Significance and Techniques of Assessment and Treatment of the Tricuspid Valve Regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGXiang ¹ , LUYao-xing ² ,  LIGang ¹ , YANGJian-an ¹

1. Department of Cardiovascular Surgery, Shenzhen Sun Yan-sen Cardiovascular Hospital, Shenzhen 518020 Guangdong, P. R. China;
2. Graduate School, University of South China, Hengyang 421001 Hunan, P. R. China;

Corresponding author：

LIGang, Email: lg9199@163.com

Keywords：

Tricuspid valve regurgitation; Valve replacement; Tricuspid valvuloplasty

DOI：

10.7507/1007-4848.20160040

Video：

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Abstract Full text Figures/Tables Video References Cited by

Functional tricuspid valve regurgitation (TR) is often secondary to left-sided valvular heart diseases. The precise diagnosis of TR degree and reasonable treatment can improve the long-term prognosis of patient. Now we believe that rectifying the TR during left cardiac valve surgery can prevent a further development of TR and avoid the reducing of the cardiac function for patients with moderate TR, tricuspid valve annulus diameter>40 mm in late diastole, tricuspid valve diameter/body surface area>21 mm/m², and intraoperative tricuspid valve diameter >70 mm, especially for patients with atrial fibrillation and atrial enlargement. The use of prosthetic ring can effectively prevent recurrence of TR in long term and we should try to use hard or semihard "C" shape prosthetic ring as much as possible. The tricuspid valve replacement should be avioded because of its higher mortality.

Citation： WANGXiang, LUYao-xing, LIGang, YANGJian-an. Significance and Techniques of Assessment and Treatment of the Tricuspid Valve Regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(2): 183-186. doi: 10.7507/1007-4848.20160040 Copy

