Hungerford Sara L, Rye Eleanor E, Hansen Peter S, Bhindi Ravinay, Choong Christopher
Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia; Department of Cardiology, Tufts University Hospital, Boston, Massachusetts.
Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
J Am Soc Echocardiogr. 2023 Apr;36(4):366-380.e1. doi: 10.1016/j.echo.2023.01.013. Epub 2023 Feb 6.
Chronic tricuspid regurgitation (TR) results in progressive right ventricular (RV) volume overload, followed by right-sided chamber dilatation, RV systolic dysfunction, and eventual low-output cardiac failure. Severe TR is associated with considerable morbidity and mortality, and yet until recently, patients in the late stage of their disease course had limited treatment options. Cognizant of the high mortality rates associated with surgical intervention, tricuspid valve (TV) transcatheter edge-to-edge repair (TEER) has emerged as a promising solution for patients with severe TR. As has been learned from the transcatheter mitral valve TEER experience, detailed morphological and mechanistic assessment of the TV with transthoracic and transesophageal imaging is essential to optimal patient selection and procedural success. The current review will provide a comprehensive overview of TV anatomy, the updated mechanistic classification of TR, and key echocardiographic considerations in the evaluation, management, and follow-up of patients undergoing TV TEER.
慢性三尖瓣反流(TR)会导致进行性右心室(RV)容量超负荷,继而出现右心腔扩张、RV收缩功能障碍,最终发展为低心排血量心力衰竭。严重TR与相当高的发病率和死亡率相关,然而直到最近,处于疾病晚期的患者治疗选择仍然有限。考虑到手术干预相关的高死亡率,三尖瓣(TV)经导管缘对缘修复术(TEER)已成为重度TR患者的一种有前景的治疗方案。从经导管二尖瓣TEER经验中可知,通过经胸和经食管成像对TV进行详细的形态学和机制评估对于优化患者选择和手术成功至关重要。本综述将全面概述TV解剖结构、TR的更新机制分类,以及在接受TV TEER患者的评估、管理和随访中的关键超声心动图考量因素。
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