From the Guidelines
Tricuspid regurgitation should be managed with a focus on treating the underlying cause and controlling symptoms, with surgical intervention considered for severe symptomatic cases, as it can improve survival and quality of life 1.
Management of Tricuspid Regurgitation
The management of tricuspid regurgitation depends on the severity of the condition and the presence of symptoms.
- Mild tricuspid regurgitation often requires no specific treatment beyond regular monitoring with echocardiography.
- For moderate to severe cases, management focuses on treating the underlying cause and controlling symptoms.
- Diuretics like furosemide (20-80mg daily) can reduce fluid overload and swelling.
- ACE inhibitors or angiotensin receptor blockers may help manage blood pressure and reduce cardiac workload.
- For patients with atrial fibrillation, rate control medications (beta-blockers or calcium channel blockers) and anticoagulation therapy are important.
Surgical Intervention
Severe symptomatic tricuspid regurgitation may eventually require surgical intervention, either valve repair or replacement, as recommended by the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1.
- Correction of symptomatic severe primary TR can be beneficial for patients with symptoms due to severe primary TR that are unresponsive to medical therapy.
- Replacement may be required because of the extent and severity of the underlying pathology.
- Reduction or elimination of the regurgitant volume load can alleviate systemic venous and hepatic congestion and decrease reliance on diuretics.
Patient Education
Patients should limit salt intake to reduce fluid retention, maintain moderate physical activity as tolerated, and have regular cardiology follow-ups.
- The condition occurs because structural abnormalities, right ventricular enlargement, or pulmonary hypertension prevent the valve leaflets from closing completely, allowing blood to leak backward during ventricular contraction, which can lead to right-sided heart failure if left untreated.
- Stages of tricuspid regurgitation, as outlined in the 2014 AHA/ACC guideline, can help guide management and treatment decisions 1.
From the Research
Definition and Prevalence of Tricuspid Regurgitation
- Tricuspid regurgitation (TR) is a condition that affects a significant number of individuals, with approximately 1.6 million people in the United States and 3.0 million in Europe having the condition 2.
- TR can be classified into two main types: primary and secondary or functional TR (FTR), with FTR being the most prevalent 3.
Causes and Risk Factors of Tricuspid Regurgitation
- Functional TR is caused by cardiomyopathies, LV valve disease, or pulmonary disease 2.
- FTR is a multifactorial disorder, resulting from maladaptive right ventricular remodeling secondary to pulmonary hypertension or from atrial fibrillation leading to dilation of the right atrium, tricuspid annulus, and base of the right ventricle, with pathological TV coaptation 3.
- Patients with TR commonly have coexisting conditions, including congestive heart failure, pulmonary hypertension, chronic lung disease, atrial fibrillation, and cardiovascular implantable electronic devices, which can increase the complexity of medical and surgical TR management 4.
Diagnosis and Assessment of Tricuspid Regurgitation
- Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease 2.
- The diagnosis and treatment of TR, including coaptation, annuloplasty devices, and prosthetic valves, success rates, morbidity/mortality, and trials are discussed 2.
Management and Treatment of Tricuspid Regurgitation
- Management includes diuretics, ACE inhibitors, and aldosterone antagonists 2.
- Surgical annuloplasty or valve replacement should be considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 2.
- Transcatheter repair/replacement is possible in patients with a LVEF <40%, dilated annuli, and impaired RV function 2.
- Recent advances in surgical techniques and transcatheter therapy, particularly edge-to-edge repair devices, have demonstrated promising results for safety, reduction in tricuspid regurgitation, and improving quality of life 5.
- Several transcatheter TV replacement and repair systems have shown efficacy and safety when used on the TV, providing an effective treatment option for patients not eligible for surgery 3.