Fate and management of tricuspid regurgitation following transcatheter pulmonary valve replacement

Authors: Beaudoin, JonathanBédard, ÉlisabethPibarot, Philippe
Abstract: Tricuspid regurgitation (TR) is a common anomaly complicating left and right heart disease. In patients with congenital right heart anomalies, TR is highly prevalent, and when severe, it is associated with adverse clinical events. Multiple mechanisms can contribute to TR in these patients including: concomitant congenital anomaly of tricuspid leaflets, presence of pacemaker lead crossing the valve, and anomalies of the right ventricle and tricuspid annulus leading to functional TR. It is important to emphasize the heterogeneity of these mechanisms in individual patients. Functional TR, as an example, can result from the variable combination of annulus dilation, right ventricular (RV) dilation, deformation, and/or systolic dysfunction, which can be attenuated by compensatory leaflet growth to prevent valve regurgitation. These factors are important as they can influence the likelihood of valve repair, thus helping to guide an eventual decision to repair, replace, or leave the valve untouched. There is an increasing role for newer imaging modalities (3-dimensional echocardiography and cardiac magnetic resonance) to assess those variables and guide therapeutic management. Management of TR is controversial in patients with right heart congenital anomalies who are undergoing pulmonary valve (PV) surgery. One important question is the relevance of correcting functional TR when an important proportion of patients will improve their TR spontaneously after pulmonary valve replacement (PVR), suggesting that a conservative approach for TR is acceptable for a large subset of patients. The other dilemma in therapeutic decisionmaking arises from the risk of recurrence of TR after tricuspid annuloplasty, which may be related to continued RV remodeling and tricuspid annulus dilation in the late post-operative phase.
Document Type: Article de recherche
Issue Date: 4 October 2016
Open Access Date: Restricted access
Document version: VoR
Permalink: http://hdl.handle.net/20.500.11794/12774
This document was published in: Journal of the American College of Cardiology, Vol. 68 (14), 1536-1539 (2016)
Elsevier Biomedical
Alternative version: 10.1016/j.jacc.2016.08.001
Collection:Articles publiés dans des revues avec comité de lecture

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