Prognostic Role of Preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) in Mitral Valve Replacement (MVR) for Rheumatic Mitral Stenosis Patients

Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.

Isolated Tricuspid Valve Repair and Right Atrial Plication Performed Using a Beating-Heart Technique for Atrial Functional Tricuspid Valve Regurgitation

Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class. There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement. Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms. TR was markedly reduced;however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the late phase. Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool. The underlying mechanism by which TR exacerbates MR requires further investigation.

Pulmonary and tricuspid regurgitation after Tetralogy of Fallot repair: A case report

BACKGROUND Tetralogy of Fallot(TOF)is one of the most common congenital heart defects,and surgery is the primary treatment.There are no precise guidelines on the treatment protocol for tricuspid regurgitation(TR)as a common complication of TOF repair.The timing for treatment in patients presenting with valve regurgitation after TOF repair is often difficult to determine.Here,we report the first case of sequential treatment of pulmonary and TR using interventional therapy.CASE SUMMARY We present the case of a 52-year-old female patient,who had a history of TOF repair at a young age.A few years later,the patient presented with pulmonary and tricuspid regurgitation.The symptoms persisted and TR worsened following percutaneous pulmonary valve implantation.Preoperative testing revealed that the patient’s disease had advanced to an intermediate to advanced stage and that her general health was precarious.Because open-heart surgery was not an option for the patient,transcatheter tricuspid valve replacement was suggested.This procedure was successful,and the patient recovered fully without any adverse effects.This case report may serve as a useful resource for planning future treatments.CONCLUSION Treatment of both valves should be considered in patients with tricuspid and pulmonary regurgitations following TOF repair.The interventional strategy could be an alternative for patients with poor general health.

Lead helix winding tricuspid chordae tendineae: A case report

BACKGROUND As left bundle branch pacing(LBBP)is more like physiological pacing,LBBP has emerged as a novel pacing strategy that uses the native conduction system to improve ventricular synchronization with stable pacing parameters.LBBP has been revealed associated with a significantly reduced risk of new-onset atrial fibrillation and heart failure compared with conventional permanent pacemaker implantation.CASE SUMMARY A 64-year-old man was admitted with a 24-h history of chest distress and shortness of breath,which continued unabated.The patient had no symptoms of chest pain,dizziness,syncope,nausea nor vomiting.There were no abnormalities found in routine examinations after admission.Twelve-lead electrocardiogram presented a result of 2:1 atrioventricular block.Coronary angiography was performed the next day and no abnormality was found.Finally,the patient agreed to received LBBP and signed the informed consent.During the process of withdrawing the Medtronic Model 3830 lead into sheath,we found the lead helix was wrapped around the chordae tendineae of the septal valve of tricuspid.Attempts to rotate the 3830 lead failed to release the lead helix from the chordae tendineae,and ultimately we used radiofrequency ablation to ablate the wrapped chordae tendineae.CONCLUSION Radiofrequency ablation effectively solved this problem without complications.It is an effective and reliable method to resolve lead winding chordae.

Clinical efficacy of two different tricuspid annuloplasty techniques in left cardiac valve surgery

Objective: To investigate the mid-and long-term clinical effects of tricuspid valvuloplasty with the implantation of an artificial plastic ring.Methods: Data of 677 patients who had functional tricuspid regurgitation and left cardiac valve disease and underwent tricuspid valvuloplasty and left cardiac valve surgery were retrospectively.Among these patients, 353 underwent simple suture annuloplasty(group A) while the rest 324 patients underwent artificial plastic ring annuloplasty(group B).The two-year and more-than-two-year clinical and ultrasonocardiograph(UCG) follow-up data of the two groups were obtained and compared.Results: A total of 600 patients(88.6%) completed the long-term follow-up(more than two years).The two-year follow-up showed no significant difference in the incidence of mild tricuspid regurgitation between the two groups(82.2% vs.92.7%, P=0.37).However, there were significantly more cases that developed into moderate to severe tricuspid regurgitation in group A than in group B(17.8% vs.7.3%, P=0.031).The long-term follow-up revealed that the recurrence rate of tricuspid regurgitation in group B was significantly lower than that in group A(11.0% vs.25.0%, P=0.029), and the ratio of cases developing into moderate to severe tricuspid regurgitation in group A was significantly higher than that in group B(28.9% vs.9.9%, P=0.007).The comparison between the two intra-group time segments showed that the development of tricuspid regurgitation in group A was significantly increased(28.9% vs.17.8%, P=0.022), but in group B it was relatively stable(9.9% vs.7.3%, P=0.52).Conclusions: Artificial ring annuloplasty is associated with significantly less tricuspid regurgitation than simple suture annuloplasty.

