Tricuspid insufficiency: from anatomy to function

Tricuspid regurgitation (TR) is a common finding during echocardiographic examination. It is undoubtedly a disease with a poor prognosis. One-year survival has been reported for patients with severe TR of 63% regardless of other concomitant conditions such as reduced left ventricular ejection fraction or increased pulmonary artery systolic pressure. However, data on the prognostic significance according to etiology and quantitative assessment of severity are scarce. Transthoracic echocardiography is the main diagnostic tool to determine the etiology and severity of TR. Quantitative, rather than qualitative, multiparametric approaches are recommended for assessing TR severity, such as estimation of vena contracta, effective regurgitant orifice, and regurgitant jet area. However, a recent trial on the feasibility of transcatheter devices has shown that the current classification of TR may fail to stratify patients with TR of a “torrential” nature, who appear to have a different prognosis compared to patients with severe IT. A new classification has recently been published based on a quantitative multiparametric echocardiographic evaluation, which includes the degrees of massive and torrential. Surgical correction of isolated TR continues to be the procedure with the highest mortality among valve surgical procedures. Therefore, data on the prognosis of different types and grades of TR patients are mandatory in order to better stratify our patients and decide the optimal timing for surgery or other procedures. In this review we summarize the epidemiological, anatomical, diagnostic data and new therapeutic alternatives that exist in this exciting field of tricuspid regurgitation.