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Tricuspid regurgitation

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The following summarized guidelines for the evaluation and management of tricuspid regurgitation are prepared by our editorial team based on guidelines from the American Heart Association (AHA/ACC 2021) and the European Society of Cardiology (ESC/EACTS 2021).


1.Diagnostic investigations

Transthoracic echocardiography: obtain TTE in patients with TR to evaluate the presence and severity of TR, determine the etiology, measure the sizes of right-sided chambers and IVC, assess RV systolic function, estimate pulmonary artery systolic pressure, and characterize any associated left-sided heart disease.
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2.Diagnostic procedures

Cardiac catheterization: consider obtaining invasive measurement of the cardiac index, right-sided diastolic pressures, pulmonary artery pressures, and pulmonary vascular resistance, as well as right ventriculography in patients with TR, if clinical and noninvasive data are discordant or inadequate.

3.Medical management

Consider offering diuretics in patients with signs and symptoms of right-sided HF attributable to severe TR (stages C and D).
Consider treating the primary causes of HF (such as pulmonary vasodilators to reduce elevated pulmonary artery pressures, guideline-directed medical therapy for HF with reduced LVEF or rhythm control of AF) in patients with signs and symptoms of right-sided HF attributable to severe secondary TR (stages C and D).

4.Therapeutic procedures

Transcatheter tricuspid valve intervention: consider performing transcatheter intervention in symptomatic inoperable patients with secondary severe TR at a heart valve center with expertise in the treatment of tricuspid valve disease.

5.Surgical interventions

Indications for surgery, asymptomatic patients, AHA/ACC: consider performing isolated tricuspid valve surgery in asymptomatic patients with severe primary TR (stage C) and progressive RV dilation or systolic dysfunction.

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  • Indications for surgery (symptomatic patients)

6.Specific circumstances

Patients with tricuspid stenosis: perform surgery in symptomatic patients with severe tricuspid stenosis and in patients with severe tricuspid stenosis undergoing left-sided valve intervention.

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  • Pregnant patients (before pregnancy)

  • Pregnant patients (during pregnancy)

  • Patients undergoing non-cardiac surgery