Application effect of thoracoscopic tricuspid valvuloplasty in geriatric patients with tricuspid valve disease

BACKGROUND Thoracoscopic-assisted technology can ensure that doctors can implement minimally invasive treatment through the right intercostal incision or small incision of the lower sternum.This approach not only can achieve a cardiac correction effect equivalent to that of a thoracotomy but also has the benefit of a clear surgical field ensuring the safety of surgical treatment.AIM To investigate the effect of thoracoscopic tricuspid valvuloplasty in patients with tricuspid valve disease.METHODS A total of 41 patients with tricuspid valve disease underwent traditional thoracotomy treatment between January 2018 and June 2020.Forty-one patients with tricuspid valve disease who underwent thoracoscopic tricuspid valvuloplasty treatment between July 2020 and June 2021 in our hospital were selected as controls for our retrospective analysis.The study group underwent thoracoscopic tricuspid valvuloplasty,while traditional thoracotomy was performed in the control group.The operation conditions(the duration of extracorporeal circulation,aorta blocking,endotracheal intubation,and surgery),inflammatory response-related indices(C-reactive protein and white blood cell count)before and after surgery,parameters related to myocardial injury(myocardial troponin T,creatine kinase isoenzyme,creatine kinase,and lactate dehydrogenase),and the incidence of adverse events in the two groups was counted.RESULTS The duration of extracorporeal circulation(109.35±50.31 min),aortic occlusion(94.26±59.61 min),endotracheal intubation(12.59±3.54 h),and hospital stay(5.29±2.34 d)in the study group were shorter than those in the control group(114.91±46.98 min,101.37±61.44 min,13.11±4.01 h,7.09±3.11 d,respectively).The difference in hospital stay between the two groups was statistically significant(P<0.05).Serum C-reactive protein level(4.69±1.35 mg/L)and white blood cell count(6.21±1.97×10^(9)/L)in the study group were found to be not significantly different than those in the control group(5.01±1.18 mg/L,5.98±2.01×10^(9)/L,respectively;P>0.05).Myocardial troponin T(0.04±0.02 ng/mL),creatine kinase isoenzyme(4.02±1.11 mg/mL),creatine kinase(91.35±10.44 U/L),and lactate dehydrogenase(179.81±60.04 U/L)in the study group were also not statistically significant different than those in the control group(0.05±0.03 ng/mL,3.97±1.05 mg/mL,89.69±13.05 U/L,186.35±56.96 U/L;P>0.05).After the operation,serum C-reactive protein level(7.89±1.73 mg/L)and white blood cell count(10.76±2.35×10^(9)/L)in the study group were significantly lower than those in the control group(9.96±2.04 mg/L,14.84±3.07×10^(9)/L,respectively)(P<0.05).In addition,myocardial troponin T(0.89±0.32 ng/mL),creatine kinase isoenzyme(26.96±4.95 mg/mL),creatine kinase(608.32±202.33 U/L),and lactate dehydrogenase(282.56±101.34 U/L)in the study group were lower than those in the control group(2.61±0.69 ng/mL,34.37±6.87 mg/mL,689.94±214.64 U/L,369.15±114.46 U/L)(P<0.05).The incidence of adverse events in the study group(4.88%)was lower than that in the control group(19.51%)(P<0.05).CONCLUSION Thoracoscopic tricuspid valvuloplasty can achieve good results in treating patients with tricuspid valve disease,reduce the risk of adverse events,and promote the rapid recovery of patients.

