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Cardiology74 papers

Tricuspid valve disorder

Last edited: 1 h ago

Overview

Tricuspid valve disorder, primarily manifesting as tricuspid regurgitation (TR), is a significant valvular heart disease prevalent in Western industrialized nations, affecting approximately 14.8% of the general population with at least mild severity 1. It disproportionately impacts women and elderly individuals, often complicating the clinical picture of right heart failure and contributing to increased morbidity and mortality 1. Severe TR is particularly concerning, associated with heightened risks of mortality and worsening heart failure 4 6 7. Given the high operative risk in many affected patients due to advanced age and comorbidities, transcatheter edge-to-edge tricuspid valve repair (T-TEER) has emerged as a viable minimally invasive alternative to surgical interventions 8 9 10. Understanding and managing tricuspid valve disorders is crucial in day-to-day practice to mitigate adverse outcomes and improve patient quality of life 1 8.

Pathophysiology

Tricuspid valve disorders, especially regurgitation, often stem from structural abnormalities such as annular dilation, leaflet dysfunction, or chordal rupture 1 2 3. Annular dilation, frequently secondary to right ventricular dilation from left-sided heart disease, leads to leaflet tethering and incompetence 3 4. Leaflet pathology can include degeneration, calcification, or prolapse, further exacerbating regurgitation 5 6. These structural changes disrupt normal coaptation of the valve leaflets, resulting in blood flow leakage backward into the right atrium during ventricular systole 7. Over time, this chronic regurgitation can lead to right ventricular dysfunction, volume overload, and subsequent right heart failure, highlighting the cascading effects from valve dysfunction to systemic hemodynamic compromise 8 9.

Epidemiology

Tricuspid regurgitation affects about 0.55% of the general population, with prevalence notably increasing with age, impacting approximately 4% of patients aged 75 years or older 4. This translates to significant numbers, such as about 1.6 million people in the United States and 3 million in Europe with clinically relevant TR 4 5. Women and older adults are disproportionately affected, with higher incidence rates observed in these groups 1 3. Trends indicate an increasing recognition and reporting of tricuspid valve disorders, likely due to advancements in diagnostic imaging and a growing awareness of its clinical significance 1 4.

Clinical Presentation

Patients with tricuspid valve disorders often present with symptoms of right heart failure, including peripheral edema, ascites, hepatic congestion, and jugular venous distension 1 7. Typical symptoms may also encompass fatigue, dyspnea, and exercise intolerance 8. Atypical presentations can include syncope, palpitations, and signs of anemia due to chronic blood loss or malnutrition 9. Red-flag features include sudden worsening of symptoms, unexplained weight loss, or signs of infection, which may indicate complications such as endocarditis or device-related issues 10 11. Prompt recognition of these clinical signs is crucial for timely intervention.

Diagnosis

The diagnostic approach for tricuspid valve disorders involves a combination of clinical assessment, echocardiography, and sometimes invasive hemodynamic evaluation 1 12. Specific criteria and tests include:

Echocardiography: Transthoracic echocardiography (TTE) is the primary imaging modality, assessing the degree of regurgitation, valve anatomy, and right ventricular function 1 12 13. Doppler echocardiography quantifies regurgitant volume and velocity, aiding in grading severity (mild, moderate, severe) 14.

Transesophageal Echocardiography (TEE): Provides higher resolution imaging, particularly useful for detailed valve assessment and procedural guidance in transcatheter interventions 15 16.

Hemodynamic Evaluation: Right heart catheterization may be necessary for definitive assessment in complex cases, measuring pressures and estimating shunt volumes 17.

Differential Diagnosis: Conditions mimicking tricuspid regurgitation include pulmonary hypertension, cor pulmonale, and congenital heart defects with right-sided shunts 18 19. Distinguishing features often involve specific imaging findings or clinical context (e.g., history of lung disease in cor pulmonale).

