Tricuspid Regurgitation/Stenosis

Question 1

Severe TR hemodynamics

Answer 1

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 2

Tricuspid Regurgitation

Recommendations for Timing of Intervention?

Answer 2

1. severe TR (Stages C and D) undergoing left-sided valve surgery.
2. progressive TR (Stage B) undergoing left-sided valve surgery, tricuspid valve surgery with either: 1) tricuspid annular dilation (tricuspid annulus end diastolic diameter >4.0 cm or > 7cm on direct intraop measurement) or 2) prior signs and symptoms of right-sided HF.
3. In patients with signs and symptoms of right-sided HF and severe primary TR (Stage D), isolated tricuspid valve surgery can be beneficial to reduce symptoms.
4. In patients with signs and symptoms of rightsided HF and severe isolated secondary TR attributable to annular dilation (in the absence of pulmonary hypertension or left-sided disease) who are poorly responsive to medical
   therapy (Stage D).
   5.In asymptomatic patients with severe primary TR (Stage C) and progressive RV dilation or systolic dysfunction.
5. In patients with signs and symptoms of rightsided 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.**

Right HF: Dyspnea on exertion, fatigue,ascites, edema

A value greater than or equal to 35 mm Hg is considered PAH and classified as follows: mild PAH (35 50 mm Hg), moderate PAH (50 70 mm Hg), and severe pulmonary hypertension (> 70 mm Hg).

Question 3

Tricuspid regurgitation

Ring prostheses are sized according to the:

Answer 3

Ring prostheses are sized according to the** intratrigonal length of the septal leaflet, **as this length is spared in annular dilation.

Question 4

TV repair

Risk factors for failure include:

Answer 4

1. pulmonary arterial hypertension
2. ring annuloplasty with a larger ring size
3. suture rather than ring annuloplasty
4. LV dysfunction
5. retention of trans-tricuspid valve ICD or pacemaker leads.

A value greater than or equal to 35 mm Hg is considered PAH and classified as follows: mild PAH (35 50 mm Hg), moderate PAH (50 70 mm Hg), and** severe pulmonary hypertension (> 70 mm Hg). **

Question 5

Echo criteria for severe tricuspid stenosis

Answer 5

1. Peak tricuspid inflow velocity during inspiration >1 m/s
2. inflow time-velocity integral >60 cm
3. valve area ≤1 cm2
4. A mean transvalvular pressure gradient ≥5 mm Hg at normal heart rate is also seen with TS.
5. Pressuer 1/2 time ≥ 190ms

Question 6

Tricuspid Stenosis

Most commonly involved commisure?

Answer 6

The anteroseptal commisure