Right Ventricle Assessment before Tricuspid Valve Interventions

In new Guideline for the Management of Patients with Valvular Heart Disease for tricuspid regurgitation (TR) is focused the importance of measurement of right-sided diastolic pressures and right ventriculography, pulmonary artery pressures, and pulmonary vascular resistance. Assessment of right ventricular (RV) dimensions and function is pivotal to select patients with severe tricuspid regurgitation who may benefit from tricuspid valve intervention. However, with the exception of tricuspid valve annulus diameter, there is no other cut-off value that defines severe RV dysfunction or dilation for this specific group of patients. It may be difficult, if not impossible, to establish a cut-off value of RV dysfunction since the RV may be exposed to pressure and volume overload, myocardial ischemia, intrinsic myocardial disease or pericardial constraint. Furthermore, the response of the RV to tricuspid valve intervention may vary according to each aetiology and the time course of the disease (acute or chronic). Comprehensive assessment of RV function should address in shape remodelling; functional remodelling; tissue remodelling. This assessment should be performed in optimal loading conditions and after euvolemia has been achieved. It’s now that there is no other cut-off value that defines severe RV dysfunction or dilation for patients with severe TR with the exception of tricuspid valve annulus diameter. It may be difficult, if not impossible, to establish a cut-off value of RV dysfunction since the RV may be exposed to pressure and volume overload, myocardial ischemia, intrinsic myocardial disease or pericardial constraint. In this review we analyze the relationship between right ventricular (RV) and TR in term of outcomes and mortality predictor in patients undergoing percutaneous or invasive treatment for severe TR.