1.	Antunes MJ, Barlow JB. Management of tricuspid valve regurgita-tion. Heart, 2007, 93(2): 271-276.
2.	Kwak JJ, Kim YJ, Kim MK, et al. Development of tricuspid regurgi-tation late after left-sided valve surgery:a single-center experience with long-term echocardiographic examinations. Am Heart J, 2008, 155(4): 732-737.
3.	Matsunaga A, Duran CM. Progression of tricuspid regurgitation after repaored functional ischemic mitral regurgitation. Circulation, 2005, 112(9 Suppl): I453-I457.
4.	魏丹, 孟旭, 李岩, 等.左心瓣膜术后心房颤动与三尖瓣反流的关系.心肺血管病杂志, 2012, 31(1): 36-39.
5.	虞聪, 董念国, 史嘉玮, 等.继发性三尖瓣反流危险因素的Meta分析.中国循证医学杂志, 2013, 13(12): 1482-1491.
6.	Song H, Kim MJ, Chung CH, et al. Factors associated with develop-ment of late significant tricuspid regurgitation after successful left-sided valve surgery. Heart, 2009, 95(11): 931-936.
7.	Lzumi C, Lga K, Konishi T. Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease. J Heart Valve Dis, 2002, 11(3): 353-356.
8.	Zhu TY, Min XP, Zhang HB, et al. Preoperative risk factors for residual tricuspid regurgitation after isolated left-sided valve surgery:a systematic review and meta-analysis. Cardiol, 2014, 129(4): 242-249.
9.	Kwon DA, Park JS, Chang HJ, et al. Prediction of outcome in patients undergoing surgery for severe tricuspid regurgitation following mitral valve surgery and role of role of tricuspid annular systolic velocity. Am J Cardiol, 2006, 98(5): 659-661.
10.	Kuwaki K, Morishita K, Tsukamoto M, et al. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease. Eur J Cardiothorac Surg, 2001, 20(3): 577-582.
11.	王湘, 陈长春, 李刚, 等.三尖瓣瓣膜置换术的临床分析.中国胸心血管外科临床杂志, 2007, 14(1): 16-19.
12.	MaurizioT, Hugo V, Francesco M, et al. The Growing clinical Importance of secondary tricuspid regurgitation. J Am Coll Cardiol, 2012, 59(8): 703-710.
13.	Ruel M, Rubens FD, Masters RG, et al. Late incidence and predic-tors of persistent or recurrent heart failure in patients with mitral prothetic valves. J Thorac Cardiovasc Sury, 2004, 128(2): 278-283.
14.	Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol, 2004, 43(3): 405-409.
15.	Calafiore AM, Gallina S, laco AL, et al. Mitral valve surgery for functional mitral regurgitation:should moderate-or-more tricuspid regurgitation be treated:A propensity score analysis. Ann Thorac Surg, 2009, 87(3): 698-703.
16.	Di Mauro M, Bivona A, Laco AL. et al. Mitral valve surgery for func-tional mitral regurgition:prognostic role of tricuspid regurgitation. Eur J Cardiothorac Surg, 2009, 35(4): 635-639.
17.	Kim JB, Yoo DG, Kim GS, et al. Mild-to-moderate functional tricu-spid regurgitation in patients undergoing valve replacement for rheumatic mitral disease:the influence of tricuspid valve repair on clinical and echocardiographic outcomes. Heart, 2012, 98(1): 24-30.
18.	Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regur-gitation or dilatation:which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1): 127-132.
19.	Goldsstone AB, Howard JL, Cohen JE, et al. Natural history of coexistent tricuspid regurgitation in patients with degenerative mitral valve disease:implications for future guidelines. J Thorac Cardiovasc Surg, 2014, 148(6): 2802-2809.
20.	Colombo T, Russo C, Ciliberto GR, et al. Tricuspid regurgitation secondary to mitral valve disease: tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg, 2001, 9(4): 369-377.
21.	Van de Veire Nico R, Braun J, Delgado V, et al. Tricuspid annulo-plasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg, 2011, 141(6): 1431-1439.
22.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the manage-ment of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
23.	Zhu TY, Meng X, Han J, et al. An alternative intraoperative method based on annular circumference for the decision-making of proph-ylactic tricuspid annuloplasty. J heart Valve Dis, 2014, 23(3): 370-376.
24.	Zhu TY, Wang JG, Meng X. Does concomitant tricuspid annulao-plasty increase perioperative mortality and morbidity when correc-ting left-sided valve disease? Interact Cardiovasc Thorac Surg, 2015, 20(1): 114-118.
25.	Brewer RJ, Cabrera R, El-Atrache M, et al. Relationship of tricuspid repair at the time of left ventricular assist device implantation and survival. Int J Artif Organs, 2014, 37(11): 834-838.
26.	Raja SG, Dreyfus GD. Basis for intervention on functional tricuspid regurgitation. Semin Thorac Cardiovasc Surg, 2010, 22(1): 79-83.
27.	Chopra HK, Nanda NC, Fan P, et al. Can two-dimensional echocar-diography and Doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol, 1989, 14(5): 1266-1274.
28.	Rogers JH, Bolling SF. The tricuspid valve:current perspective and evolving management of tricuspid regurgitation. Circulation, 2009, 119(20): 2718-2725.
29.	Shiran A, Sagie A. Tricupid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol, 2009, 53(5): 401-408.
30.	Shahzad GR, Gills DD.Surgery for functional tricuspid regurgita-tion: Current techniques, outcomes and emerging concepts. Expert Rev Cardiovasc, 2009, 7(1): 73-84.
31.	Tang GH, David TE, Singh SK, et al. Tricuspid valve repair with annuloplasty ring results in improved long-term outcomes. Circulation, 2006, 114(1 Suppl): I577-I581.
32.	Ratschiller T, Guenther T, Guenzinger R, et al. Early experiences with a new three-dimensional annuloplasty ring for the treatment of functional tricuspid regurgitation. Ann Thorac Surg, 2014, 98(6): 2039-2044.
33.	McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair:durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3): 674-85.
34.	Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation:annulus, commissure, or leaflet procedure? J Thorac Cardiovasc Surg, 2010, 139(6): 1473-1482.
35.	De Bonis M, Taramasso M, Lapenna E, et al. Management of tricuspid regurgitation. Prime Rep, 2014, 6(8): 58.
36.	Fukuda S, Gillinov AM, McCarthy PM, et al. Echocardiographic follow-up of tricuspid annuloplasty with a new three-dimensional ring in patients with functional tricuspid regurgitation. J Am Soc Echocardiogr, 2007, 20(11): 1236-1242.
37.	Lapenna E, De Bonis M, Verzini A, et al. The clover technique for the treatment of complex tricuspid valve insufficiency: midterm clinical and echocardiographic results in 66 patients. Eur J Cardiothorac Surg, 2010, 37(6): 1297-1303.
38.	Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaflet augmenta-tion to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg, 2008, 34(4): 908-910.

