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 higher the severity of 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 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 MR have concomitant TR.[2][3] Isolated mitral valve surgery for mitral valve abnormalities is associated with no improvement of TR in the majority of patients.[4] Tricuspid valve surgery at the time of operation for left-sided valvulopathy significantly decreases the rate of post-operative residual MR.[5]
Complications
- Right heart failure
- Atrial arrhythmia[6]
- Ventricular arrhythmia[6]
- Cirrhosis[7]
- Endocarditis
- Weight loss
- Loss of appetite
Prognosis
Increased morbidity and mortality associated with moderate and severe TR. The higher the severity of the TR, the worse the prognosis is.[1][8][3] Severe isolated TR is associated with a worse prognosis compared to the general population.[9] Right ventricular dysfunction is associated with postoperative morbidity and mortality following tricuspid valve surgery.[10] Residual TR following TV repair during concomitant left-sided valve surgery is associated with increased morbidity and mortality.[11] Significant predictors of postoperative residual TR following isolated mitral valve surgery in patients with MR:[12]
- Excessively dilated left atrium
- Atrial fibrillation
- Preoperative TR (2+)
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.
- ↑ 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.
- ↑ 3.0 3.1 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.
- ↑ 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.
- ↑ 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.
- ↑ 6.0 6.1 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.
- ↑ 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.
- ↑ 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.
- ↑ Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T (2003). "Predictors of residual tricuspid regurgitation after mitral valve surgery". Ann Thorac Surg. 75 (6): 1826–8. PMID 12822623.