morphologically right atrioventricular valve tricuspid? J Heart Valve Dis 1995;4:571-5.
  11. Victor S, Nayak VM. The tricuspid valve is bicuspid. J Heart Valve Dis 1994;3:27-36.
  12. Basso C, Muraru D, Badano LP, Thiene G. Anatomy and pathology of right-sided atrioventricular and semilunar valves. In: Rajamannan N, editor. Cardiac Valvular Medicine. London: Springer-Verlag; 2013. p.211-21.
  13. Miglioranza MH, Mihăilă S, Muraru D, Cucchini U, Iliceto S, Badano LP. Dynamic changes in tricuspid annular diameter measurement in relation to the echocardiographic view and timing during the cardiac cycle. J Am Soc Echocardiogr 2015;28:226-35. https://doi.org/10.1016/j.echo.2014.09.017
  14. Fukuda S, Saracino G, Matsumara Y, et al. Three-dimensional geometry of the tricuspid annulus in healthy subjects and in patients with functional tricuspid regurgitation: a real-time, 3-dimensional echocardiographic study. Circulation 2006;114(1 Suppl):I492-8. https://doi.org/10.1161/CIRCULATIONAHA.106.630764
  15. Ton-Nu TT, Levine RA, Handschumacher MD, et al. Geometric determinants of functional tricuspid regurgitation: insights from 3-dimensional echocardiography. Circulation 2006;114:143-9. https://doi.org/10.1161/CIRCULATIONAHA.106.611889
  16. Badano LP, Muraru D, Enriquez-Sarano M. Assessment of functional tricuspid regurgitation. Eur Heart J 2013;34:1875-85. https://doi.org/10.1093/eurheartj/ehs474
  17. Dreyfus GD, Martin RP, Chan KM, Dulguerov F, Alexandrescu C. Functional tricuspid regurgitation: a need to revise our understanding. J Am Coll Cardiol 2015;65:2331-6. https://doi.org/10.1016/j.jacc.2015.04.011
  18. Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation 2009;119:2718-25. https://doi.org/10.1161/CIRCULATIONAHA.108.842773
  19. Lancellotti P, Moura L, Pierard LA, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve diseases). Eur J Echocardiogr 2010;11:307-32. https://doi.org/10.1093/ejechocard/jeq031
  20. Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 1999;83:897-902. https://doi.org/10.1016/S0002-9149(98)01064-9
  21. Badano LP, Agricola E, Perez de Isla L, Gianfagna P, Zamorano JL. Evaluation of the tricuspid valve morphology and function by transthoracic real-time three-dimensional echocardiography. Eur J Echocardiogr 2009;10:477-84. https://doi.org/10.1093/ejechocard/jep044
  22. Muraru D, Badano LP. Assessment of tricuspid valve morphology and function. In: Badano LP, Lang RM, Zamorano JL, editors. Textbook of real-time three dimensional echocardiography. London: Springler; 2011. p.173-82.
