Functional tricuspid regurgitation: Current understanding_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Liang ,  HUANG Huanlei

1. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, P.R.China;
2. Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, P.R.China;

Corresponding author：

HUANG Huanlei, Email: hhuanlei@hotmail.com

Keywords：

Tricuspid regurgitation; functional; tricuspid valve repair; tricuspid valve replacement

DOI：

10.7507/1007-4848.201906028

Video：

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Abstract Full text Figures/Tables Video References Cited by

Functional tricuspid regurgitation is referred to tricuspid regurgitation due to enlargement of right ventricular and dilation of tricuspid annulus. Patients with chronic progressive tricuspid regurgitation have poor prognosis, poor quality of life and heavy economic burden. This article provides a comprehensive review of functional tricuspid regurgitation in terms of anatomical basis, pathological stage, imaging assessment and surgical decision making.

Citation： YANG Liang, HUANG Huanlei. Functional tricuspid regurgitation: Current understanding. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(6): 716-720. doi: 10.7507/1007-4848.201906028 Copy

1.	Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation, 2009, 119(20): 2718-2725.
2.	Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol, 2004, 43(3): 405-409.
3.	McCarthy PM, Sales VL. Evolving indications for tricuspid valve surgery. Curr Treat Options Cardiovasc Med, 2010, 12(6): 587-597.
4.	Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1): 127-132.
5.	Chan V, Burwash IG, Lam BK, et al. Clinical and echocardiographic impact of functional tricuspid regurgitation repair at the time of mitral valve replacement. Ann Thorac Surg, 2009, 88(4): 1209-1215.
6.	Yiwu L, Yingchun C, Jianqun Z, et al. Exact quantitative selective annuloplasty of the tricuspid valve. J Thorac Cardiovasc Surg, 2001, 122(3): 611-614.
7.	van Rosendael PJ, Kamperidis V, Kong WK, et al. Computed tomography for planning transcatheter tricuspid valve therapy. Eur Heart J, 2017, 38(9): 665-674.
8.	Raja SG, Dreyfus GD. Basis for intervention on functional tricuspid regurgitation. Semin Thorac Cardiovasc Surg, 2010, 22(1): 79-83.
9.	Lancellotti P, Tribouilloy C, Hagendorff A, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging, 2013, 14(7): 611-644.
10.	Nishimura R, Otto C, Bonow R, et al. 2017 AHA/ACC focused update of the 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 Clinical Practice Guidelines. Circulation, 2017, 135(25): e1159-1195.
11.	Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr, 2003, 16(7): 777-802.
12.	Flachskampf FA, Klinghammer L. European Association of Echocardiography recommendations for assessment of valvular regurgitation: a correction. Eur J Echocardiogr, 2010, 11(10): 807-807.
13.	Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr, 2017, 30(4): 303-371.
14.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease executive summary. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
15.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4): S1-S44.
16.	Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg, 2014, 118(1): 21-68.