1. Antunes MJ, Barlow JB. Management of tricuspid valve regurgita-tion. Heart, 2007, 93(2): 271-276.
2. Kwak JJ, Kim YJ, Kim MK, et al. Development of tricuspid regurgi-tation late after left-sided valve surgery:a single-center experience with long-term echocardiographic examinations. Am Heart J, 2008, 155(4): 732-737.
3. Matsunaga A, Duran CM. Progression of tricuspid regurgitation after repaored functional ischemic mitral regurgitation. Circulation, 2005, 112(9 Suppl): I453-I457.
4. 魏丹, 孟旭, 李岩, 等.左心瓣膜术后心房颤动与三尖瓣反流的关系.心肺血管病杂志, 2012, 31(1): 36-39.
5. 虞聪, 董念国, 史嘉玮, 等.继发性三尖瓣反流危险因素的Meta分析.中国循证医学杂志, 2013, 13(12): 1482-1491.
6. Song H, Kim MJ, Chung CH, et al. Factors associated with develop-ment of late significant tricuspid regurgitation after successful left-sided valve surgery. Heart, 2009, 95(11): 931-936.
7. Lzumi C, Lga K, Konishi T. Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease. J Heart Valve Dis, 2002, 11(3): 353-356.
8. Zhu TY, Min XP, Zhang HB, et al. Preoperative risk factors for residual tricuspid regurgitation after isolated left-sided valve surgery:a systematic review and meta-analysis. Cardiol, 2014, 129(4): 242-249.
9. Kwon DA, Park JS, Chang HJ, et al. Prediction of outcome in patients undergoing surgery for severe tricuspid regurgitation following mitral valve surgery and role of role of tricuspid annular systolic velocity. Am J Cardiol, 2006, 98(5): 659-661.
10. Kuwaki K, Morishita K, Tsukamoto M, et al. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease. Eur J Cardiothorac Surg, 2001, 20(3): 577-582.
11. 王湘, 陈长春, 李刚, 等.三尖瓣瓣膜置换术的临床分析.中国胸心血管外科临床杂志, 2007, 14(1): 16-19.
12. MaurizioT, Hugo V, Francesco M, et al. The Growing clinical Importance of secondary tricuspid regurgitation. J Am Coll Cardiol, 2012, 59(8): 703-710.
13. Ruel M, Rubens FD, Masters RG, et al. Late incidence and predic-tors of persistent or recurrent heart failure in patients with mitral prothetic valves. J Thorac Cardiovasc Sury, 2004, 128(2): 278-283.
14. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol, 2004, 43(3): 405-409.
15. Calafiore AM, Gallina S, laco AL, et al. Mitral valve surgery for functional mitral regurgitation:should moderate-or-more tricuspid regurgitation be treated:A propensity score analysis. Ann Thorac Surg, 2009, 87(3): 698-703.
16. Di Mauro M, Bivona A, Laco AL. et al. Mitral valve surgery for func-tional mitral regurgition:prognostic role of tricuspid regurgitation. Eur J Cardiothorac Surg, 2009, 35(4): 635-639.
17. Kim JB, Yoo DG, Kim GS, et al. Mild-to-moderate functional tricu-spid regurgitation in patients undergoing valve replacement for rheumatic mitral disease:the influence of tricuspid valve repair on clinical and echocardiographic outcomes. Heart, 2012, 98(1): 24-30.
18. Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regur-gitation or dilatation:which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1): 127-132.
19. Goldsstone AB, Howard JL, Cohen JE, et al. Natural history of coexistent tricuspid regurgitation in patients with degenerative mitral valve disease:implications for future guidelines. J Thorac Cardiovasc Surg, 2014, 148(6): 2802-2809.
20. Colombo T, Russo C, Ciliberto GR, et al. Tricuspid regurgitation secondary to mitral valve disease: tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg, 2001, 9(4): 369-377.
