Article

Assessment of functional tricuspid regurgitation

Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, Padua 35128, Italy.
European Heart Journal (Impact Factor: 14.72). 01/2013; 34. DOI: 10.1093/eurheartj/ehs474
Source: PubMed

ABSTRACT Functional tricuspid regurgitation (FTR) is characterized by structurally normal leaflets and is due to the deformation of the valvulo-ventricular complex. While mild FTR is frequent and usually benign, patients with severe FTR may develop progressive ventricular dysfunction and incur increased mortality. Therefore, FTR should not be ignored, should be appropriately diagnosed and quantified by Doppler echocardiography, and should be evaluated for corrective surgical procedures. At present, referral for surgical correction of FTR is often delayed until patients develop intractable heart failure. However, this strategy frequently translates in poor clinical outcome characterized by notable operative mortality and reduced long-term survival. Appropriate patient selection and proper timing for tricuspid valve (TV) repair or replacement are crucial for optimal outcome, but objective criteria for clinical decison-making remain poorly defined. In the present paper, we review the anatomy of the normal TV, the pathophysiology of FTR, the assessment of its severity and functional significance, and propose an algorithm for selecting patients for surgical treatment.

Download full-text

Full-text

Available from: Maurice E Sarano, Aug 22, 2015
0 Followers
 · 
314 Views
  • Source
    • "Advancements in computer and transducer technology permit the acquisition of 3D data sets with adequate spatial and temporal resolution for assessing most of cardiac pathologies. 3DE enables the visualization of cardiac structures from virtually any perspective, providing a more anatomically sound and intuitive display, as well as an accurate quantitative evaluation of anatomy and function of heart valves [5] [6] [7] [8] [9] [10]. In addition, 3DE overcomes geometric assumptions and enables an accurate quantitative and reproducible evaluation of cardiac chambers [11] [12], thus offering solid elements for patient management [13] [14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Three-dimensional echocardiography is a novel imaging technique based on acquisition and display of volumetric data sets in the beating heart. This permits a comprehensive evaluation of left ventricular (LV) anatomy and function from a single acquisition and expands the diagnostic possibilities of noninvasive cardiology. It provides the possibility of quantitating geometry and function of LV without preestablished assumptions regarding cardiac chamber shape and allows an echocardiographic assessment of the LV that is less operator-dependent and therefore more reproducible. Further developments and improvements for widespread routine applications include higher spatial and temporal resolution to improve image quality, faster acquisition, processing and reconstruction, and fully automated quantitative analysis. At present, three-dimensional echocardiography complements routine 2DE in clinical practice, overcoming some of its limitations and offering additional valuable information that has led to recommending its use for routine assessment of the LV of patients in whom information about LV size and function is critical for their clinical management.
    05/2014; 2014:897431. DOI:10.1155/2014/897431
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to determine the risk factors for tricuspid regurgitation (TR) progression in a contemporary population of patients referred to echocardiography. In a case-control study, we compared 100 consecutive patients with TR progression on serial echocardiograms, (trivial or mild TR on the first echocardiogram and moderate or severe functional TR on a follow-up echocardiogram) with 100 patients matched for age and gender, having mild TR at baseline and no TR progression. Mean age was 72±10 y, 55% were males, and time to TR progression was 5.3±2.9 y. Less than 10% had rheumatic heart disease (RHD). Left ventricular ejection fraction (LVEF) was preserved (≥50%) in 85% of the TR progression group and 74% of the control group (p=0.06). Pulmonary artery systolic pressure (PASP) increased from 41±16 to 56±18 mmHg in the TR progression group and decreased from 44±13 to 41±11 mmHg in the control group (p<0.0001). Independent risk factors for TR progression were PASP change during follow-up (OR per 1 mmHg 1.14, 95% CI 1.06-1.23, p<0.0001), permanent atrial fibrillation (AF) (OR 14.3, 95% CI 4.6-44.2, p<0.0001) and coronary artery disease (OR 5.7, 95% CI 1.4-22.8, p=0.015). All-cause mortality at 3 years was 20% for patients without TR progression, 42% for moderate TR and 63% for severe TR, p<0.0001. Progression to severe TR independently predicted subsequent mortality. In conclusion, in patients with low prevalence of RHD and preserved LVEF, PASP increase and permanent AF were the most powerful risk factors for TR progression. Progression to severe TR was an independent predictor of subsequent mortality.
    The American journal of cardiology 01/2013; 113(6). DOI:10.1016/j.amjcard.2013.11.055 · 3.43 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Valvular regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular regurgitation. The echocardiographic assessment of valvular regurgitation should integrate the quantification of the regurgitation, assessment of the valve anatomy and function, as well as the consequences of valvular disease on cardiac chambers. In clinical practice, the management of patients with valvular regurgitation thus largely integrates the results of echocardiography. It is crucial to provide standards that aim at establishing a baseline list of measurements to be performed when assessing regurgitation.
    06/2013; 14(7). DOI:10.1093/ehjci/jet105
Show more