Tricuspid regurgitation medical therapy: Difference between revisions
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(/* 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (DO NOT EDIT){{cite journal|last1=Vahanian|first1=Alec|last2=Alfieri|first2=Ottavio|last3=Andreotti|first3=Felicita|last4=Antunes|first4=Manuel J.|last5=Barón-Esquivi...) |
(/* 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (DO NOT EDIT){{cite journal|last1=Vahanian|first1=Alec|last2=Alfieri|first2=Ottavio|last3=Andreotti|first3=Felicita|last4=Antunes|first4=Manuel J.|last5=Barón-Esquivi...) |
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The selective use of pulmonary vasodilators in patients with [[pulmonary hypertension|pulmonary artery hypertension]] may improve the valvular regurgitation.<ref name="pmidPMID: 27048553">{{cite journal| author=Rodés-Cabau J, Taramasso M, O'Gara PT| title=Diagnosis and treatment of tricuspid valve disease: current and future perspectives. | journal=Lancet | year= 2016 | volume= 388 | issue= 10058 | pages= 2431-2442 | pmid=PMID: 27048553 | doi=10.1016/S0140-6736(16)00740-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27048553 }} </ref><ref name="pmid23063102">{{cite journal| author=Antoniou T, Koletsis EN, Prokakis C, Rellia P, Thanopoulos A, Theodoraki K et al.| title=Hemodynamic effects of combination therapy with inhaled nitric oxide and iloprost in patients with pulmonary hypertension and right ventricular dysfunction after high-risk cardiac surgery. | journal=J Cardiothorac Vasc Anesth | year= 2013 | volume= 27 | issue= 3 | pages= 459-66 | pmid=23063102 | doi=10.1053/j.jvca.2012.07.020 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23063102 }} </ref> | The selective use of pulmonary vasodilators in patients with [[pulmonary hypertension|pulmonary artery hypertension]] may improve the valvular regurgitation.<ref name="pmidPMID: 27048553">{{cite journal| author=Rodés-Cabau J, Taramasso M, O'Gara PT| title=Diagnosis and treatment of tricuspid valve disease: current and future perspectives. | journal=Lancet | year= 2016 | volume= 388 | issue= 10058 | pages= 2431-2442 | pmid=PMID: 27048553 | doi=10.1016/S0140-6736(16)00740-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27048553 }} </ref><ref name="pmid23063102">{{cite journal| author=Antoniou T, Koletsis EN, Prokakis C, Rellia P, Thanopoulos A, Theodoraki K et al.| title=Hemodynamic effects of combination therapy with inhaled nitric oxide and iloprost in patients with pulmonary hypertension and right ventricular dysfunction after high-risk cardiac surgery. | journal=J Cardiothorac Vasc Anesth | year= 2013 | volume= 27 | issue= 3 | pages= 459-66 | pmid=23063102 | doi=10.1053/j.jvca.2012.07.020 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23063102 }} </ref> | ||
==2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (DO NOT EDIT)<ref name="VahanianAlfieri2012">{{cite journal|last1=Vahanian|first1=Alec|last2=Alfieri|first2=Ottavio|last3=Andreotti|first3=Felicita|last4=Antunes|first4=Manuel J.|last5=Barón-Esquivias|first5=Gonzalo|last6=Baumgartner|first6=Helmut|last7=Borger|first7=Michael Andrew|last8=Carrel|first8=Thierry P.|last9=De Bonis|first9=Michele|last10=Evangelista|first10=Arturo|last11=Falk|first11=Volkmar|last12=Iung|first12=Bernard|last13=Lancellotti|first13=Patrizio|last14=Pierard|first14=Luc|last15=Price|first15=Susanna|last16=Schäfers|first16=Hans-Joachim|last17=Schuler|first17=Gerhard|last18=Stepinska|first18=Janina|last19=Swedberg|first19=Karl|last20=Takkenberg|first20=Johanna|last21=Von Oppell|first21=Ulrich Otto|last22=Windecker|first22=Stephan|last23=Zamorano|first23=Jose Luis|last24=Zembala|first24=Marian|last25=Bax|first25=Jeroen J.|last26=Baumgartner|first26=Helmut|last27=Ceconi|first27=Claudio|last28=Dean|first28=Veronica|last29=Deaton|first29=Christi|last30=Fagard|first30=Robert|last31=Funck-Brentano|first31=Christian|last32=Hasdai|first32=David|last33=Hoes|first33=Arno|last34=Kirchhof|first34=Paulus|last35=Knuuti|first35=Juhani|last36=Kolh|first36=Philippe|last37=McDonagh|first37=Theresa|last38=Moulin|first38=Cyril|last39=Popescu|first39=Bogdan A.|last40=Reiner|first40=Željko|last41=Sechtem|first41=Udo|last42=Sirnes|first42=Per Anton|last43=Tendera|first43=Michal|last44=Torbicki|first44=Adam|last45=Vahanian|first45=Alec|last46=Windecker|first46=Stephan|last47=Popescu|first47=Bogdan A.|last48=Von Segesser|first48=Ludwig|last49=Badano|first49=Luigi P.|last50=Bunc|first50=Matjaž|last51=Claeys|first51=Marc J.