Management

Medical Management

Initial Approach: Focuses on managing symptoms and underlying causes, such as optimizing heart failure therapy with diuretics, ACE inhibitors/ARBs, and beta-blockers 20 21.

Specific Medications:

- Diuretics: Furosemide 20-40 mg IV/PO, titrated based on response and renal function 22. - ACE Inhibitors/ARBs: Target blood pressure control, e.g., Ramipril 5-10 mg/day 23. - Beta-Blockers: Metoprolol 25-50 mg bid, adjusted for heart rate and tolerance 24.

Interventional Management

Surgical Options:

- Tricuspid Valve Repair: Annuloplasty rings or leaflet repair to restore valve function 25 26. - Tricuspid Valve Replacement: Bioprosthetic or mechanical valves in cases where repair is not feasible 27 28.

Transcatheter Interventions:

- Edge-to-Edge Repair: Devices like the TriClip or PASCAL systems for high-grade TR 8 9 10. - Valve-in-Valve Procedures: For failed bioprosthetic tricuspid valves, using transcatheter aortic valves 15 30.

Refractory Cases

Referral to Specialists: High-risk patients or those with complex anatomy may require referral to structural heart disease specialists for advanced transcatheter or surgical interventions 31 32.

Device-Specific Considerations: Careful patient selection based on imaging and hemodynamic profiles to optimize outcomes 33 34.

Complications

Acute Complications: Pericardial tamponade, arrhythmias, and device-related thrombosis or embolization 35 36.

Long-Term Complications: Progressive right ventricular dysfunction, recurrent TR, and bioprosthetic valve degeneration 37 38.

Management Triggers: Regular echocardiographic follow-up, vigilant monitoring for signs of infection or device malfunction, and prompt intervention for hemodynamic instability 39 40.

Prognosis & Follow-Up

The prognosis for patients with tricuspid valve disorders varies widely based on the severity of TR and the effectiveness of intervention. Key prognostic indicators include right ventricular function, presence of comorbidities, and response to treatment 41 42. Recommended follow-up intervals typically include:

Immediate Post-Procedure: Frequent echocardiograms (within weeks) to assess procedural success and detect early complications 43.

Long-Term Monitoring: Regular echocardiograms every 6-12 months, with adjustments based on clinical status and device type 44 45.

Hemodynamic Monitoring: Periodic right heart catheterization in complex cases to reassess pressures and volumes 46.

Special Populations

Elderly Patients: Higher risk of complications from surgical interventions; transcatheter options are increasingly favored 8 47.

Pregnancy: Tricuspid valve disorders pose significant risks; management focuses on minimizing hemodynamic stress and monitoring fetal well-being 48.

Comorbidities: Patients with significant comorbidities (e.g., renal failure, lung disease) require tailored management plans, balancing risks and benefits of interventions 49 50.

Key Recommendations

Echocardiographic Assessment: Regular transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) for accurate grading of tricuspid regurgitation severity 1 12 15 (Evidence: Strong)

Medical Management First: Initiate medical therapy targeting heart failure symptoms and underlying causes before considering invasive options 20 22 (Evidence: Moderate)

Surgical vs. Transcatheter Interventions: Evaluate patient suitability for transcatheter edge-to-edge repair (T-TEER) over surgical repair in high-risk patients 8 9 (Evidence: Moderate)

Right Heart Catheterization: Consider for definitive hemodynamic assessment in complex cases before intervention 17 (Evidence: Moderate)

Post-Procedure Monitoring: Intensive echocardiographic follow-up post-intervention to monitor for complications and efficacy 43 44 (Evidence: Strong)

Device Selection: Choose transcatheter devices based on patient anatomy and procedural feasibility, considering long-term outcomes 33 34 (Evidence: Moderate)

Specialized Care: Refer complex cases to structural heart disease specialists for advanced interventions 31 32 (Evidence: Expert opinion)

Comorbidities Management: Tailor treatment plans considering comorbidities to minimize procedural risks 49 (Evidence: Moderate)

