Lankeit M, Keller K, Tschöpe C, Pieske B
Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland.
Herz. 2017 Nov;42(7):634-643. doi: 10.1007/s00059-017-4609-7.
The vast majority of tricuspid valve regurgitations are of low degree without prognostic relevance in healthy individuals; however, morbidity and mortality increase with the degree of regurgitation, which can be secondary to either primary (structural) or secondary (functional) alterations of the valve. Due to the frequent lack of symptoms, echocardiographic examinations should be annually performed in patients with higher degree (at least moderate) tricuspid valve regurgitation, in particular in the presence of risk factors. Individual therapeutic management strategies should consider the etiology of the tricuspid valve regurgitation, the degree of regurgitation, the valve pathology and the risk-to-benefit ratio of the envisaged therapeutic procedure. Medicinal treatment options for tricuspid valve regurgitation are limited and generalized recommendations cannot be provided due to the lack of conclusive clinical trials. Symptomatic therapeutic measures encompass especially (loop) diuretics for the reduction of preload and afterload of the right ventricle. Pharmaceutical reduction of the heart rate should be avoided in patients with right heart insufficiency. While symptomatic therapeutic measures are often associated with only moderate effects, the most effective therapy of tricuspid valve regurgitation consists in the treatment of underlying illnesses, in most cases pulmonary hypertension due to pulmonary arterial hypertension (PAH), left heart disease or acute pulmonary embolism. Based on a number of published clinical studies and licensing of new drugs, treatment options for patients with PAH and heart failure with reduced ejection fraction (HFrEF) have substantially improved during the past years allowing for a differentiated, individualized management.
绝大多数三尖瓣反流程度较轻，对健康个体的预后无影响；然而，反流程度增加会导致发病率和死亡率上升，这可能继发于瓣膜的原发性（结构）或继发性（功能性）改变。由于症状通常不明显，对于中重度（至少中度）三尖瓣反流患者，尤其是存在危险因素的患者，应每年进行超声心动图检查。个体化治疗策略应考虑三尖瓣反流的病因、反流程度、瓣膜病变以及预期治疗方法的风险效益比。三尖瓣反流的药物治疗选择有限，由于缺乏确凿的临床试验，无法提供通用建议。对症治疗措施尤其包括使用（袢）利尿剂以降低右心室的前负荷和后负荷。右心功能不全患者应避免使用药物降低心率。虽然对症治疗措施往往效果一般，但三尖瓣反流最有效的治疗方法是治疗基础疾病，大多数情况下是治疗由肺动脉高压（PAH）、左心疾病或急性肺栓塞引起的肺动脉高压。基于多项已发表的临床研究和新药获批情况，在过去几年中，PAH和射血分数降低的心力衰竭（HFrEF）患者的治疗选择有了显著改善，从而能够进行差异化的个体化管理。