|last52=Drinkovic|first52=Niksa|last53=Filippatos|first53=Gerasimos|last54=Habib|first54=Gilbert|last55=Kappetein|first55=A. Pieter|last56=Kassab|first56=Roland|last57=Lip|first57=Gregory Y.H.|last58=Moat|first58=Neil|last59=Nickenig|first59=Georg|last60=Otto|first60=Catherine M.|last61=Pepper|first61=John|last62=Piazza|first62=Nicolo|last63=Pieper|first63=Petronella G.|last64=Rosenhek|first64=Raphael|last65=Shuka|first65=Naltin|last66=Schwammenthal|first66=Ehud|last67=Schwitter|first67=Juerg|last68=Mas|first68=Pilar Tornos|last69=Trindade|first69=Pedro T.|last70=Walther|first70=Thomas|title=Guidelines on the management of valvular heart disease (version 2012)|journal=European Heart Journal|volume=33|issue=19|year=2012|pages=2451–2496|issn=1522-9645|doi=10.1093/eurheartj/ehs109}}</ref><ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }}<ref name="pmid28298458">{{cite journal |vauthors=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A |title=2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines |journal=Circulation |volume=135 |issue=25 |pages=e1159–e1195 |date=June 2017 |pmid=28298458 |doi=10.1161/CIR.0000000000000503 |url=}} | ==2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (DO NOT EDIT)<ref name="VahanianAlfieri2012">{{cite journal|last1=Vahanian|first1=Alec|last2=Alfieri|first2=Ottavio|last3=Andreotti|first3=Felicita|last4=Antunes|first4=Manuel J.|last5=Barón-Esquivias|first5=Gonzalo|last6=Baumgartner|first6=Helmut|last7=Borger|first7=Michael Andrew|last8=Carrel|first8=Thierry P.|last9=De Bonis|first9=Michele|last10=Evangelista|first10=Arturo|last11=Falk|first11=Volkmar|last12=Iung|first12=Bernard|last13=Lancellotti|first13=Patrizio|last14=Pierard|first14=Luc|last15=Price|first15=Susanna|last16=Schäfers|first16=Hans-Joachim|last17=Schuler|first17=Gerhard|last18=Stepinska|first18=Janina|last19=Swedberg|first19=Karl|last20=Takkenberg|first20=Johanna|last21=Von Oppell|first21=Ulrich Otto|last22=Windecker|first22=Stephan|last23=Zamorano|first23=Jose Luis|last24=Zembala|first24=Marian|last25=Bax|first25=Jeroen J.|last26=Baumgartner|first26=Helmut|last27=Ceconi|first27=Claudio|last28=Dean|first28=Veronica|last29=Deaton|first29=Christi|last30=Fagard|first30=Robert|last31=Funck-Brentano|first31=Christian|last32=Hasdai|first32=David|last33=Hoes|first33=Arno|last34=Kirchhof|first34=Paulus|last35=Knuuti|first35=Juhani|last36=Kolh|first36=Philippe|last37=McDonagh|first37=Theresa|last38=Moulin|first38=Cyril|last39=Popescu|first39=Bogdan A.|last40=Reiner|first40=Željko|last41=Sechtem|first41=Udo|last42=Sirnes|first42=Per Anton|last43=Tendera|first43=Michal|last44=Torbicki|first44=Adam|last45=Vahanian|first45=Alec|last46=Windecker|first46=Stephan|last47=Popescu|first47=Bogdan A.|last48=Von Segesser|first48=Ludwig|last49=Badano|first49=Luigi P.|last50=Bunc|first50=Matjaž|last51=Claeys|first51=Marc J.|last52=Drinkovic|first52=Niksa|last53=Filippatos|first53=Gerasimos|last54=Habib|first54=Gilbert|last55=Kappetein|first55=A. Pieter|last56=Kassab|first56=Roland|last57=Lip|first57=Gregory Y.H.|last58=Moat|first58=Neil|last59=Nickenig|first59=Georg|last60=Otto|first60=Catherine M.|last61=Pepper|first61=John|last62=Piazza|first62=Nicolo|last63=Pieper|first63=Petronella G.|last64=Rosenhek|first64=Raphael|last65=Shuka|first65=Naltin|last66=Schwammenthal|first66=Ehud|last67=Schwitter|first67=Juerg|last68=Mas|first68=Pilar Tornos|last69=Trindade|first69=Pedro T.|last70=Walther|first70=Thomas|title=Guidelines on the management of valvular heart disease (version 2012)|journal=European Heart Journal|volume=33|issue=19|year=2012|pages=2451–2496|issn=1522-9645|doi=10.1093/eurheartj/ehs109}}</ref><ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }}<ref name="pmid28298458">{{cite journal |vauthors=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A |title=2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines |journal=Circulation |volume=135 |issue=25 |pages=e1159–e1195 |date=June 2017 |pmid=28298458 |doi=10.1161/CIR.0000000000000503 |url=}}</ref>== | ||
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Revision as of 18:17, 2 March 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2] Fatimo Biobaku M.B.B.S [3]
Overview
The main therapy is treatment of underlying cause. The aim of medical therapy among patients with tricuspid regurgitation is to treat right heart failure, left heart failure, and/or pulmonary hypertension in case they are present. Medical therapy with diuretics is given to reduce volume overload. Treatment with medications such as vasodilators to relieve pulmonary hypertension may also be of benefit.