  23. Kim HK, Kim YJ, Park JS, et al. Determinants of the severity of functional tricuspid regurgitation. Am J Cardiol 2006;98:236-42. https://doi.org/10.1016/j.amjcard.2006.01.082
  24. Tribouilloy CM, Enriquez-Sarano M, Bailey KR, Tajik AJ, Seward JB. Quantification of tricuspid regurgitation by measuring the width of the vena contracta with Doppler color flow imaging: a clinical study. J Am Coll Cardiol 2000;36:472-8. https://doi.org/10.1016/S0735-1097(00)00762-2
  25. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:e57-185. https://doi.org/10.1016/j.jacc.2014.02.536
  26. Song JM, Jang MK, Choi YS, et al. The vena contracta in functional tricuspid regurgitation: a real-time three-dimensional color Doppler echocardiography study. J Am Soc Echocardiogr 2011;24:663-70. https://doi.org/10.1016/j.echo.2011.01.005
  27. Chen TE, Kwon SH, Enriquez-Sarano M, Wong BF, Mankad SV. Three-dimensional color Doppler echocardiographic quantification of tricuspid regurgitation orifice area: comparison with conventional two-dimensional measures. J Am Soc Echocardiogr 2013;26:1143-52. https://doi.org/10.1016/j.echo.2013.07.020
  28. Mascherbauer J, Maurer G. The forgotten valve: lessons to be learned in tricuspid regurgitation. Eur Heart J 2010;31:2841-3. https://doi.org/10.1093/eurheartj/ehq303
  29. Topilsky Y, Tribouilloy C, Michelena HI, Pislaru S, Mahoney DW, Enriquez-Sarano M. Pathophysiology of tricuspid regurgitation: quantitative Doppler echocardiographic assessment of respiratory dependence. Circulation 2010;122:1505-13. https://doi.org/10.1161/CIRCULATIONAHA.110.941310
  30. Miglioranza MH, Mihaila S, Muraru D, Cucchini U, Iliceto S, Badano LP. Variability of Tricuspid Annulus Diameter Measurement in Healthy Volunteers. JACC Cardiovasc Imaging 2015;8:864-6. https://doi.org/10.1016/j.jcmg.2014.09.010
  31. de Agustin JA, Viliani D, Vieira C, et al. Proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography applied for tricuspid regurgitation quantification. J Am Soc Echocardiogr 2013;26:1063-72. https://doi.org/10.1016/j.echo.2013.06.006
  32. Kim HK, Kim YJ, Park EA, et al. Assessment of hemodynamic effects of surgical correction of severe functional tricuspid regurgitation: cardiac magnetic resonance imaging study. Eur Heart J 2010;31:1520-8. https://doi.org/10.1093/eurheartj/ehq063
  33. Maffessanti F, Gripari P, Pontone G, et al. Three-dimensional dynamic assessment of tricuspid and mitral annuli using cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2013;14:986-95.
  34. Anwar AM, Soliman OI, Nemes A, van Geuns RJ, Geleijnse ML, Ten Cate FJ. Value of assessment of tricuspid annulus: real-time three-dimensional echocardiography and magnetic resonance imaging. Int J Cardiovasc Imaging 2007;23:701-5. https://doi.org/10.1007/s10554-006-9206-4
  35. van Rosendael PJ, Joyce E, Katsanos S, et al. Tricuspid valve remodelling in functional tricuspid regurgitation: multidetector row computed tomography insights. Eur Heart J Cardiovasc Imaging 2016;17:96-105.
  36. Nasis A, Mottram PM, Cameron JD, Seneviratne SK. Current and evolving clinical applications of multidetector cardiac CT in assessment of structural heart disease. Radiology 2013;267:11-25. https://doi.org/10.1148/radiol.13111196
  37. Tops LF, Krishnan SC, Schuijf JD, Schalij MJ, Bax JJ. Noncoronary applications of cardiac multidetector row computed tomography. JACC Cardiovascular imaging 2008;1:94-106.
  38. Porter A, Shapira Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J Heart Valve Dis 1999;8:57-62.
  39. De Bonis M, Lapenna E, Sorrentino F, et al. Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyopathy. Eur J Cardiothorac Surg 2008;33:600-6. https://doi.org/10.1016/j.ejcts.2008.01.011
  40. Di Mauro M, Bezante GP, Di Baldassarre A, et al. Functional tricuspid regurgitation: an underestimated issue. Int J Cardiol 2013;168:707-15. https://doi.org/10.1016/j.ijcard.2013.04.043
  41. Vassileva CM, Shabosky J, Boley T, Markwell S, Hazelrigg S. Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg 2012;143:1043-9. https://doi.org/10.1016/j.jtcvs.2011.07.004
  42. Di Mauro M, Bivona A, Iaco AL, et al. Mitral valve surgery for functional mitral regurgitation: prognostic role of tricuspid regurgitation. Eur J Cardiothorac Surg 2009;35:635-9; discussion 639-40. https://doi.org/10.1016/j.ejcts.2008.12.040
  43. Ruel M, Kulik A, Rubens FD, et al. Late incidence and determinants of reoperation in patients with prosthetic heart valves. Eur J Cardiothorac Surg 2004;25:364-70. https://doi.org/10.1016/j.ejcts.2003.12.013
  44. Tang GH, David TE, Singh SK, Maganti MD, Armstrong S, Borger MA. Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes. Circulation 2006;114(1 Suppl):I577-81. https://doi.org/10.1161/CIRCULATIONAHA.106.179120
  45. Rivera R, Duran E, Ajuria M. Carpentier's flexible ring versus De Vega's annuloplasty. A prospective randomized study. J Thorac Cardiovasc Surg 1985;89:196-203.
