The Tricuspid Valve: Misnamed and Misunderstood!

Yet despite the careful reporting and words of advice from experts, the overall message is that the TV is still rather enigmatic but should not be overlooked. Readers will come to understand that much has been learned. For example, note that careful imaging has revealed only slightly more than half of tricuspid valves are truly "tricuspid"! Yet, TV stenosis is easiest to understand. Rheumatic heart disease, and rarely carcinoid, lupus and congenital stenosis, cover that base. If TV leaflets are fused, transcatheter balloon valvotomy can even be considered. However, tricuspid regurgitation (TR) is a more complex story and the pathophysiology surrounding TR still can baffle us.

 Tricuspid Valve Disease: The Forgotten Valve No Longer Forgotten​

Over the past several years, focused research efforts have led to innovative surgical and transcatheter treatment options for aortic and mitral valve diseases. Now, these same efforts are on the rise in another area – the tricuspid valve – with the hope of achieving similar advantages and outcomes for patients.

Anatomy and Physiology of the Tricuspid Valve

The TV is the largest and most apically positioned of the 4 cardiac valves with a normal orifice area between 7 and 9 cm2

Ebstein’s Anomaly of the Tricuspid Valve

The tricuspid valve separates the right upper chamber (the right atrium) and the right lower chamber (the right ventricle) of the heart. In a normal heart, the tricuspid valve closes completely when the right ventricle squeezes to push blood to the lungs, to prevent blood from going backward. In Ebstein’s anomaly of the tricuspid valve, some blood being pushed into the right ventricle “leaks” back into the right atrium because the valve does not close completely. The atrium may become enlarged because of the extra volume of blood; and, in severe cases, heart failure can result. Some children with Ebstein’s anomaly of the tricuspid valve also have an atrial septal defect (ASD), a hole in the wall between the two upper chambers of the heart, or other heart defects.

The Tricuspid Valve

Show Outline Before publication of the article by Hauck and associates in this issue of the Proceedings (pages 851 to 863), descriptions of tricuspid valve pathology in large series have been limited primarily to postinflammatory disease (rheumatic heart disease). Reports of noninflammatory disease processes involving the tricuspid valve have been sporadic and have encompassed only small series of patients. The vast experience of Hauck and colleagues and their description of the tricuspid valve pathology are invaluable contributions to the study of valvular heart disease.

The tricuspid valve and the right heart: anatomical, pathological and imaging specifications

A better understanding of the complex three-dimensional (3D) structure of the tricuspid valve and the right ventricle has facilitated the development of novel transcatheter therapies for tricuspid regurgitation (TR), a frequent valvular heart disease that has been largely ignored. Whilst a trivial to mild degree of TR is frequently observed and considered benign (in the absence of pulmonary hypertension or heart failure), the prevalence of significant (moderate and severe) TR may reach 16% in selected populations.

The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options

Tricuspid valve disease is an often underrecognized clinical problem that is associated with significant morbidity and mortality. Unfortunately, patients will often present late in their disease course with severe right-sided heart failure, pulmonary hypertension, and life-limiting symptoms that have few durable treatment options. Traditionally, the only treatment for tricuspid valve disease has been medical therapy or surgery; however, there have been increasing interest and success with the use of transcatheter tricuspid valve therapies over the past several years to treat patients with previously limited therapeutic options.

Tricuspid Regurgitation: Predicting the Need for Intervention, Procedural Success, and Recurrence of Disease

Interest in tricuspid valve (TV) pathology has rapidly expanded in response to studies showing poor clinical outcomes in patients with functional tricuspid regurgitation (TR) and the limited indications and options for treatment, resulting in significant undertreatment of the disease/

Tricuspid valve disease: diagnosis, prognosis and management of a rapidly evolving field

Tricuspid valve disease, and particularly tricuspid regurgitation, is a highly prevalent condition with a complex pathophysiology and long-term adverse consequences. Although historically neglected, tricuspid valve disease has gained increasing recognition, with important advances in the assessment and management of this disorder over the past 2 decades. Surgical treatment remains the standard of care, but it continues to have one of the the highest death rates among all cardiac valve-related procedures, and a broad range of patients still do not receive effective therapy for tricuspid valve disease in contemporary clinical practice. Therefore, several alternative, less-invasive technologies for treating patients with severe, native tricuspid valve disease at high surgical risk have been developed in the past decade, with promising early results.