Interventional treatment of tricuspid regurgitation

Excerpt

Significant tricuspid regurgitation (TR) is a common condition affecting more than 2% of individuals over the age of 75 years [ 1]. In the overwhelming majority of cases tricuspid regurgitation develops secondarily. It is the result of incomplete leaflet coaptation caused by tricuspid annular dilatation and/or leaflet tethering due to right ventricular dilatation. Progressive volume overload of the right ventricle promotes a vicious circle characterized by further dilatation of right ventricle, tricuspid annulus and right atrium, which promotes further worsening of TR. Frequently, patients presenting with significant TR also suffer from atrial fibrillation, which may contribute to further annular dilatation. Long-standing TR, specifically in the setting of increased pulmonary pressures, can promote irreversible structural right ventricular, tricuspid annular and right atrial remodelling. It is associated with impaired prognosis in heart failure with preserved as well as reduced ejection fraction [ 2, 3]. An increasing body of evidence also relates moderate/severe TR to an increased mortality risk, which is independent of pulmonary pressures or right ventricular (RV) function [ 4, 5]. …