Moderate Secondary Tricuspid Regurgitation: Does It Worth More Time to Conserve?

Background: Concomitant repair of moderate secondary tricuspid regurgitation (STR) during mitral valve surgery is still subject of controverse. This research aims to study the early and mid-term postoperative influence of tricuspid repair on the clinical outcomes and right ventricular functions. Methods: This is a retrospective cohort study of 92 patients with moderate STR who underwent tricuspid valve repair between October 2014 and December 2017, in the cardiothoracic surgery department, Menoufia University Hospital. Patients were assessed clinically and by echocardiography at one month and after 24 months postoperatively for the degree of tricuspid regurgitation (TR), right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: In this study, mean age of patients was 58.33 ± 4.06 years. We had a significant improvement in the grade of TR from preoperative period to follow up data observed at 1-month postoperative and 2-years follow-up (P = 0.0001). After one month postoperatively, no TR was detected in 74 cases (80.4%), and in 71 (84.5%) after two years. Mean right ventricular diameter decreased significantly from 23 ± 3.32 mm preoperatively to 21.9 ± 3 mm at 2-years postoperatively. An increase of TAPSE was from 19.96 ± 3.7 mm preoperatively to 20.3 ± 3.9 mm at 1-month postoperative (p = 0.55) and there was significant increase in late postoperative value. Conclusion: We highly recommend repair for moderate TR during mitral valve surgery to avoid progression of TR. Tricuspid repair was able to reduce the grade of regurgitation after two years of surgery and improved right ventricular functions.

Safety of an improved patent ductus arteriosus occluder for transcatheter closure of perimembranous ventricular septal defects with abnormally attached tricuspid chordae tendineae

BACKGROUND The off-label use of various devices has been reported for the transcatheter closure of perimembranous ventricular septal defects(PmVSD) because of serious complications, such as heart block and tricuspid regurgitation(TR),associated with conventional ventricular septal defect devices. However, whether certain defects such as PmVSD with abnormally attached tricuspid are fit for interventional treatment is still disputable.AIM To explore the feasibility and safety of transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae using an improved patent ductus arteriosus(PDA) occluder.METHODS We retrospectively analyzed 20 patients diagnosed with PmVSD with abnormally attached tricuspid chordae tendineae who underwent interventional treatment using an improved PDA occluder at our center from January 2012 to January 2016. Baseline characteristics and procedural and follow-up data were analyzed.RESULTS All 20 patients achieved procedure success. No heart block occurred during the operation. One patient had a transient complete right bundle branch block within48 h post-procedure and reverted to normal rhythm after intravenous injections of dexamethasone for 3 d. For all 20 patients, no residual shunt was observed by transthoracic echocardiography post-procedure. During the average follow-up period of 2.4 years, no severe TR was observed.CONCLUSION Using of the improved PDA occluder for the transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae is a safe and promising treatment option. However, long-term follow-up in a large group of patients is still warranted.

Clinical outcomes of tricuspid valve repair accompanying left-sided heart disease

