Tricuspid regurgitation surgery: Difference between revisions

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(/* 2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) {{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, et al. |title=2008 Focused update incorporated into the ACC/AHA ...)
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==2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==
==2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==


===Tricuspid Valve Replacement in Triscupid Regurgitation (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>===
===Tricuspid Valve Replacement (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>===


{|class="wikitable"
{|class="wikitable"
Line 16: Line 16:
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Tricuspid valve repair is beneficial for severe [[TR]] in patients with [[mitral valve disease]] requiring [[mitral valve surgery]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Tricuspid valve repair is beneficial for severe [[TR]] in patients with [[mitral valve disease]] requiring [[mitral valve surgery]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki>
|}
|}


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|-
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Tricuspid valve replacement or [[annuloplasty]] is not indicated in asymptomatic patients with [[TR]] whose pulmonary artery systolic                                          pressure is less than 60 mm Hg in the presence of a normal [[mitral valve]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Tricuspid valve replacement or [[annuloplasty]] is not indicated in asymptomatic patients with [[TR]] whose pulmonary artery systolic                                          pressure is less than 60 mm Hg in the presence of a normal [[mitral valve]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' Tricuspid valve replacement or [[annuloplasty]] is not indicated in patients with mild primary [[TR]].  ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' Tricuspid valve replacement or [[annuloplasty]] is not indicated in patients with mild primary [[TR]].  ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


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|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Tricuspid valve replacement or [[annuloplasty]] is reasonable for severe primary [[TR]] when symptomatic. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Tricuspid valve replacement or [[annuloplasty]] is reasonable for severe primary [[TR]] when symptomatic. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Tricuspid valve replacement is reasonable for severe [[TR]] secondary to diseased/abnormal tricuspid valve leaflets not amenable                                          to [[annuloplasty]] or repair. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Tricuspid valve replacement is reasonable for severe [[TR]] secondary to diseased/abnormal tricuspid valve leaflets not amenable                                          to [[annuloplasty]] or repair. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Tricuspid valve replacement or [[annuloplasty]] is reasonable for severe primary [[TR]] when symptomatic. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Tricuspid valve replacement or [[annuloplasty]] is reasonable for severe primary [[TR]] when symptomatic. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


===Indications for Intervention in Tricuspid Regurgitation in Young Adults and Adolescents (DO NOT EDIT)<ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>===
===Indications for Intervention Adolescents (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>===


{|class="wikitable"
{|class="wikitable"
Line 52: Line 52:
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Surgery for severe [[TR]] is recommended for adolescent and young adult patients with deteriorating exercise capacity ([[NYHA]] functional                                          class III or IV). ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Surgery for severe [[TR]] is recommended for adolescent and young adult patients with deteriorating exercise capacity ([[NYHA]] functional                                          class III or IV). ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Surgery for severe [[TR]] is recommended for adolescent and young adult patients with progressive [[cyanosis]] and [[arterial oxygen saturation|arterial saturation]]                                          less than 80% at rest or with exercise. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Surgery for severe [[TR]] is recommended for adolescent and young adult patients with progressive [[cyanosis]] and [[arterial oxygen saturation|arterial saturation]]                                          less than 80% at rest or with exercise. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[cardiac catheterization|Interventional catheterization]] closure of the atrial communication is recommended for the adolescent or young adult with [[TR]]                                          who is [[hypoxemic]] at rest and with exercise intolerance due to increasing [[hypoxemia]] with exercise, when the [[tricuspid valve]]                                          appears difficult to repair surgically. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[cardiac catheterization|Interventional catheterization]] closure of the atrial communication is recommended for the adolescent or young adult with [[TR]]                                          who is [[hypoxemic]] at rest and with exercise intolerance due to increasing [[hypoxemia]] with exercise, when the [[tricuspid valve]]                                          appears difficult to repair surgically. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


Line 64: Line 64:


|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Surgery for severe [[TR]] is reasonable in adolescent and young adult patients with [[NYHA]] functional class II symptoms if the [[tricuspid valve|valve]]                                          appears to be repairable. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Surgery for severe [[TR]] is reasonable in adolescent and young adult patients with [[NYHA]] functional class II symptoms if the [[tricuspid valve|valve]]                                          appears to be repairable. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Surgery for severe [[TR]] is reasonable in adolescent and young adult patients with [[atrial fibrillation]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Surgery for severe [[TR]] is reasonable in adolescent and young adult patients with [[atrial fibrillation]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


