ECHO 2013 / Right Heart Valvular Disease When to Intervene
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Recognizing functional tricuspid
regurgitation
Excluding other causes
Functional tricuspid regurgitation
Tricuspid regurgitation that occurs despite the presence of structurally normal tricuspid leaflets and chords
End result of left heart problem
left atrial hypertension pulmonary hypertension right ventricular dysfunction/remodeling tricuspid regurgitation
Due to primary RV problem
right ventricular dysfunction/remodeling tricuspid regurgitation
Due to annular dilation (e.g.AF)
Echocardiographic Appearance of Functional TR
Gibson TC et al. J Am Coll Cardiol 1984;4:1052-7
Annular dilation
Annular dilation
PA pressure
Impact of General Anesthesia
Gemayel et al Circulation 2001; 104(17) II-676
Awake |
Asleepp |
RV
RA
ERO: 0.40 cm2 Regurgitant volume: 55 cc VC= 6.7 mm
RA
LA
RV
ERO: 0.09 cm2 Regurgitant volume: 9.7 cc
Surgery (Tricuspid Repair)
•At the time of left sided surgery
•If severe and symptomatic
Receiver-operating characteristic (ROC) curves of preoperative %TR and TV tethering distance and area in prediction of post-op TR (age, LV and RV fxn not shown)
Annular dimension not predictive
Fukuda S et al. Circulation 2005;111:975-979
Copyright © American Heart Association
Primary disorders of the TV