Key result
Pericardiectomy normalizes tricuspid annular mobility and reduces tethered functional tricuspid regurgitation from moderate to mild.
Why the study?
Functional tricuspid regurgitation is usually caused by annular dilation and leaflet tethering from right atrial or right ventricular remodeling, whereas extrinsic factors that impair annular motion are rare.
Does pericardiectomy improve tricuspid annular mobility and reduce tricuspid regurgitation severity in a patient with constrictive pericarditis and non-atrial/non-ventricular functional tricuspid regurgitation?
Case Report (n=1)
Does pericardiectomy improve tricuspid annular mobility and reduce tricuspid regurgitation severity in a patient with constrictive pericarditis and non-atrial/non-ventricular functional tricuspid regurgitation?
This case report identifies a reversible form of functional tricuspid regurgitation caused by pericardial constraint (non-atrial/non-ventricular fTR) that improves with pericardiectomy alone, potentially avoiding unnecessary tricuspid valve intervention.
Recognize constrictive pericarditis as rare extrinsic fTR cause without RA/RV dilation; leaves open pericardiectomy effects on regurgitation.
Background Functional tricuspid regurgitation (fTR) is usually caused by annular dilation and leaflet tethering secondary to right atrial (RA) or right ventricular (RV) remodeling. Rarely, extrinsic factors may impair annular motion. Case summary We report a 83-year-old woman with constrictive pericarditis who presented with right-sided heart failure and moderate tricuspid regurgitation. Multimodality imaging revealed a thickened pericardium, preserved RA and RV size, and a non-dilated, saddle-shaped annulus with markedly reduced motion. Following pericardiectomy, tricuspid annular mobility normalized, right-sided pressures decreased, and TR improved from moderate to mild. We introduce the term non-atrial/non-ventricular functional tricuspid regurgitation to describe this rare mechanism of isolated annular dysfunction caused by pericardial tethering. Discussion This case highlights a novel, distinct and reversible form of fTR caused by pericardial constraint rather than chamber remodeling. We propose the term non-atrial/non-ventricular fTR to describe this mechanism. Recognizing this entity may guide surgical decision-making and avoid unnecessary tricuspid valve intervention.
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Veetil et al. (2026) conducted a case report in Constrictive pericarditis with moderate functional tricuspid regurgitation (n=1). Pericardiectomy was evaluated on Tricuspid regurgitation severity and annular mobility. Pericardiectomy in an 83-year-old woman normalized tricuspid annular mobility and improved pericardial-tethered functional tricuspid regurgitation from moderate to mild.
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