Transplant-TR: A Few Points

The reported incidence of tricuspid valve regurgitation in the heart transplant population varies widely, occurring in 20-83% of patients [1, 2]. Regardless of the actual incidence, most tricuspid regurgitation after transplantation is mild (either asymptomatic or easily-controlled with diuretics). On occasion, however, the degree of regurgitation may be of such severity as to warrant tricuspid valve surgery [3, 4]. The etiology of TR in this select population has been attributed to a number of theoretical mechanisms: anastomotic technique; ischemic reperfusion injury; iatrogenic damage from endocardial biopsy; size mismatch between donor and recipient hearts; and chronic rejection. While deciphering the mechanism responsible may be difficult, it should be noted that the onset of tricuspid valve disease may have profound consequences in this vulnerable population.