cardiovascular disorders
Tricuspid Regurgitation
Treatment of Tricuspid Regurgitation
Treatment of cause Sometimes annuloplasty or valve repair or replacement Very mild tricuspid regurgitation is a normal finding and requires no action. Medical treatment of causes (eg, heart failure, endocarditis) is indicated. Medical therapy with loop diuretics can relieve congestion.Aldosteroneantagonists may be of additive benefit as they counter secondary hyperaldosteronism due to hepatic congestion. Treating the etiology is important in secondary TR. Timing of intervention for tricuspid regurgitationdepends on the patient's symptoms and RV function. Patients with severe tricuspid regurgitation should undergo operation as soon as symptoms are present despite medical treatment or when there is moderate, progressive RV enlargement or dysfunction. Severe LV dysfunction or severe pulmonary hypertension may make the surgical risk prohibitive. During surgery for left-sided heart lesions, patients with moderate or mild TR with dilated annulus > 40 mm can undergo tricuspid annuloplasty, slowing progression to severe TR. However, tricuspid annuloplasty increases risk of the need for permanent pacing five-fold. The net clinical benefit is not certain and awaits long-term follow up of the randomized trial addressing this issue ( Treatment reference ). Surgical options include Annuloplasty Valve repair Valve replacement Annuloplasty, in which the tricuspid valve annulus is sutured to a prosthetic ring or a tailored reduction in annulus circumferential size is done, is indicated when TR is due to annular dilation. Valve repair or replacement is indicated when TR is due to primary valve abnormalities or when annuloplasty is not technically feasible. Tricuspid valve repair is generally preferred to replacement. 10 years. A bioprosthetic valve requires temporary anticoagulation (see also Anticoagulation for patients with a prosthetic cardiac valve ). Progress is being made toward a percutaneous valve repair procedure. Early studies have shown improvement in the degree of regurgitation and in right-sided hemodynamics. Development of a percutaneous repair procedure will allow lower risk repair much earlier in the natural history of severe TR. 1.Gammie JS, Chu MWA, Falk V, et al: Concomitant tricuspid repair in patients with degenerative mitral regurgitation.N Engl J Med386(4):327–339, 2022. doi: 10.1056/NEJMoa2115961 