Tricuspid

Question 1

Presentation of advanced TR

Answer 1

1. elevated “c-V”
2. a systolic murmur at the lower sternal border that increases in intensity with inspiration.
3. pulsatile liver edge

Question 2

Severe TR - Echocardiographic findings

Answer 2

1. Central jet area >10.0 cm²
2. Vena contracta width >0.70 cm
3. CW jet density and contour: dense, triangular with early peak
4. Hepatic vein flow: systolic reversal

Question 3

ECHO findings of Tricuspid regurgitation

Central jet area?

Answer 3

Central jet area >10.0 cm2

Question 4

Severe TR ECHO Vena contracta

Answer 4

Vena contracta width >0.70 cm

Question 5

Tricuspid valve ECHO consistent with Normal RV function

Answer 5

Normal RV systolic function is defined by several parameters, including:

• TAPSE: >16 mm
• tricuspid valve annular velocity (S’) >10.0cm/s
• RV end-systolic area <20.0 cm²
• fractional area change >35%.

Question 6

Initial medical therapy with right side heart failure

Answer 6

Diuretics can be used to decrease volume over-

load in these patients.

Loop diuretics are typically provided and may relieve systemic congestion, but their use can be limited by worsening low-flow syndrome.

Aldosterone antagonists may be of additive benefit, especially in the setting of hepatic congestion, which may promote secondary hyperaldosteronism.

Question 7

Mortality associated with Reoperation for severe, isolated TR after left-sidedvalve surgery?

Answer 7

Reoperation for severe, isolated TR after left-sided

valve surgery is associated with a perioperative

mortality rate of 10% to 25%.

Question 8

Left uncorrected at the time of left-sided valve sur-

gery, mild or moderate degrees of functional TR may

progress how often?

Answer 8

Left uncorrected at the time of left-sided valve sur-

gery, mild or moderate degrees of functional TR may

progress over time in approximately 25% of patients and result in reduced long-term functional outcome and survival.

Question 9

Risk factors for worsening TR at the time of left side surgery

Answer 9

Risk factors for persistence and/or progression of

TR include:

1. tricuspid annulus dilation:
   
   • > 40 mm diameter or 21 mm/m² on preoperative TTE
2. degree of RV dysfunction/remodeling
3. leaflet tethering height
4. pulmonary artery
5. hypertension
6. AF
7. nonmyxomatous etiology of MR
8. intra-annular RV pacemaker or implantable cardioverterdefi brillator leads

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