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Tricuspid valve regurgitation: no longer the “forgotten valve”

Tricuspid regurgitation (TR) is often an incidental finding on routine echocardiography. While a mild degree is generally regarded as a benign physiological entity, moderate and severe TR are associated with worse outcome... Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease. Whereas primary/organic TR (caused by a structural abnormality) is relatively infrequent, secondary or functional TR (caused by dilatation of the tricuspid annulus and remodelling of the right ventricle and right atrium) is the predominant cause, and isolated TR, associated with atrial fibrillation, is an emerging entity.

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 Fixing a leaky tricuspid valve

Once referred to as the forgotten valve, the tricuspid valve has been getting more attention of late. Earlier this year, the FDA approved two catheter-based devices for repairing a leaky tricuspid valve (see "Understanding heart valve disease"). Both devices have been shown to relieve symptoms and improve quality of life for people with moderate to severe tricuspid regurgitation, which affects about 4% of people ages 75 and older.

Articles of Interest

Showtime For the Tricuspid Valve

TR is a more significant and prevalent clinical issue compared to tricuspid stenosis (TS), which is rare, almost always seen in the context of rheumatic heart disease, and as a result seldom seen in developed countries. When severe, TS can be addressed surgically, particularly in patients undergoing left-heart valve surgery. As with other valvular heart diseases, TR increases with age. The prevalence is higher in women than men, perhaps as much as fourfold higher, but men are more frequently diagnosed with TR. The basis for the higher female prevalence is unclear but is thought to relate to the higher prevalence of heart failure with preserved ejection fraction (HFpEF) in women.

The tricuspid valve in review: anatomy, pathophysiology and echocardiographic assessment with focus on functional tricuspid regurgitation

Tricuspid valve (TV) disease, mostly seen as tricuspid regurgitation (TR) in adults, is the most common right-sided valvular heart lesion. Physiological trace to mild TR is very common and anatomically normal. For decades, even moderate or greater TR has been considered a benign condition and therefore has been under-treated. Most recently, moderate and severe TR have been established as independent predictors of mortality in patients with significant left-sided valve disease and LV dysfunction.

The Tricuspid Valve: Current Perspective and Evolving Management of Tricuspid Regurgitation

Cardiovascular specialists have entered an era of renewed interest and enthusiasm surrounding the diagnosis and treatment of valvular heart disease, driven in part by emerging percutaneous therapies for the treatment of aortic, pulmonic, and mitral valve disease. Despite this wave of investigation, little or no attention has been given to the treatment of tricuspid valve disease.

Tricuspid Valve Disease: The Forgotten Valve No Longer Forgotten​

Over the past several years, focused research efforts have led to innovative surgical and transcatheter treatment options for aortic and mitral valve diseases. Now, these same efforts are on the rise in another area – the tricuspid valve – with the hope of achieving similar advantages and outcomes for patients.

Resources

TriClip

TriClip™ Transcatheter Edge-to-Edge Repair (TEER) offers a minimally invasive treatment option to improve quality of life (QoL) and functional status in patients with symptomatic severe tricuspid regurgitation, despite optimal medical therapy, who are at intermediate or greater risk for surgery.