Seghatol-Eslami Frank F, Liu Kan
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110-1083, USA.
Rev Cardiovasc Med. 2025 May 8;26(5):28173. doi: 10.31083/RCM28173. eCollection 2025 May.
Once considered the "forgotten valve and ventricle", the tricuspid valve and right ventricle are now recognized as critical structures with significant clinical and prognostic implications. Growing evidence has highlighted that tricuspid regurgitation (TR) and right heart failure are not merely secondary phenomena that resolve following the treatment of left-sided heart disease. Instead, TR and right heart failure contribute to adverse outcomes and increased mortality if left untreated. This paradigm shift has fueled extensive clinical research, leading to a deeper understanding of the pathophysiology of TR and right ventricular (RV) dysfunction. Additionally, advancements in cardiovascular imaging have facilitated early detection, risk stratification, and innovative therapeutic approaches for TR and right heart failure. This article explores the evolving landscape of tricuspid valve disease, emphasizing the importance of early recognition and the role of emerging imaging technologies in improving patient outcomes. Thanks to progress in imaging technology, especially echocardiography, as well as cardiac magnetic resonance and cardiac computer tomography, enhanced studies can be conducted on the tricuspid valve pathology to delineate the various mechanisms involved in TR and RV dysfunction and offer patients a tailored medical, as well as surgical and transcatheter therapies. These unparalleled technological advances would not be possible without the hard work of physicians, scientists, surgeons, interventional cardiologists, and echocardiographers worldwide, despite the many challenges they experience daily and in every procedure. Many patients with TR present at an advanced stage of disease progression, often with severe regurgitation and clinical manifestations associated with poor outcomes. Additionally, a significant proportion of these patients have either undergone previous open-heart surgery for left-sided valvular disease or are considered high-risk surgical candidates due to multiple comorbid conditions. In recent years, transcatheter therapy has emerged as a viable alternative for this high-risk population, offering a less invasive option for those previously deemed "inoperable". This breakthrough has transformed the therapeutic landscape for valvular heart disease, particularly for TR, providing new hope and improved outcomes for patients who were once left with limited treatment options.
三尖瓣和右心室曾被视为“被遗忘的瓣膜和心室”，如今被公认为具有重大临床和预后意义的关键结构。越来越多的证据表明，三尖瓣反流（TR）和右心衰竭不仅仅是在治疗左心疾病后会缓解的继发现象。相反，如果不进行治疗，TR和右心衰竭会导致不良后果并增加死亡率。这种范式转变推动了广泛的临床研究，使人们对TR和右心室（RV）功能障碍的病理生理学有了更深入的了解。此外，心血管成像技术的进步促进了对TR和右心衰竭的早期检测、风险分层以及创新治疗方法的发展。本文探讨了三尖瓣疾病不断变化的格局，强调了早期识别的重要性以及新兴成像技术在改善患者预后方面的作用。由于成像技术的进步，尤其是超声心动图、心脏磁共振成像和心脏计算机断层扫描，现在可以对三尖瓣病变进行更深入的研究，以阐明TR和RV功能障碍所涉及的各种机制，并为患者提供量身定制的药物治疗、手术治疗和经导管治疗。如果没有全球范围内的医生、科学家、外科医生、介入心脏病学家和超声心动图专家的辛勤工作，尽管他们在日常工作和每一个手术过程中都面临诸多挑战，这些无与伦比的技术进步是不可能实现的。许多TR患者在疾病进展的晚期才出现症状，通常伴有严重反流以及与不良预后相关的临床表现。此外，这些患者中有很大一部分要么之前因左心瓣膜疾病接受过心脏直视手术，要么由于多种合并症被视为高风险手术候选人。近年来，经导管治疗已成为这一高风险人群的可行替代方案，为那些以前被认为“无法手术”的患者提供了一种侵入性较小的选择。这一突破改变了心脏瓣膜病的治疗格局，尤其是对于TR，为那些曾经治疗选择有限的患者带来了新的希望并改善了预后。