AIM To determine whether the need for additional tricuspid valve repair is an independent risk factor when surgery is required for a left-sided heart disease.METHODS One hundred and eighty patients(68 ± 12 years,79 males) underwent tricuspid annuoplasty.Cox proportionalhazards regression model for multivariate analysis was performed for variables found significant in univariate analyses.RESULTS Tricuspid regurgitation etiology was functional in 154 cases(86%),organic in 16 cases(9%),and mixed in10 cases(6%),respectively.Postoperative mortality at 30 days was 11.7%.Mean follow-up was 51.7 mo with survival at 5 years of 73.5%.Risk factors for mortality were acute endocarditis [hazard ratio(HR) = 9.22(95%CI:2.87-29.62),P < 0.001],ischemic heart disease requiring myocardial revascularization [HR = 2.79(1.26-6.20),P = 0.012],and aortic valve stenosis [HR = 2.6(1.15-5.85),P = 0.021].Significant predictive factors from univariate analyses were double-valve replacement combined with tricuspid annuloplasty [HR = 2.21(1.11-4.39),P = 0.003] and preoperatively impaired ejection fraction [HR = 1.98(1.04-3.92),P = 0.044].However,successful mitral valve repair showed a protective effect [HR = 0.32(0.10-0.98),P = 0.046].Additionally,in instances where tricuspid regurgitation required the need for concomitant tricuspid valve repair,mortality predictor scores such as Euroscore 2 could be shortened to a simple Euroscore-tricuspid comprised of only 7 inputs.The explanation may lie in the fact that significant tricuspid regurgitation following leftsided heart disease represents an independent risk factor encompassing several other factors such as pulmonary arterial hypertension and dyspnea.CONCLUSION Tricuspid annuloplasty should be used more often as a concomitant procedure in the presence of relevant tricuspid regurgitation,although it usually reveals an overly delayed correction of a left-sided heart disease.

Clinical results of tricuspid valve replacement—a 21-case report

Objective： To summarize the clinical experiences of 21 patients treated with tricuspid valve replacement （TVR） and investigate the surgical indications and methods. Methods： Data from 21 patients who underwent TVR from December 2002 to March 2009 were retrospectively collected and analyzed. The mean age was 48.86± 15.37 years （range： 20-72 years）. The underlying disease of the patients was classified as rheumatic （n = 10）, congenital （n = 8）, endocarditis （n = 2） or chest trauma （n = 1）. Previous cardiac surgery had been performed in 12 patients （57.14%）. Results： In-hospital death occurred in two patients （9.52%）. Postoperative morbidities included cardiac failure （n = 2）, bleeding related re-operation （n = 1）, and plural effusion （n = 2）. Conclusion： The early outcomes of TVR were acceptable. At the present time TVR can be performed through optimal perioperative management.

Transcatheter interventions for severe tricuspid regurgitation:a literature review

The prevalence of tricuspid regurgitation(TR)increases with age,affecting 65%-85%of adults.Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus(leaflets,chordae,papillary muscles,or annulus).Secondary TR is due to insufficient coaptation from dilation of tricuspid valve annulus due to the right ventricle(RV)or right at-rium(RA)remodeling and increased RV pressures.Isolated TR is without increased RV pressures and is associated with atrial fibrillation.Mild TR is a benign disease.Moderate to severe tricuspid regurgitation has independently been associated with in-creased mortality.Most of these patients are treated medically due to poor outcomes with surgical repair of isolated TR.The in-hospital mortality rate is 8.8%,and the median length of stay in hospital is 11 days resulting in higher healthcare costs.Even if the patients undergo surgical repair or replacement,available data do not show improvement in survival.With a more detailed un-derstanding of the complex anatomy and physiology of the tricuspid valve and significant complications from untreated tricusp-id valve disease,the approach to the management of TR has shifted from a conservative approach to a process of prevention and intervention.In the past decade,transcatheter tricuspid valve interventions and tricuspid annuloplasty rings have been de-veloped,contributing to decreased mortality from surgical repair.Transcatheter tricuspid valve intervention techniques have im-proved survival,quality of life,and reduced heart failure rehospitalization.This review summarizes normal anatomy,types of TR,etiology and different mechanisms of TR,echocardiographic assessment of the severe TR,and highlights various percu-taneous transcatheter techniques for tricuspid valve repair.

