Ponna Pramod Kumar, Patin Stephen, Turaga Naga Sai Shravan, Zoltowska Dominika M, Devarkonda Vishal, Botta Ramya Krishna, Agrawal Yashwant, Dhar Gaurav
Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
J Geriatr Cardiol. 2022 Jul 28;19(7):539-550. doi: 10.11909/j.issn.1671-5411.2022.07.010.
The prevalence of tricuspid regurgitation (TR) increases with age, affecting 65%-85% of adults. Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus (leaflets, chordae, papillary muscles, or annulus). Secondary TR is due to insufficient coaptation from dilation of tricuspid valve annulus due to the right ventricle (RV) or right atrium (RA) remodeling and increased RV pressures. Isolated TR is without increased RV pressures and is associated with atrial fibrillation. Mild TR is a benign disease. Moderate to severe tricuspid regurgitation has independently been associated with increased mortality. Most of these patients are treated medically due to poor outcomes with surgical repair of isolated TR. The in-hospital mortality rate is 8.8%, and the median length of stay in hospital is 11 days resulting in higher healthcare costs. Even if the patients undergo surgical repair or replacement, available data do not show improvement in survival. With a more detailed understanding of the complex anatomy and physiology of the tricuspid valve and significant complications from untreated tricuspid valve disease, the approach to the management of TR has shifted from a conservative approach to a process of prevention and intervention. In the past decade, transcatheter tricuspid valve interventions and tricuspid annuloplasty rings have been developed, contributing to decreased mortality from surgical repair. Transcatheter tricuspid valve intervention techniques have improved survival, quality of life, and reduced heart failure rehospitalization. This review summarizes normal anatomy, types of TR, etiology and different mechanisms of TR, echocardiographic assessment of the severe TR, and highlights various percutaneous transcatheter techniques for tricuspid valve repair.
三尖瓣反流（TR）的患病率随年龄增长而增加，影响65%-85%的成年人。原发性TR由三尖瓣装置（瓣叶、腱索、乳头肌或瓣环）的先天性或后天性异常引起。继发性TR是由于右心室（RV）或右心房（RA）重塑以及RV压力增加导致三尖瓣环扩张，瓣叶对合不良所致。孤立性TR无RV压力升高，与心房颤动相关。轻度TR是一种良性疾病。中重度三尖瓣反流与死亡率增加独立相关。由于孤立性TR手术修复效果不佳，这些患者大多接受药物治疗。住院死亡率为8.8%，中位住院时间为11天，导致医疗费用更高。即使患者接受手术修复或置换，现有数据也未显示生存率有所改善。随着对三尖瓣复杂解剖结构和生理学的更深入了解以及未治疗的三尖瓣疾病的严重并发症，TR的管理方法已从保守方法转向预防和干预过程。在过去十年中，经导管三尖瓣介入治疗和三尖瓣成形环得到了发展，有助于降低手术修复的死亡率。经导管三尖瓣介入技术提高了生存率、生活质量，并减少了心力衰竭再住院率。本综述总结了正常解剖结构、TR的类型、TR的病因和不同机制、严重TR的超声心动图评估，并重点介绍了各种经皮经导管三尖瓣修复技术。
