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(Circulation. 2009;119:2718-2725.)
© 2009 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

The Tricuspid Valve

Current Perspective and Evolving Management of Tricuspid Regurgitation

Jason H. Rogers, MD; Steven F. Bolling, MD

From the Division of Cardiovascular Medicine, University of Davis Medical Center, Sacramento, CA (J.H.R.), and University of Michigan Cardiovascular Center, University of Michigan, Ann Arbor, MI (S.F.B.).

Correspondence to Dr Jason H. Rogers, Division of Cardiovascular Medicine, 4860 Y St, Suite 2820, Sacramento, CA 95817. E-mail jason.rogers{at}ucdmc.ucdavis.edu

Cardiovascular specialists have entered an era of renewed interest and enthusiasm surrounding the diagnosis and treatment of valvular heart disease, driven in part by emerging percutaneous therapies for the treatment of aortic, pulmonic, and mitral valve disease. Despite this wave of investigation, little or no attention has been given to the treatment of tricuspid valve disease. Tricuspid regurgitation (TR) occurs mainly from tricuspid annular dilation, which can result from left-sided heart failure from myocardial or valvular causes, right ventricular volume and pressure overload, or dilation of cardiac chambers. If untreated at the time of surgical mitral valve repair, significant residual TR negatively impacts perioperative outcomes, functional class, and survival. TR does not reliably resolve after successful mitral valve surgery. If present at the time of mitral valve surgery, TR can usually be effectively addressed with ring annuloplasty. Because reoperations for recurrent TR carry high mortality rates, few patients are offered reoperation for redo tricuspid repair or replacement. As transcatheter therapies for mitral regurgitation arise, parallel percutaneous approaches for TR may be necessary. In this article, we review the anatomy, pathophysiology, and value of mechanical correction of TR, including potential transcatheter therapies for TR.

Key Words: valve, tricuspid • valves • catheters • surgery