Line 73: Line 73:
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Surgery for severe [[TR]] may be considered in asymptomatic adolescent and young adult patients with increasing heart size and                                          a [[cardiothoracic ratio]] of more than 65%. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Surgery for severe [[TR]] may be considered in asymptomatic adolescent and young adult patients with increasing heart size and                                          a [[cardiothoracic ratio]] of more than 65%. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Surgery for severe [[TR]] may be considered in asymptomatic adolescent and young adult patients with stable heart size and an                                          [[arterial oxygen saturation|arterial saturation]] of less than 85% when the [[tricuspid valve]] appears repairable. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Surgery for severe [[TR]] may be considered in asymptomatic adolescent and young adult patients with stable heart size and an                                          [[arterial oxygen saturation|arterial saturation]] of less than 85% when the [[tricuspid valve]] appears repairable. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' In adolescent and young adult patients with [[TR]] who are mildly [[cyanotic]] at rest but who become very [[hypoxemic]] with exercise,                                          closure of the atrial communication by [[cardiac catheterization|interventional catheterization]] may be considered when the valve does not appear amenable                                          to repair. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' In adolescent and young adult patients with [[TR]] who are mildly [[cyanotic]] at rest but who become very [[hypoxemic]] with exercise,                                          closure of the atrial communication by [[cardiac catheterization|interventional catheterization]] may be considered when the valve does not appear amenable                                          to repair. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' If surgery for [[Ebstein’s anomaly]] is planned in adolescents and young adult patients (tricuspid valve repair or replacement),                                          a preoperative electrophysiological study may be considered to identify accessory pathways. If present, these may be considered                                          for mapping and ablation either preoperatively or at the time of surgery.  ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' If surgery for [[Ebstein’s anomaly]] is planned in adolescents and young adult patients (tricuspid valve repair or replacement),                                          a preoperative electrophysiological study may be considered to identify accessory pathways. If present, these may be considered                                          for mapping and ablation either preoperatively or at the time of surgery.  ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


Line 88: Line 88:
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Severe [[TR]] in the setting of surgery for multivalvular disease should be corrected. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Severe [[TR]] in the setting of surgery for multivalvular disease should be corrected. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


Line 96: Line 96:


|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Tricuspid annuloplasty is reasonable for mild [[TR]] in patients undergoing [[MV surgery]] when there is [[pulmonary hypertension]]                                or tricuspid annular dilatation. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Tricuspid annuloplasty is reasonable for mild [[TR]] in patients undergoing [[MV surgery]] when there is [[pulmonary hypertension]]                                or tricuspid annular dilatation. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


Line 105: Line 105:
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Intraoperative [[transesophageal echocardiography]] is recommended for valve repair surgery. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Intraoperative [[transesophageal echocardiography]] is recommended for valve repair surgery. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki>


|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Intraoperative [[transesophageal echocardiography]] is recommended for [[valve replacement surgery]] with a stentless [[xenograft]], [[homograft]],                                    or [[autograft]] valve.([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]])<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Intraoperative [[transesophageal echocardiography]] is recommended for [[valve replacement surgery]] with a stentless [[xenograft]], [[homograft]],                                    or [[autograft]] valve.([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: B'']])<nowiki>"</nowiki>
|}
|}


Line 116: Line 116:


|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intraoperative [[transesophageal echocardiography]] is reasonable for all patients undergoing cardiac valve surgery. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intraoperative [[transesophageal echocardiography]] is reasonable for all patients undergoing cardiac valve surgery. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


Revision as of 17:02, 8 November 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

In most cases, surgery is not indicated since the root problem lies with a dilated or damaged right ventricle. Medical therapy with diuretics is the mainstay of treatment. Unfortunately, this can lead to volume depletion and decreased cardiac output. Indeed, one must often accept a certain degree of symptomatic tricuspid insufficiency in order to prevent a decrease in cardiac output. Treatment with medicines to reduce cardiac afterload may also be of benefit but a similar risk of depressed cardiac output applies.