  46. McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg 2004;127:674-85. https://doi.org/10.1016/j.jtcvs.2003.11.019
  47. Dreyfus GD, Corbi PJ, Chan KM, Bahrami T. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg 2005;79:127-32. https://doi.org/10.1016/j.athoracsur.2004.06.057
  48. Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg 2012;143:632-8. https://doi.org/10.1016/j.jtcvs.2011.12.006
  49. Navia JL, Brozzi NA, Klein AL, et al. Moderate tricuspid regurgitation with left-sided degenerative heart valve disease: to repair or not to repair? Ann Thorac Surg 2012;93:59-67; discussion 68-9. https://doi.org/10.1016/j.athoracsur.2011.08.037
  50. Taramasso M, Maisano F, De Bonis M, et al. Prognostic impact and late evolution of untreated moderate (2/4+) functional tricuspid regurgitation in patients undergoing aortic valve replacement. J Card Surg 2016;31:9-14. https://doi.org/10.1111/jocs.12656
  51. Starck CT, Kempfert J, Falk V. Tricuspid valve interventions: surgical techniques and outcomes. EuroIntervention 2015;11 Suppl W:W128-32.
  52. Taramasso M, Pozzoli A, Guidotti A, et al. Percutaneous tricuspid valve therapies: the new frontier. Eur Heart J 2016;pii:ehv766. [Epub ahead of print]
  53. Lauten A, Figulla HR. Tricuspid valve interventions in 2015. EuroIntervention 2015;11 Suppl W:W133-6.
  54. Arsalan M, Walther T, Smith RL 2nd, Grayburn PA. Tricuspid regurgitation diagnosis and treatment. Eur Heart J 2015;pii: ehv487. [Epub ahead of print]
  55. Tornos Mas P, Rodríguez-Palomares JF, Antunes MJ. Secondary tricuspid valve regurgitation: a forgotten entity. Heart 2015;101:1840-8. https://doi.org/10.1136/heartjnl-2014-307252

Cited by

  1. Role of 3D Echocardiography in Cardiac Surgery: Strengths and Limitations vol.7, pp.3, 2016, https://doi.org/10.1007/s40140-017-0226-5
  2. 3D printing of normal and pathologic tricuspid valves from transthoracic 3D echocardiography data sets vol.18, pp.7, 2016, https://doi.org/10.1093/ehjci/jew215
  3. An overview of surgical treatment modalities and emerging transcatheter interventions in the management of tricuspid valve regurgitation vol.16, pp.2, 2016, https://doi.org/10.1080/14779072.2018.1421068
  4. Functional Tricuspid Regurgitation in Mitral Valve Disease vol.23, pp.1, 2016, https://doi.org/10.1177/1089253218807922
  5. Dynamic Systolic Changes in Tricuspid Regurgitation Vena Contracta Size and Proximal Isovelocity Surface Area in Hypoplastic Left Heart Syndrome: A Three-Dimensional Color Doppler Echocardiographic St vol.34, pp.8, 2016, https://doi.org/10.1016/j.echo.2021.03.004
  6. Recent advances in multimodality imaging of the tricuspid valve vol.18, pp.11, 2016, https://doi.org/10.1080/17434440.2021.1990753
  7. Tricuspid regurgitation in ischemic mitral regurgitation patients: prevalence, predictors for outcome and long-term follow-up vol.21, pp.1, 2016, https://doi.org/10.1186/s12872-021-01982-y