A valve-in-valve approach to manage severe bioprosthetic tricuspid valve stenosis

severe symptomatic tricuspid stenosis often requires intervention.When the etiology is bioprosthetic valve failure,a challenging situation is met.Surgical valve replacement is the gold standard of treatment for severe tricuspid valve(TV)disease.[1]However,a redo sternotomy is rarely performed for isolated TV disease due to very high perioperative mortality.[2]Evolving percutaneous technology presents new frontiers in treatment,with the valveinvalve procedure emerging as an alternative.We present a case of a 65year woman with progressive symptoms due to failure of a bioprosthetic valve in the tricuspid position who was not a surgical candidate but underwent percutaneous intervention with significant clinical improvement.

Infiltrative cardiac lymphoma with tricuspid valve involvement in a young man

Cardiac metastases are among the topics with limited systematic reviews.Theoretically,the heart can be infiltrated by any malignancy with the ability to spread to distant structures.Thus far,no specific tumors are known to have a predilection for the heart,but some do metastasize more often than others,for example,melanoma and primary mediastinal tumors.We report a case of cardiac metastasis from a diffuse large B cell lymphoma in a young man.The peculiarity of this case is that besides the involvement of right ventricle and atrium,the tricuspid valve was also infiltrated.Valvular metastasis is rarely reported in the medical literature.

Tricuspid valve endocarditis:Cardiovascular imaging evaluation and management

Right-sided infective endocarditis is an increasingly recognized disease entity,with tricuspid valve being most frequently involved.Risk factors for tricuspid valve endocarditis(TVIE)include intravenous drug use,cardiac implantable electronic devices and indwelling catheters.Staphylococcus aureus is the predominant causative organism in TVIE.The diagnosis of infective endocarditis(IE)is based on clinical manifestations,blood cultures,and the presence of valvular vegetations detected by echocardiography.Complementary imaging is helpful when there is ongoing clinical suspicion for IE following initially negative echocardiography.Multislice computed tomography allows for assessment of extra-cardiac complications in TVIE,including pulmonary septic emboli.18F-fluorodeoxyglucose positron emission tomography/computed tomography and radiolabelled white blood cell,single-photon emission computed tomography provide important clinical information concerning the presence of IE in right-sided prosthetic valves or cardiac implantable electronic devices.The aim of this review is to provide an update on TVIE,discussing the role of multimodality imaging in TVIE and the management of these patients.

Intravenous drug abuse and tricuspid valve endocarditis: Growing trends in the Middle East Gulf region

Traditionally, tricuspid valve endocarditis is uncommon in the Middle East region. However, recent global data indicate growing trends in the use of illicit drug abuse, specifically injectable heroin, in the Middle East Gulf region. The presence of many transit port services in the Middle East Gulf States has led to smuggling of substance abuse drugs in the region. The Middle East Gulf States, currently a transit market, are also becoming a growing consumer market in view of the increased substance abuse in the youth. However, there is a paucity of data with respect to the prevalence or incidence of tricuspid valve endocarditis in the region, probably due to underdiagnosis or underreporting. A high index of suspicion of tricuspid valve endocarditis is essential in patients with a history of intravenous drug abuse. This article reviews the epidemiology of illicit drug abuse in the Middle East Gulf region, as well as the diagnosis and treatment of tricuspid valve endocarditis, and calls for all physicians in the region to be vigilant while dealing with intravenous drug abuse.

Aorto-right atrial fistula: Late complication of tricuspid valve infective endocarditis

Abnormal connections between the ascending aortaand the cardiac chambers are rare, especially in thecontext of right-sided infective endocarditis(IE). Trans-thoracic echocardiography(TTE) with color-flow Dop-pler, transesophageal echocardiography(TEE), or bothmay be required for diagnosis. We present the case ofa woman admitted with right-sided heart failure(HF)symptoms. She had a previous history of tricuspid valveIE 30 years ago. TTE and TEE revealed an aorto-rightatrium fistula located just under the non-coronary cuspinto the right atrium at the level of the previously af-fected tricuspid valve. The Patient refused surgery andwas discharged home on HF medications. She has beenstable for the last 3 years. The peculiarity of this caseis the late symptomatic presentation of the aorto-atrialfistula and the unusual association to tricuspid valve IE.