17.	Lang RM, Badano LP, Tsang W, et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr, 2012, 25(1): 3-46.
18.	Hahn RT. State-of-the-art review of echocardiographic imaging in the evaluation and treatment of functional tricuspid regurgitation. Circ Cardiovasc Imaging, 2016, 9(12): pii: e005332.
19.	Dreyfus J, Durand-Viel G, Raffoul R, et al. Comparison of 2-dimensional, 3-dimensional, and surgical measurements of the tricuspid annulus size: clinical implications. Circ Cardiovasc Imaging, 2015, 8(7): e003241.
20.	Naoum C, Blanke P, Cavalcante JL, et al. Cardiac computed tomography and magnetic resonance imaging in the evaluation of mitral and tricuspid valve disease: implications for transcatheter interventions. Circ Cardiovasc Imaging, 2017, 10(3): pii: e005331.
21.	Prihadi EA, Delgado V, Hahn RT, et al. Imaging needs in novel transcatheter tricuspid valve interventions. JACC Cardiovasc Imaging, 2018, 11(5): 736-754.
22.	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(1): 96-105.
23.	Muraru D, Veronesi F, Maddalozzo A, et al. 3D printing of normal and pathologic tricuspid valves from transthoracic 3D echocardiography data sets. Eur Heart J Cardiovasc Imaging, 2017, 18(7): 802-808.
24.	Kim SM, Singh HS, Nati J, et al. Multi-modality imaging in the evaluation and treatment of tricuspid regurgitation. Curr Treat Options Cardiovasc Med, 2018, 20(9): 77.
25.	Kiely DG, Cargill RI, Lipworth BJ. AngiotensinⅡreceptor blockade and effects on pulmonary hemodynamics and hypoxic pulmonary vasoconstriction in humans. Chest, 1996, 110(3): 698-703.
26.	Kilic A, Saha-Chaudhuri P, Rankin JS, et al. Trends and outcomes of tricuspid valve surgery in North America: an analysis of more than 50,000 patients from the Society of Thoracic Surgeons database. Ann Thorac Surg, 2013, 96(5): 1546-1552.
27.	Chen Z, Ke Y, Xie X, et al. Beating-heart totally endoscopic tricuspid valvuloplasty in reoperative cardiac surgery. Ann Thorac Surg, 2019, 107(1): e79-e82.
28.	Pagnesi M, Montalto C, Mangieri A, et al. Tricuspid annuloplasty versus a conservative approach in patients with functional tricuspid regurgitation undergoing left-sided heart valve surgery: A study-level meta-analysis. Int J Cardiol, 2017, 240: 138-144.
29.	Ro SK, Kim JB, Jung SH, et al. Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2013, 146(5): 1092-1097.
30.	Antunes MJ, Girdwood RW. Tricuspid annuloplasty: a modified technique. Ann Thorac Surg, 1983, 35(6): 676-678.
31.	Carpentier A, Deloche A, Hanania G, et al. Surgical management of acquired tricuspid valve disease. J Thorac Cardiovasc Surg, 1974, 67(1): 53-65.
32.	Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg, 2008, 34(4): 908-910.
33.	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.
34.	Carrier M, Hébert Y, Pellerin M, et al. Tricuspid valve replacement: an analysis of 25 years of experience at a single center. Ann Thorac Surg, 2003, 75(1): 47-50.
35.	Rizzoli G, De Perini L, Bottio T, et al. Prosthetic replacement of the tricuspid valve: biological or mechanical? Ann Thorac Surg, 1998, 66(6 Suppl): S62-S67.
36.	Rodés-Cabau J, Hahn RT, Latib A, et al. Transcatheter therapies for treating tricuspid regurgitation. J Am Coll Cardiol, 2016, 67(15): 1829-1845.

1. Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation, 2009, 119(20): 2718-2725.
2. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol, 2004, 43(3): 405-409.
3. McCarthy PM, Sales VL. Evolving indications for tricuspid valve surgery. Curr Treat Options Cardiovasc Med, 2010, 12(6): 587-597.
4. Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1): 127-132.
5. Chan V, Burwash IG, Lam BK, et al. Clinical and echocardiographic impact of functional tricuspid regurgitation repair at the time of mitral valve replacement. Ann Thorac Surg, 2009, 88(4): 1209-1215.
6. Yiwu L, Yingchun C, Jianqun Z, et al. Exact quantitative selective annuloplasty of the tricuspid valve. J Thorac Cardiovasc Surg, 2001, 122(3): 611-614.
7. van Rosendael PJ, Kamperidis V, Kong WK, et al. Computed tomography for planning transcatheter tricuspid valve therapy. Eur Heart J, 2017, 38(9): 665-674.
8. Raja SG, Dreyfus GD. Basis for intervention on functional tricuspid regurgitation. Semin Thorac Cardiovasc Surg, 2010, 22(1): 79-83.
9. Lancellotti P, Tribouilloy C, Hagendorff A, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging, 2013, 14(7): 611-644.
10. Nishimura R, Otto C, Bonow R, et al. 2017 AHA/ACC focused update of the 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 Clinical Practice Guidelines. Circulation, 2017, 135(25): e1159-1195.
11. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr, 2003, 16(7): 777-802.
12. Flachskampf FA, Klinghammer L. European Association of Echocardiography recommendations for assessment of valvular regurgitation: a correction. Eur J Echocardiogr, 2010, 11(10): 807-807.
13. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr, 2017, 30(4): 303-371.
14. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease executive summary. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
15. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4): S1-S44.
16. Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg, 2014, 118(1): 21-68.
17. Lang RM, Badano LP, Tsang W, et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr, 2012, 25(1): 3-46.
18. Hahn RT. State-of-the-art review of echocardiographic imaging in the evaluation and treatment of functional tricuspid regurgitation. Circ Cardiovasc Imaging, 2016, 9(12): pii: e005332.
19. Dreyfus J, Durand-Viel G, Raffoul R, et al. Comparison of 2-dimensional, 3-dimensional, and surgical measurements of the tricuspid annulus size: clinical implications. Circ Cardiovasc Imaging, 2015, 8(7): e003241.
20. Naoum C, Blanke P, Cavalcante JL, et al. Cardiac computed tomography and magnetic resonance imaging in the evaluation of mitral and tricuspid valve disease: implications for transcatheter interventions. Circ Cardiovasc Imaging, 2017, 10(3): pii: e005331.
21. Prihadi EA, Delgado V, Hahn RT, et al. Imaging needs in novel transcatheter tricuspid valve interventions. JACC Cardiovasc Imaging, 2018, 11(5): 736-754.
22. 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(1): 96-105.
23. Muraru D, Veronesi F, Maddalozzo A, et al. 3D printing of normal and pathologic tricuspid valves from transthoracic 3D echocardiography data sets. Eur Heart J Cardiovasc Imaging, 2017, 18(7): 802-808.
24. Kim SM, Singh HS, Nati J, et al. Multi-modality imaging in the evaluation and treatment of tricuspid regurgitation. Curr Treat Options Cardiovasc Med, 2018, 20(9): 77.
25. Kiely DG, Cargill RI, Lipworth BJ. AngiotensinⅡreceptor blockade and effects on pulmonary hemodynamics and hypoxic pulmonary vasoconstriction in humans. Chest, 1996, 110(3): 698-703.
26. Kilic A, Saha-Chaudhuri P, Rankin JS, et al. Trends and outcomes of tricuspid valve surgery in North America: an analysis of more than 50,000 patients from the Society of Thoracic Surgeons database. Ann Thorac Surg, 2013, 96(5): 1546-1552.
27. Chen Z, Ke Y, Xie X, et al. Beating-heart totally endoscopic tricuspid valvuloplasty in reoperative cardiac surgery. Ann Thorac Surg, 2019, 107(1): e79-e82.
28. Pagnesi M, Montalto C, Mangieri A, et al. Tricuspid annuloplasty versus a conservative approach in patients with functional tricuspid regurgitation undergoing left-sided heart valve surgery: A study-level meta-analysis. Int J Cardiol, 2017, 240: 138-144.
29. Ro SK, Kim JB, Jung SH, et al. Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2013, 146(5): 1092-1097.
30. Antunes MJ, Girdwood RW. Tricuspid annuloplasty: a modified technique. Ann Thorac Surg, 1983, 35(6): 676-678.
31. Carpentier A, Deloche A, Hanania G, et al. Surgical management of acquired tricuspid valve disease. J Thorac Cardiovasc Surg, 1974, 67(1): 53-65.
32. Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg, 2008, 34(4): 908-910.
33. 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.
34. Carrier M, Hébert Y, Pellerin M, et al. Tricuspid valve replacement: an analysis of 25 years of experience at a single center. Ann Thorac Surg, 2003, 75(1): 47-50.
35. Rizzoli G, De Perini L, Bottio T, et al. Prosthetic replacement of the tricuspid valve: biological or mechanical? Ann Thorac Surg, 1998, 66(6 Suppl): S62-S67.
36. Rodés-Cabau J, Hahn RT, Latib A, et al. Transcatheter therapies for treating tricuspid regurgitation. J Am Coll Cardiol, 2016, 67(15): 1829-1845.

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Functional tricuspid regurgitation: Current understanding

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