Indications for Tricuspid Valve

Question 1

What are the two Class 2a indications for medical management of TR?

Answer 1

Patients with severe symptoms (Class C and D), they need to be treated with diuretics.

Patients with secondary TR (severe symptoms) to treat the primary cause of the HF

Question 2

What is the Class I indication for intervention in patients with severe TR?

Answer 2

In patents undergoing left-sided surgery , tricuspid valve intervention is recommended in patients with severe TR

Question 3

What are the 3 Class 2a indications for intervention in patients with TR?

Answer 3

1. In patients with progressive TR (Stage B) undergoing left-sided valve surgery, tricuspid valve surgery is beneficial in the context of annular dilatation (>4.0cm) or prior signs of right-sided HF
2. In patients with severe symptoms (Stage C and D), isolated tricuspid valve surgery can be useful to reduce symptoms and recurrent hospitalizations.
3. In patients with signs and symptoms of right-sided HF and severe isolated secondary TR (in the absence of pulmonary hypertension or left-sided disease) who are poorly responsive to medical therapy, isolated TV can be beneficial to reduce symptoms and recurrent hospitalizations.

Question 4

What are the 2 Class 2b indications for intervention in patients with TR?

Answer 4

1. In asymptomatic patients with severe primary TR (Stage C) and progressive RV dilation or systolic dysfunction, isolated tricuspid valve surgery may be considered
2. In patients with signs and symptoms of right- sided HF and severe TR (Stage D) who have undergone previous left-sided valve surgery, reoperation with isolated tricuspid valve surgery may be considered in the absence of severe pulmonary hypertension or severe RV systolic dysfunction

Question 5

What are the 4 Valve hemodynamics of Stage B of TR (according to the AHA Class)?

Answer 5

Central jet <50% RA
Vena contracta width <0.7 cm
ERO <0.40 cm2
Regurgitant volume <45 mL

Question 6

What are the 6 Valve hemodynamics of Stage C of TR (according to the AHA Class)?

Answer 6

1. Central jet ≥50% RA
2. Vena contracta width ≥0.7 cm
3. ERO ≥0.40 cm2
4. Regurgitant volume ≥45 mL
5. Dense continuous wave signal with triangular shape
6. Hepatic vein systolic flow reversal

Question 7

What are the 6 Valve hemodynamics of Stage D of TR (according to the AHA Class)?

Answer 7

1. Central jet ≥50% RA
2. Vena contracta width ≥0.7 cm
3. ERO ≥0.40 cm2
4. Regurgitant volume ≥45 mL
5. Dense continuous wave signal with triangular shape
6. Hepatic vein systolic flow reversal

Question 8

What makes Stage C different from Stage D TR?

Answer 8

The symptoms. Patients with Stage D have severe symptoms.