Tricuspid regurgitation natural history, complications and prognosis
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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
Tricuspid regurgitation (TR) is a common finding. TR is mostly a trace or mild regurgitation and usually has no symptoms when pulmonary hypertension and heart failure are absent.[1] However, moderate and severe TR are associated with increased morbidity and mortality. The more severe the TR, the worse the prognosis.[1]
Natural History
TR is a common valvular abnormality usually presenting with no symptoms when pulmonary hypertension and heart failure are absent.[1] When symptoms are present, they develop progressively. TR might not be recognised clinically until fairly late in its natural history.[2] Patients with significant TR may remain asymptomatic, despite impaired right ventricular function.[3] Significant degrees of TR has been noted with the onset of atrial fibrillation, especially in older patients above 75years of age.[2] TR can be present in isolation or associated with other medical conditions. TR commonly occurs among patients with mild/moderate mitral regurgitation (MR) or mitral stenosis. Approximately 30-50% of patients with severe MR have significant secondary TR.[3][4][5]Severe TR with pulmonary hypertension/right ventricular dysfunction has a worse prognosis and frequently requires surgical intervention. Isolated mitral valve surgery for mitral valve abnormalities is associated with no improvement of TR in the majority of patients.[6] It is also not uncommon to have residual TR following isolated left-sided valve surgery, especially when some preoperative risk factors are present.[7] Tricuspid valve surgery at the time of left-sided valvulopathy decreases the rate of post-operative residual tricuspid regurgitation.[8]
Risk factors for residual TR following isolated left-sided valve surgery
There is an increased risk of residual tricuspid regurgitation following isolated left-sided valve surgery if the following preoperative risk factors are present:[7]
- Older age
- Female gender
- Atrial fibrillation
- Rheumatic etiology
- Mitral valve surgery
- Previous valve surgery
- Long duration of left-sided valve disease before surgery
- 2+/3+ preoperative TR
- Enlarged left and right atria
Complications
Complications of tricuspid regurgitation include:[9][10][11]
- Right heart failure
- Atrial arrhythmia
- Ventricular arrhythmia
- Cirrhosis
- Endocarditis
- Weight loss
- Anorexia
Prognosis
Increased morbidity and mortality associated with moderate and severe TR. The higher the severity of the TR, the worse the prognosis.[1][12][13] Severe isolated TR is associated with a worse prognosis compared to the general population.[14] Right ventricular dysfunction is associated with postoperative morbidity and mortality following tricuspid valve surgery.[15] Residual TR following TV repair during concomitant left-sided valve surgery is associated with increased morbidity and mortality.[16]
References
- ↑ 1.0 1.1 1.2 1.3 Nath J, Foster E, Heidenreich PA (2004). "Impact of tricuspid regurgitation on long-term survival". J Am Coll Cardiol. 43 (3): 405–9. doi:10.1016/j.jacc.2003.09.036. PMID 15013122.
- ↑ 2.0 2.1 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). - ↑ 3.0 3.1 Dreyfus GD, Martin RP, Chan KM, Dulguerov F, Alexandrescu C (2015). "Functional tricuspid regurgitation: a need to revise our understanding". J Am Coll Cardiol. 65 (21): 2331–6. doi:10.1016/j.jacc.2015.04.011. PMID pmidPMID:_26022823 Check
|pmid=value (help). - ↑ Koelling TM, Aaronson KD, Cody RJ, Bach DS, Armstrong WF (2002). "Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction". Am Heart J. 144 (3): 524–9. PMID 12228791 PMID: 12228791 Check
|pmid=value (help). - ↑ Cohen SR, Sell JE, McIntosh CL, Clark RE (1987). "Tricuspid regurgitation in patients with acquired, chronic, pure mitral regurgitation. II. Nonoperative management, tricuspid valve annuloplasty, and tricuspid valve replacement". J Thorac Cardiovasc Surg. 94 (4): 488–97. PMID 3657251.
- ↑ Sagie A, Schwammenthal E, Palacios IF, King ME, Leavitt M, Freitas N; et al. (1994). "Significant tricuspid regurgitation does not resolve after percutaneous balloon mitral valvotomy". J Thorac Cardiovasc Surg. 108 (4): 727–35. PMID 7934109.
- ↑ 7.0 7.1 Zhu TY, Min XP, Zhang HB, Meng X (2014). "Preoperative risk factors for residual tricuspid regurgitation after isolated left-sided valve surgery: a systematic review and meta-analysis". Cardiology. 129 (4): 242–9. doi:10.1159/000367589. PMID 25402599.
- ↑ Tager R, Skudicky D, Mueller U, Essop R, Hammond G, Sareli P (1998). "Long-term follow-up of rheumatic patients undergoing left-sided valve replacement with tricuspid annuloplasty--validity of preoperative echocardiographic criteria in the decision to perform tricuspid annuloplasty". Am J Cardiol. 81 (8): 1013–6. PMID 9576162.
- ↑ Anyanwu AC, Adams DH (2010). "Functional tricuspid regurgitation in mitral valve disease: epidemiology and prognostic implications". Semin Thorac Cardiovasc Surg. 22 (1): 69–75. doi:10.1053/j.semtcvs.2010.05.006. PMID 20813320.
- ↑ Naschitz JE, Goldstein L, Zuckerman E, Yeshurun D, Wolfson V (2000). "Benign course of congestive cirrhosis associated with tricuspid regurgitation: does pulsatility protect against complications of venous hypertension?". J Clin Gastroenterol. 30 (2): 213–4. PMID 10730933.
- ↑ 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 pmid19470901 Check
|pmid=value (help). - ↑ Taramasso M, Vanermen H, Maisano F, Guidotti A, La Canna G, Alfieri O (2012). "The growing clinical importance of secondary tricuspid regurgitation". J Am Coll Cardiol. 59 (8): 703–10. doi:10.1016/j.jacc.2011.09.069. PMID 22340261.
- ↑ Cohen SR, Sell JE, McIntosh CL, Clark RE (1987). "Tricuspid regurgitation in patients with acquired, chronic, pure mitral regurgitation. I. Prevalence, diagnosis, and comparison of preoperative clinical and hemodynamic features in patients with and without tricuspid regurgitation". J Thorac Cardiovasc Surg. 94 (4): 481–7. PMID 3657250.
- ↑ Topilsky Y, Nkomo VT, Vatury O, Michelena HI, Letourneau T, Suri RM; et al. (2014). "Clinical outcome of isolated tricuspid regurgitation". JACC Cardiovasc Imaging. 7 (12): 1185–94. doi:10.1016/j.jcmg.2014.07.018. PMID 25440592.
- ↑ Pozzoli A, Elisabetta L, Vicentini L, Alfieri O, De Bonis M (2016). "Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes". Gen Thorac Cardiovasc Surg. 64 (9): 509–16. doi:10.1007/s11748-016-0677-5. PMID 27329290.
- ↑ Sorabella RA, Mamuyac E, Yerebakan H, Najjar M, Choi V, Takayama H; et al. (2015). "Residual Tricuspid Regurgitation following Tricuspid Valve Repair during Concomitant Valve Surgery Worsens Late Survival". Heart Surg Forum. 18 (6): E226–31. doi:10.1532/hsf.1469. PMID 26726709.