Tricuspid Regurgitation: A Review of Current Interventional Management

Figures

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  Figure 1. Tricuspid valve anatomy highlighting vulnerable structures. Annular crescent shape vulnerable to dilation. Septal leaflet small size and lack of papillary muscle create coaptation vulnerability. Tricuspid leaflets: A indicates anterior; P, posterior; and S, septal.

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  Figure 2. Moderate tricuspid regurgitation demonstrated by transthoracic echocardiography. A, Parasternal right ventricle inflow view. B, Parasternal short axis at the level of the aortic valve view. C, Apical 4‐chamber view. D, Subcostal view.

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  Figure 3. Example of clip‐like coaptation device. Pictured is the TriClip device courtesy of Abbott Structural Heart Solutions.

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  Figure 4. Example of annuloplasty device. Pictured is the Cardioband device courtesy of Edwards Lifesciences.

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  Figure 5. Examples of valve implants. Panel (A) shows the Evoque system courtesy of Edwards Lifesciences, which is a valve‐in‐valve implant. Panel (B) shows the TricValve courtesy of P & F Products, which is a caval valve implant.

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  Figure 6. Flow diagram guiding management of patients with severe TR on TTE. In any patients with symptomatic severe TR the first management step is medical therapy through volume optimization with diuretics. Primary and isolated severe TR should always be referred to a valve team for consideration of intervention. Secondary severe TR should have underlying cause addressed first; thereafter if severe TR persists referral to valve team is recommended to consider intervention. HF indicates heart failure; TEE, transesophageal echocardiography; and TR, tricuspid regurgitation