Abstract
Tricuspid regurgitation (TR) secondary to left-sided valvular heart disease is the most frequent cause of tricuspid insufficiency. Severe mitral and aortic valve disease is associated with pulmonary hypertension and right ventricular pressure overload leading to dilatation of right ventricle (RV), dilatation of tricuspid anulus and development of secondary TR.
Echocardiography is the technique of choice to evaluate aetiology of TR, quantify its severity and assess the annular dilatation, leaflet tethering , dilatation and systolic function of RV. Cardiac magnetic resonance imaging (MRI) is the gold standard in the assessment of RV volumes and ventricular function.
Cardiac CT and 3D echocardiography show a good correlation with MRI in evaluation of RV. Secondary TR is severe and progressive disease.
If left untreated, it leads to irreversible RV damage and right heart failure. Surgical annuloplasty with annuloplasty ring is indicated in patients undergoing left-sided valve surgery not only in severe TR but also in mild to moderate TR with annular dilatation.
Isolated TR late after left-sided valvular surgery is a severe disease with high operative mortality. Development of symptoms, progression of RV dilatation or impairment of RV function are indications for redo surgery.
Novel transcatheter therapies aim at restoring annular dilatation and leaflet coaptation.