TY  - CHAP
M1  - Book, Section
TI  - Tricuspid Valve Disease
A1  - Joyce, David L.
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
PY  - 2014
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - EpidemiologyAlthough  as  many  as  70  percent  of  Americans  may  have  a  small  amount  of  tricuspid  regurgitation  (TR)  on  echocardiogram,  true  disease  of  the  tricuspid  valve  only  affects  0.8  percent  of  the  population.  Approximately  8000  surgical  procedures  are  performed  for  tricuspid  disease  each  year  in  the  United  States.  The  most  common  manifestation  of  tricuspid  valve  disease  is  functional  TR,  which  occurs  secondary  to  left-sided  heart  valve  disease  and  is  present  in  approximately  30  percent  of  patients  with  severe  mitral  regurgitation  and  up  to  53  percent  of  patients  undergoing  mitral  valve  surgery.  Risk  factors  for  TR  include  age  (OR  1.5/9.9  years;  95  percent  CI  1.3–1.7),  body  mass  index  (OR  0.7/4.3  kg/m2;  95  percent  CI  0.6–0.8),  and  female  gender  (OR  1.2;  95  percent  CI  1.0–1.6).PathophysiologyIn  most  cases,  tricuspid  valve  disease  presents  as  functional  regurgitation  secondary  to  left-sided  valvular  disease  or  heart  failure  (particularly  in  the  setting  of  pulmonary  hypertension).  Structural  causes  of  tricuspid  valve  disease  are  less  common,  and  include  rheumatic  heart  disease,  endocarditis,  carcinoid,  papillary  muscle  dysfunction,  trauma  (often  from  endomyocardial  biopsies  or  pacemaker  lead  placement),  and  congenital  anomalies.Clinical  featuresTricuspid  valve  disease  is  often  detected  incidentally  during  evaluation  for  left  heart  conditions.  Signs  and  symptoms  are  often  consistent  with  congestive  heart  failure  and  can  include  dyspnea  on  exertion,  orthopnea,  jugular  venous  distention,  ascites,  and  peripheral  edema.  Advanced  disease  also  can  present  with  hemoptysis  and  paroxysmal  nocturnal  dyspnea.  Physical  examination  reveals  a  pansystolic  (TR)  or  presystolic  [tricuspid  stenosis  (TS)]  murmur  in  the  fourth  and  fifth  intercostal  spaces  at  the  left  sternal  border  or  epigastrium.  Hepatojugular  reflux,  pulsatile  liver,  and  signs  of  hepatic  dysfunction  also  may  be  present.  Tricuspid  endocarditis  often  presents  with  pneumonia  or  manifestations  of  septic  emboli.DiagnosticsElectrocardiographic  features  include  peaked  P  waves  or  a  Q  wave  in  V1  as  a  result  of  right  atrial  volume  overload  and  enlargement.  Plain  chest  radiography  may  demonstrate  cardiomegaly  with  right-sided  chamber  enlargement.  Doppler  and  two-dimensional  echocardiography  confirm  the  diagnosis,  revealing  structural  abnormalities  and  measuring  pulmonary  arterial  pressures,  degree  of  stenosis/regurgitation,  and  right  ventricular  dysfunction.  Cardiac  catheterization  usually  confirms  elevated  right  atrial  and  ventricular  end-diastolic  pressures  in  TR.  A  diastolic  pressure–atrioventricular  pressure  gradient  that  increases  with  respiration  is  found  in  patients  with  significant  TS.  Tricuspid  endocarditis  is  typically  diagnosed  in  the  setting  of  major  criteria  that  include  valvular  vegetations  and  pyrexia;  positive  blood  cultures,  septic  pulmonary  emboli,  and  a  murmur  constitute  the  minor  criteria.TreatmentTricuspid  valve  repair  or  replacement  is  indicated  for  TS  and  moderate-to-severe  TR,  usually  associated  with  New  York  Heart  Association  class  III  or  IV  symptoms.  TS  is  usually  treated  with  commissurotomy.Surgical  techniques  for  TR  include  bicuspidization,  DeVega  suture  annuloplasty,  Carpentier  ring  annuloplasty,  and  prosthetic  valve  replacement.OutcomesUntreated,  the  1-year  survival  in  patients  with  severe,  moderate,  mild,  and  absent  TR  is  approximately  60,  70,  90,  and  91  percent,  respectively.  The  DeVega  suture  annuloplasty  for  TR  is  associated  with  a  4  percent  operative  mortality,  a  5  percent  recurrence  rate,  and  an  actuarial  survival  rate  of  71.5  percent  at  14  years.  Carpentier  ring  annuloplasty  is  associated  with  an  actuarial  survival  of  68.3  percent  at  10  years.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104590736
ER  -