From the Guidelines
Respiratory variation greater than 50% in the tricuspid valve flow is a critical finding that requires immediate attention, as it may indicate severe tricuspid regurgitation or cardiac tamponade, and management should prioritize reducing morbidity, mortality, and improving quality of life. The increased respiratory variation occurs because during inspiration, the negative intrathoracic pressure increases venous return to the right heart while simultaneously decreasing left heart filling, exaggerating the normal respiratory variation seen in tricuspid flow. According to the most recent study 1, severe tricuspid regurgitation is associated with reduced survival, and interventional cardiologists should be familiar with the clinical presentation, diagnosis, grading, and dynamic nature of this disease.
Key Considerations
- The patient's clinical status and the cause of the tricuspid valve abnormality usually determine the appropriate therapeutic strategy, as noted in 1.
- Medical therapies like diuretic agents and afterload reduction with pulmonary vasodilators can be useful in providing symptomatic relief, as mentioned in 1.
- Recently, a number of less-invasive investigational therapies have been developed and are undergoing clinical trial evaluation, including TEER, annuloplasty, and valve replacement, as discussed in 1.
- The indications for concomitant tricuspid intervention with left-sided valve surgery should be considered in patients with annular dilation or right ventricular dysfunction, as suggested in 1.
Management Priorities
- Reducing morbidity and mortality by addressing the underlying cause of tricuspid regurgitation or cardiac tamponade.
- Improving quality of life by alleviating symptoms and preventing further complications.
- Considering the patient's clinical status, the cause of the tricuspid valve abnormality, and the potential benefits and risks of different therapeutic strategies, as noted in 1 and 1.
From the Research
Respiratory Variation and Tricuspid Regurgitation
- Respiratory variation > 50% on the triscuspid is an indicator of severe tricuspid regurgitation (TR) 2, 3.
- Severe TR is a complex condition associated with symptomatic heart failure and significant morbidity and mortality 3.
- The diagnosis of TR can be assessed using echocardiography, which can measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease 2.
Management of Tricuspid Regurgitation
- Medical therapy for TR is frequently ineffective, and surgical intervention is often associated with high risk 3, 4.
- Transcatheter tricuspid valve repair or replacement is an emerging therapy for high-risk patients with TR, offering a safer alternative to surgical intervention 2, 4, 5, 6.
- Recent advances in transcatheter technology have led to the development of innovative treatment concepts, including edge-to-edge repair devices, which have demonstrated promising results for safety and reduction in tricuspid regurgitation 4, 6.
Patient Selection and Treatment
- Patient selection for percutaneous treatment of TR is crucial, and anatomical challenges specific to the tricuspid valve must be considered 4.
- The MitraClip in the tricuspid position (TriClip) is the most widely used TV repair device, and several prospective trials are currently investigating various devices in this arena 4.
- Primary care providers should be aware of which patients could potentially benefit from tricuspid valve intervention for tricuspid regurgitation and refer them for optimal treatment 5.