21. Van de Veire Nico R, Braun J, Delgado V, et al. Tricuspid annulo-plasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg, 2011, 141(6): 1431-1439.
22. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the manage-ment of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
23. Zhu TY, Meng X, Han J, et al. An alternative intraoperative method based on annular circumference for the decision-making of proph-ylactic tricuspid annuloplasty. J heart Valve Dis, 2014, 23(3): 370-376.
24. Zhu TY, Wang JG, Meng X. Does concomitant tricuspid annulao-plasty increase perioperative mortality and morbidity when correc-ting left-sided valve disease? Interact Cardiovasc Thorac Surg, 2015, 20(1): 114-118.
25. Brewer RJ, Cabrera R, El-Atrache M, et al. Relationship of tricuspid repair at the time of left ventricular assist device implantation and survival. Int J Artif Organs, 2014, 37(11): 834-838.
26. Raja SG, Dreyfus GD. Basis for intervention on functional tricuspid regurgitation. Semin Thorac Cardiovasc Surg, 2010, 22(1): 79-83.
27. Chopra HK, Nanda NC, Fan P, et al. Can two-dimensional echocar-diography and Doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol, 1989, 14(5): 1266-1274.
28. Rogers JH, Bolling SF. The tricuspid valve:current perspective and evolving management of tricuspid regurgitation. Circulation, 2009, 119(20): 2718-2725.
29. Shiran A, Sagie A. Tricupid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol, 2009, 53(5): 401-408.
30. Shahzad GR, Gills DD.Surgery for functional tricuspid regurgita-tion: Current techniques, outcomes and emerging concepts. Expert Rev Cardiovasc, 2009, 7(1): 73-84.
31. Tang GH, David TE, Singh SK, et al. Tricuspid valve repair with annuloplasty ring results in improved long-term outcomes. Circulation, 2006, 114(1 Suppl): I577-I581.
32. Ratschiller T, Guenther T, Guenzinger R, et al. Early experiences with a new three-dimensional annuloplasty ring for the treatment of functional tricuspid regurgitation. Ann Thorac Surg, 2014, 98(6): 2039-2044.
33. McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair:durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3): 674-85.
34. Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation:annulus, commissure, or leaflet procedure? J Thorac Cardiovasc Surg, 2010, 139(6): 1473-1482.
35. De Bonis M, Taramasso M, Lapenna E, et al. Management of tricuspid regurgitation. Prime Rep, 2014, 6(8): 58.
36. Fukuda S, Gillinov AM, McCarthy PM, et al. Echocardiographic follow-up of tricuspid annuloplasty with a new three-dimensional ring in patients with functional tricuspid regurgitation. J Am Soc Echocardiogr, 2007, 20(11): 1236-1242.
37. Lapenna E, De Bonis M, Verzini A, et al. The clover technique for the treatment of complex tricuspid valve insufficiency: midterm clinical and echocardiographic results in 66 patients. Eur J Cardiothorac Surg, 2010, 37(6): 1297-1303.
38. Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaflet augmenta-tion to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg, 2008, 34(4): 908-910.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Significance and Techniques of Assessment and Treatment of the Tricuspid Valve Regurgitation

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