Medical Therapy
Right Heart Failure
Patients with trucspid regurgitation and symptoms of right heart failure should receive diuretics in order to reduce their volume overload. Loop diuretics are commonly used. Aldosterone antagonists can be beneficial among patients with hyperaldosteronism secondary to hepatic congestion. Diuretics should be administered intravenously whenever the patient has intestinal edema as oral treatment with diuretics is inefficacious.[1]
Left Heart Failure
If left heart failure is present, the therapeutic strategy should be targeted towards the treatment of the underlying pathophysiological mechanism.
Pulmonary Hypertension
The selective use of pulmonary vasodilators in patients with pulmonary artery hypertension may improve the valvular regurgitation.[2][3]
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease (DO NOT EDIT)[4]
| Class IIa |
| "1. Diuretics can be useful for patients with severe TR and signs of right-sided HF (stage D). (Level of Evidence: C)" |
| Class IIb |
| "1. Medical therapies to reduce elevated pulmonary artery pressures and/or pulmonary vascular resistance might be considered in patients with severe functional TR (stages C and D). (Level of Evidence: C)" |
References
- ↑ Bruce CJ, Connolly HM (2009). "Right-sided valve disease deserves a little more respect". Circulation. 119 (20): 2726–34. doi:10.1161/CIRCULATIONAHA.108.776021. PMID 19470901.
- ↑ Rodés-Cabau J, Taramasso M, O'Gara PT (2016). "Diagnosis and treatment of tricuspid valve disease: current and future perspectives". Lancet. 388 (10058): 2431–2442. doi:10.1016/S0140-6736(16)00740-6. PMID 27048553 PMID: 27048553 Check
|pmid=value (help). - ↑ Antoniou T, Koletsis EN, Prokakis C, Rellia P, Thanopoulos A, Theodoraki K; et al. (2013). "Hemodynamic effects of combination therapy with inhaled nitric oxide and iloprost in patients with pulmonary hypertension and right ventricular dysfunction after high-risk cardiac surgery". J Cardiothorac Vasc Anesth. 27 (3): 459–66. doi:10.1053/j.jvca.2012.07.020. PMID 23063102.
- ↑ Vahanian, Alec; Alfieri, Ottavio; Andreotti, Felicita; Antunes, Manuel J.; Barón-Esquivias, Gonzalo; Baumgartner, Helmut; Borger, Michael Andrew; Carrel, Thierry P.; De Bonis, Michele; Evangelista, Arturo; Falk, Volkmar; Iung, Bernard; Lancellotti, Patrizio; Pierard, Luc; Price, Susanna; Schäfers, Hans-Joachim; Schuler, Gerhard; Stepinska, Janina; Swedberg, Karl; Takkenberg, Johanna; Von Oppell, Ulrich Otto; Windecker, Stephan; Zamorano, Jose Luis; Zembala, Marian; Bax, Jeroen J.; Baumgartner, Helmut; Ceconi, Claudio; Dean, Veronica; Deaton, Christi; Fagard, Robert; Funck-Brentano, Christian; Hasdai, David; Hoes, Arno; Kirchhof, Paulus; Knuuti, Juhani; Kolh, Philippe; McDonagh, Theresa; Moulin, Cyril; Popescu, Bogdan A.; Reiner, Željko; Sechtem, Udo; Sirnes, Per Anton; Tendera, Michal; Torbicki, Adam; Vahanian, Alec; Windecker, Stephan; Popescu, Bogdan A.; Von Segesser, Ludwig; Badano, Luigi P.; Bunc, Matjaž; Claeys, Marc J.; Drinkovic, Niksa; Filippatos, Gerasimos; Habib, Gilbert; Kappetein, A. Pieter; Kassab, Roland; Lip, Gregory Y.H.; Moat, Neil; Nickenig, Georg; Otto, Catherine M.; Pepper, John; Piazza, Nicolo; Pieper, Petronella G.; Rosenhek, Raphael; Shuka, Naltin; Schwammenthal, Ehud; Schwitter, Juerg; Mas, Pilar Tornos; Trindade, Pedro T.; Walther, Thomas (2012). "Guidelines on the management of valvular heart disease (version 2012)". European Heart Journal. 33 (19): 2451–2496. doi:10.1093/eurheartj/ehs109. ISSN 1522-9645.