ECHO 2013 / Right Heart Valvular Disease When to Intervene

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Guidelines are limited

The evidence base is weak

•TV and PV valvular heart disease is clinically “less important” than that of the MV and AV

•Isolated right sided disease relatively rare

•Isolated right sided interventions rare

•Symptoms/signs confounded by co-existing conditions (cardiac/non-cardiac)

•Methods of assessing impact on the right heart less developed/studied

•Role of stress testing not studied

•Limited data on timing for intervention

•Most guidelines are by consensus

•ACC/AHA and ESC guidelines are not consistent

•Guidelines are influenced by frequency of repair vs. replacement and association of TV with left sided disease (you’re in there anyway)

Guideline Summary

•For the tricuspid valve, surgery is indicated for:

–Severe regurgitation with symptoms or at the time of left sided surgery

–Moderate regurgitation with left sided surgery and predictors of poor outcome (annular dilation, PHTN)

–Severe TS with symptoms or at time of left-sided surgery

•For the pulmonic valve:

–PS with peak-to-peak >30 and symptomatic stenosis

–PS with peak-to-peak >40

–Severe regurgitation with RV decompensation

•Just emerging are:

–recommendations based on RV function

–Predictors of unsuccessful repair

•Initial

•Recurrence

Tricuspid Valve

Transthoracic views of TV

RV Inflow view

Ant

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