Percutaneous pulmonary and tricuspid valve implantations: An update

The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology.Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status.Although techniquesof percutaneous pulmonary valve implantation have been described just a decade ago,two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide.In contrast,percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status.Taking into account that an "interdisciplinary challenging",heterogeneous population of patients previously treated by corrective,semi-corrective or palliative surgical procedures is growing inexorably,there is a rapidly increasing need of treatment options besides redo-surgery.Therefore,the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures,to update on current devices,to discuss indications and patient selection criteria,to report on clinical results and finally to consider future directions.

Characterization of Malalignment between Atrial and Ventricular Septa in Overriding/Straddling Tricuspid and Mitral Valves

Objective:Overriding/straddling of an atrioventricular valve is a consequence of atrial-ventricular septal malalignment.We sought to characterize the malalignment by analogizing it to a flap-door and using structured approach.Methods:The echocardiograms and magnetic resonance images of 35 patients with overriding/straddling tricuspid or mitral valve were evaluated to assess the following modifiers;the malaligned part of the septum,the reference structure,and the mechanism,direction and severity of malalignment.Results:The pathology included classic overriding tricuspid valve in 15,classic overriding mitral valve in 12,and overriding tricuspid valve with left juxtaposition of atrial appendages in 8.In classic overriding tricuspid valve,the ventricular septum was hinged to the anterior interventricular groove and its insertion to the posterior interventricular groove was displaced toward the right ventricle.The VSD primarily involved the inlet but also extended toward the anterior interventricular groove.In classic overriding mitral valve,the ventricular septum was hinged to the posterior interventricular groove and crux cordis.Its insertion to the anterior interventricular groove was displaced toward the left ventricle.The VSD primarily involved the anterior part but also extended toward the inlet.Overriding tricuspid valve with left juxtaposition of atrial appendages had a mild degree of malalignment with displacement/rotation of the atrioventricular junction.Evenly spaced short-axis images were most helpful in characterizing the pathology.Conclusions:Overriding/straddling atrioventricular valves can be easily understood by analogizing the atrial-ventricular septal malalignment to a flap-door and describing the pathology in a structured manner.Contrary to what has previously been known,the VSD is not limited to the inlet or outlet part of the ventricular septum.

Association between cardiovascular implantable electronic devices and tricuspid regurgitation: a case- control study

Cardiovascular implantable electronic devices(CIEDs)are widely used in the modern era.Every year,about 730,000 permanent pacemakers and 330,000 CIEDs are implanted worldwide.CIEDs have been known to increase the life expectancy of millions of people and improve their quality of life by controlling the heart rate and atrioventricular and interventricular synchronization and preventing sudden cardiac death.[1]The tricuspid valve consists of the annulus,leaflets,chordae tendineae,and papillary muscles.Interaction between the endocardial lead and any component of this structure can lead to tricuspid valve dysfunction,thereby resulting in tricuspid regurgitation(TR).[2]CIED-related TR has been shown to be an independent predictor of hospitalization for heart failure.[3,4]

Functional Tricuspid Regurgitation and Ring Annuloplasty Repair

Functional tricuspid regurgitation(TR)primarily arises from asymmetric dilation of the tricuspid annulus in the setting of right ventricular dysfunction and enlargement in response to left-sided myocardial and valvular abnormalities.Even if the TR is not severe at the time of mitral valve surgery,it can worsen and even appear late after successful mitral valve surgery,which portends a poor prognosis.Despite data demonstrating inferior outcomes in the presence of residual TR,surgical repair for functional TR remains underused.Acceptance of TR,in the presence of tricuspid annular dilation,may be unacceptable.Surgical repair should consist of placement of a rigid or semirigid annular ring,which has been shown to provide superior durability as compared with suture and flexible band techniques.Finally,percutaneous annuloplasty for correction of functional TR may allow treatment of patients with recurrent TR at high risk of reoperation.