2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [1]

Tricuspid Valve Replacement (DO NOT EDIT) [1]

Class I
"1. Tricuspid valve repair is beneficial for severe TR in patients with mitral valve disease requiring mitral valve surgery. (Level of Evidence: B)"
Class III
"1. Tricuspid valve replacement or annuloplasty is not indicated in asymptomatic patients with TR whose pulmonary artery systolic pressure is less than 60 mm Hg in the presence of a normal mitral valve. (Level of Evidence: C)"
"2. Tricuspid valve replacement or annuloplasty is not indicated in patients with mild primary TR. (Level of Evidence: C)"
Class IIa
"1. Tricuspid valve replacement or annuloplasty is reasonable for severe primary TR when symptomatic. (Level of Evidence: C)"
"2. Tricuspid valve replacement is reasonable for severe TR secondary to diseased/abnormal tricuspid valve leaflets not amenable to annuloplasty or repair. (Level of Evidence: C)"
Class IIb
"1. Tricuspid valve replacement or annuloplasty is reasonable for severe primary TR when symptomatic. (Level of Evidence: C)"

Indications for Intervention Adolescents (DO NOT EDIT) [1]

Class I
"1. Surgery for severe TR is recommended for adolescent and young adult patients with deteriorating exercise capacity (NYHA functional class III or IV). (Level of Evidence: C)"
"2. Surgery for severe TR is recommended for adolescent and young adult patients with progressive cyanosis and arterial saturation less than 80% at rest or with exercise. (Level of Evidence: C)"
"3. Interventional catheterization closure of the atrial communication is recommended for the adolescent or young adult with TR who is hypoxemic at rest and with exercise intolerance due to increasing hypoxemia with exercise, when the tricuspid valve appears difficult to repair surgically. (Level of Evidence: C)"
Class IIa
"1. Surgery for severe TR is reasonable in adolescent and young adult patients with NYHA functional class II symptoms if the valve appears to be repairable. (Level of Evidence: C)"
"2. Surgery for severe TR is reasonable in adolescent and young adult patients with atrial fibrillation. (Level of Evidence: C)"
Class IIb
"1. Surgery for severe TR may be considered in asymptomatic adolescent and young adult patients with increasing heart size and a cardiothoracic ratio of more than 65%. (Level of Evidence: C)"
"2. Surgery for severe TR may be considered in asymptomatic adolescent and young adult patients with stable heart size and an arterial saturation of less than 85% when the tricuspid valve appears repairable. (Level of Evidence: C)"
"3. In adolescent and young adult patients with TR who are mildly cyanotic at rest but who become very hypoxemic with exercise, closure of the atrial communication by interventional catheterization may be considered when the valve does not appear amenable to repair. (Level of Evidence: C)"
"4. If surgery for Ebstein’s anomaly is planned in adolescents and young adult patients (tricuspid valve repair or replacement), a preoperative electrophysiological study may be considered to identify accessory pathways. If present, these may be considered for mapping and ablation either preoperatively or at the time of surgery. (Level of Evidence: C)"

Tricuspid Valve Surgery (DO NOT EDIT) [1]

Class I
"1. Severe TR in the setting of surgery for multivalvular disease should be corrected. (Level of Evidence: C)"
Class IIa
"1. Tricuspid annuloplasty is reasonable for mild TR in patients undergoing MV surgery when there is pulmonary hypertension or tricuspid annular dilatation. (Level of Evidence: C)"

Intraoperative Assessment (DO NOT EDIT) [1]

Class I
"1. Intraoperative transesophageal echocardiography is recommended for valve repair surgery. (Level of Evidence: B)"
"2. Intraoperative transesophageal echocardiography is recommended for valve replacement surgery with a stentless xenograft, homograft, or autograft valve.(Level of Evidence: B)"
Class IIa
"1. Intraoperative transesophageal echocardiography is reasonable for all patients undergoing cardiac valve surgery. (Level of Evidence: C)"

Sources

  • 2008 ACC/AHA Guidelines incorporated into the 2006 guidelines for the management of patients with valvular heart disease [1]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)

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