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STATE-OF-THE-ART PAPER

Tricuspid Regurgitation in Mitral Valve Disease

Incidence, Prognostic Implications, Mechanism, and Management

Avinoam Shiran, MD^_*,_* and Alex Sagie, MD^,

^_* Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel

Manuscript received May 28, 2008; revised manuscript received August 12, 2008, accepted September 15, 2008.

^_* Reprint requests and correspondence: Dr. Avinoam Shiran, Director, Echocardiography, Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa 34362, Israel (Email: av.shiran{at}gmail.com).

Tricuspid regurgitation (TR) in patients with mitral valve (MV) disease is associated with poor outcome and predicts poor survival, heart failure, and reduced functional capacity. It is common if left untreated after MV replacement mainly in rheumatic patients, but it is also common in patients with ischemic mitral regurgitation. It is less common, however, in those with degenerative mitral regurgitation. It might appear many years after surgery and might not resolve after correcting the MV lesion. Late TR might be caused by prosthetic valve dysfunction, left heart disease, right ventricular (RV) dysfunction and dilation, persistent pulmonary hypertension, chronic atrial fibrillation, or by organic (mainly rheumatic) tricuspid valve disease. Most commonly, late TR is functional and isolated, secondary to tricuspid annular dilation. Outcome of isolated tricuspid valve surgery is poor, because RV dysfunction has already occurred at that point in many patients. MV surgery or balloon valvotomy should be performed before RV dysfunction, severe TR, or advanced heart failure has occurred. Tricuspid annuloplasty with a ring should be performed at the initial MV surgery, and the tricuspid annulus diameter (3.5 cm) is the best criterion for performing the annuloplasty. In this article we will review the current data available for understanding the prognostic implications, mechanism, and management of TR in patients with MV disease.

Key Words: congestive heart failure • mitral valve • tricuspid regurgitation • tricuspid valve • valve surgery

Abbreviations and Acronyms   AF = atrial fibrillation   LV = left ventricle/ventricular   MR = mitral regurgitation   MV = mitral valve   MVR = mitral valve replacement   RV = right ventricle/ventricular   TA = tricuspid annulus   TR = tricuspid regurgitation   TV = tricuspid valve

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