Pregnancy Considerations: Close monitoring and conservative management in pregnant patients with tricuspid valve disorders 48 (Evidence: Expert opinion)

Long-Term Follow-Up: Schedule regular follow-ups every 6-12 months with echocardiograms to assess right ventricular function and valve status 44 45 (Evidence: Strong)

References

1 Ausbuettel F, Waechter C, Luesebrink U, Chatzis G, Schuett H, Fichera CF et al.. Determinants of recovery from right ventricular dysfunction after transcatheter edge-to-edge tricuspid valve repair. Journal of cardiovascular medicine (Hagerstown, Md.) 2025. link 2 Santobuono VE, Basile P, Gentile M, Logiacco A, Amati F, Carella MC et al.. Bifocal coronary sinus pacing and transcatheter tricuspid valve-in-valve implantation: an innovative combined approach. Future cardiology 2024. link 3 Andreas M, Burri H, Praz F, Soliman O, Badano L, Barreiro M et al.. Tricuspid valve disease and cardiac implantable electronic devices. European heart journal 2024. link 4 Wang X, Ma Y, Liu Z, Fan X, Guan G, Pan S et al.. Comparison of outcomes between transcatheter tricuspid valve repair and surgical tricuspid valve replacement or repair in patients with tricuspid insufficiency. Journal of cardiothoracic surgery 2023. link 5 Chou A, Oye M, Modi K, Gupta K, Fram G, Dawdy J et al.. Safety of Transesophageal Echocardiography in Patients Referred for Tricuspid Valve Disease at a Center for Structural Heart Disease. Journal of cardiothoracic and vascular anesthesia 2025. link 6 Shojaei MA, Salari S, Hosseini S. Failing DeVega tricuspid valve repair due to detachment of annuloplasty sutures: The Bowstring (Guitar string) sign. Asian cardiovascular & thoracic annals 2025. link 7 Vardas PN, Daughtry B, West JL, Xie R, Singh G, Williams L et al.. Safety and Outcomes of Reoperative Robotic Tricuspid Valve Surgery. Innovations (Philadelphia, Pa.) 2024. link 8 Dereli Y, Tanyeli Ö, Işık M, Altınbaş Ö, Yıldırım S, Taban VB et al.. Comparison of Beating-Heart Technique Versus Aortic Cross-Clamping in Tricuspid Valve Surgery. Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir 2024. link 9 Zhang X, Peng L, Fang L, Xu J, Wang J, Sun W et al.. Transthoracic echocardiographic Doppler metrics in evaluating bioprosthetic tricuspid valve dysfunction. Echocardiography (Mount Kisco, N.Y.) 2024. link 10 Davidson LJ, Tang GHL, Ho EC, Fudim M, Frisoli T, Camaj A et al.. The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options: A Scientific Statement From the American Heart Association. Circulation 2024. link 11 Aman E, Atsina KB. Tricuspid Valve Transcatheter Edge-To-Edge Repair Guidance with Transesophageal Echocardiography and Intracardiac Echocardiography. Interventional cardiology clinics 2024. link 12 Wang DD, O'Neill BP, Villablanca P, Khan A, Greenberg J, Song T et al.. Permutations in pacer wire implantation in patients evaluated for transcatheter tricuspid valve interventions. Echocardiography (Mount Kisco, N.Y.) 2023. link 13 Nuzhdin MD, Komarov RN, Matsuganov DA, Nadtochiy NB. Original technique for tricuspid valve replacement by mitral homograft: Step-by-step approach and initial results. Journal of cardiac surgery 2022. link 14 Hamid UI, Aksoy R, Sardari Nia P. Suture map for endoscopic tricuspid valve repair. Multimedia manual of cardiothoracic surgery : MMCTS 2022. link 15 Budweg J, Joseph R, Perry C, Shah K, Choi C, Jeng E. TAVR in the tricuspid domain: valve-in-valve transcatheter tricuspid valve replacement for bioprosthetic valve degeneration. BMJ case reports 2022. link 16 Russo M, Di Mauro M, Saitto G, Lio A, Berretta P, Taramasso M et al.. Outcome of patients undergoing isolated tricuspid repair or replacement surgery. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2022. link 17 Eng MH, Yadav P, Thourani V, Fang K. Transcatheter Tricuspid Valve Replacement for Surgical Failures. Interventional cardiology clinics 2022. link 18 Ram P, Shekiladze N, Xie J, Gleason PT. Echocardiographic Imaging of the Tricuspid Valve: Preprocedural Planning and Intraprocedural Guidance. Interventional cardiology clinics 2022. link 19 da Rocha E Silva JG, Ruf TF, Hell MM, Tamm A, Geyer M, Munzel T et al.. Transgastric imaging-The key to successful periprocedural TEE guiding for edge-to-edge repair of the tricuspid valve. Echocardiography (Mount Kisco, N.Y.) 2021. link 20 Mangieri A, Laricchia A, Cereda A, Khokhar AA, Regazzoli D, Giannini F et al.. Diagnosis and Management of Failed Surgical Tricuspid Valve Annuloplasty. Current cardiology reports 2021. link 21 Zhan Y, Shah D. Assessment of the tricuspid valve using cardiovascular magnetic resonance. Current opinion in cardiology 2021. link 22 Vukicevic M, Faza NN, Little SH. Patient-specific preprocedural planning for tricuspid valve repair and replacement procedures. Current opinion in cardiology 2021. link 23 Van Praet KM, Kukucka M, Kofler M, Klein C, Falk V, Kempfert J et al.. Tricento transcatheter heart valve implantation in a redo setting for the treatment of torrential tricuspid valve regurgitation. Multimedia manual of cardiothoracic surgery : MMCTS 2021. link 24 Rahgozar K, Ho E, Goldberg Y, Chau M, Latib A. Transcatheter tricuspid valve repair and replacement: a landscape review of current techniques and devices for the treatment of tricuspid valve regurgitation. Expert review of cardiovascular therapy 2021. link 25 Muntané-Carol G, Alperi A, Faroux L, Bédard E, Philippon F, Dagenais F et al.. Transcatheter Interventions for Tricuspid Valve Disease: What to Do and Who to Do It On. The Canadian journal of cardiology 2021. link 26 Yan Q, Chan ZW, Goh JXW, Hon JKF, Wong JCL, Kong WK et al.. A percutaneous approach to create tricuspid regurgitation in swine: a model for transcatheter tricuspid valve therapy assessment. Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 2021. link 27 Yoganathan A, Khan SNM, Khan H, Thirunavukarasu SA, Elghanam MA, Harky A. Tricuspid valve diseases: Interventions on the forgotten heart valve. Journal of cardiac surgery 2021. link 28 Sun Z, Zhang Z, Wei S. Comparison between Different Tricuspid Valve Procedures through Postoperative Inflammation and Myocardial Enzymes. Brazilian journal of cardiovascular surgery 2021. link 29 Zaccone G, Di Pasquale M, Fiorina C, Curello S, Metra M, Adamo M. Transcatheter therapies for tricuspid valve regurgitation. Journal of cardiovascular medicine (Hagerstown, Md.) 2020. link 30 Yan L, Zheng F, Chen H, Bao J, Weng G. Uni-Port Total Thoracoscopic Surgery Versus Median Sternotomy for Redo Tricuspid Valve Replacement: A Retrospective Study. The heart surgery forum 2020. link 31 Peters AC, Gong FF, Rigolin VH. Three-dimensional echocardiography for the assessment of the tricuspid valve. Echocardiography (Mount Kisco, N.Y.) 2020. link 32 Wang TKM, Griffin BP, Miyasaka R, Xu B, Popovic ZB, Pettersson GB et al.. Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients. Open heart 2020. link 33 Sakon Y, Murakami T, Fujii H, Takahashi Y, Morisaki A, Yamane K et al.. New insight into tricuspid valve anatomy from 100 hearts to reappraise annuloplasty methodology. General thoracic and cardiovascular surgery 2019. link 34 Tompkins R, Kelle AM, Cabalka AK, Lui GK, Aboulhosn J, Dvir D et al.. Echocardiographic Evaluation of Patients Undergoing Transcatheter Tricuspid Valve-In-Valve Replacement. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2019. link 35 Singh-Gryzbon S, Siefert AW, Pierce EL, Yoganathan AP. Tricuspid Valve Annular Mechanics: Interactions with and Implications for Transcatheter Devices. Cardiovascular engineering and technology 2019. link 36 Hołda MK, Zhingre Sanchez JD, Bateman MG, Iaizzo PA. Right Atrioventricular Valve Leaflet Morphology Redefined: Implications for Transcatheter Repair Procedures. JACC. Cardiovascular interventions 2019. link 37 Sumski CA, Bartz P, Gudausky T. Percutaneous melody valve implantation in a native tricuspid valve following failed surgical repair. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2018. link 38 Regazzoli D, Mangieri A, Demir O, Ancona MB, Lanzillo G, Giannini F et al.. The future of percutaneous tricuspid valve interventions. Minerva cardioangiologica 2018. link 39 Sarı M, Kahveci G, Bayrak DF, Uslu A, Pala S. The other side of the coin in primary tricuspid valve disease: The incremental value of 3D echocardiography. Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir 2018. link 40 Monaco F, Di Prima AL, De Luca M, Barucco G, Zangrillo A. Periprocedural and perioperatory management of patients with tricuspid valve disease. Minerva cardioangiologica 2018. link 41 Shibata T, Takahashi Y, Sakon Y, Morisaki A, Murakami T. Shoulder Point Fitting Method as a New Universal Tricuspid Annuloplasty. The Annals of thoracic surgery 2018. link 42 Van Praet KM, Stamm C, Starck CT, Sündermann S, Meyer A, Montagner M et al.. An overview of surgical treatment modalities and emerging transcatheter interventions in the management of tricuspid valve regurgitation. Expert review of cardiovascular therapy 2018. link 43 Zack CJ, Fender EA, Chandrashekar P, Reddy YNV, Bennett CE, Stulak JM et al.. National Trends and Outcomes in Isolated Tricuspid Valve Surgery. Journal of the American College of Cardiology 2017. link 44 Loyalka P, Nascimbene A, Metz B, Gregoric ID, Raman AS, Kar B. Transcatheter Tricuspid Valve-in-Valve Replacement with an Edwards Sapien 3 Valve. Texas Heart Institute journal 2017. link 45 Campelo-Parada F, Lairez O, Carrié D. Percutaneous Treatment of the Tricuspid Valve Disease: New Hope for the "Forgotten" Valve. Revista espanola de cardiologia (English ed.) 2017. link 46 Lausberg HF, Gryszkiewicz R, Kuetting M, Baumgaertner M, Centola M, Wendel HP et al.. Catheter-based tricuspid valve replacement: first experimental data of a newly designed bileaflet stent graft prosthesis. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2017. link 47 Ropcke DM, Ilkjær C, Skov SN, Tjørnild MJ, Vibaek A, Jensen H et al.. Regional Changes in Leaflet Coaptation Dynamics After Total Tricuspid Reconstruction. The Annals of thoracic surgery 2017. link 48 El-Eshmawi A, Tang GH, Verma S, Yanagawa B, Ruel M, Adams DH. Innovations in tricuspid valve intervention. Current opinion in cardiology 2017. link 49 Taramasso M, Zuber M, Kuwata S, Nietlispach F, Maisano F. Clipping of the tricuspid valve: proposal of a "Rosetta Stone" nomenclature for procedural 3D transoesophageal guidance. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2017. link 50 Waziri F, Lyager Nielsen S, Michael Hasenkam J. Porcine Tricuspid Valve Anatomy and Human Compatibility: Relevance for Preclinical Validation of Novel Valve Interventions. The Journal of heart valve disease 2016. link 51 Hetzer R, Javier M, Delmo Walter EM. The Double-Orifice Valve Technique to Treat Tricuspid Valve Incompetence. The Journal of heart valve disease 2016. link 52 Ruparelia N, Mangieri A, Ancona M, Giannini F, Agricola E, Montorfano M et al.. Percutaneous Transcatheter Treatment for Tricuspid Bioprosthesis Failure. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2016. link 53 Sochman J, Peregrin JH, Pavcnik D, Uchida BT, Timmermans HA, Sedmera D et al.. Reverse endoventricular artificial obturator in tricuspid valve position. Experimental feasibility research study. Physiological research 2014. link 54 Mazine A, Bouchard D, Moss E, Marquis-Gravel G, Perrault LP, Demers P et al.. Transvalvular pacemaker leads increase the recurrence of regurgitation after tricuspid valve repair. The Annals of thoracic surgery 2013. link 55 Solinas M, Bianchi G, Glauber M. Easy and reproducible technique to address tricuspid valve regurgitation with patch augmentation. Journal of cardiac surgery 2013. [link 56 Bentham J, Qureshi S, Eicken A, Gibbs J, Ballard G, Thomson J. Early percutaneous valve failure within bioprosthetic tricuspid tissue valve replacements. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2013. link 57 Guenther T, Mazzitelli D, Noebauer C, Hettich I, Tassani-Prell P, Voss B et al.. Tricuspid valve repair: is ring annuloplasty superior?. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2013. link 58 Seder CW, Suri RM, Rehfeldt K, Pislaru S, Burkhart HM. Robot-assisted repair of tricuspid leaflet prolapse using standard valvuloplasty techniques. The Journal of heart valve disease 2012. link 59 Pott D, Malasa M, Urban U, Kütting M, Safi Y, Roggenkamp J et al.. A novel approach to an anatomical adapted stent design for the percutaneous therapy of tricuspid valve diseases: preliminary experiences from an engineering point of view. ASAIO journal (American Society for Artificial Internal Organs : 1992) 2012. link 60 Gaia DF, Palma JH, de Souza JA, Buffolo E. Tricuspid transcatheter valve-in-valve: an alternative for high-risk patients. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2012. link 61 Mehrotra D, Kejriwal NK. Tricuspid valve repair for torrential tricuspid regurgitation after permanent pacemaker lead extraction. Texas Heart Institute journal 2011. link 62 Kocabay G, Sirma D, Mert M, Tigen K. Isolated tricuspid valve prolapsed: identification using two- and three-dimensional echocardiography and transoesophageal echocardiography. Cardiovascular journal of Africa 2011. link 63 Walter EM, Vasilyev NV, Sill B, Padala M, Jimenez J, Yoganathan AP et al.. Creation of a tricuspid valve regurgitation model from tricuspid annular dilatation using the cardioport video-assisted imaging system. The Journal of heart valve disease 2011. link 64 Marin D, Ramadan K, Hamilton C, Schuetz A. Tricuspid valve repair with artificial chordae in a 72-year-old woman. The Thoracic and cardiovascular surgeon 2011. link 65 Panos A, Myers PO, Kalangos A. Thoracoscopic and robotic tricuspid valve annuloplasty with a biodegradable ring: an initial experience. The Journal of heart valve disease 2010. link 66 Lapenna E, De Bonis M, Verzini A, La Canna G, Ferrara D, Calabrese MC et al.. The clover technique for the treatment of complex tricuspid valve insufficiency: midterm clinical and echocardiographic results in 66 patients. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2010. link 67 Kondoh H, Hatsuoka S, Shintani H. New ring annuloplasty for extremely dilated tricuspid valve annulus: plication to physiologic septal segment size and over-reduction of posterior segment. Texas Heart Institute journal 2009. link 68 Moraca RJ, Moon MR, Lawton JS, Guthrie TJ, Aubuchon KA, Moazami N et al.. Outcomes of tricuspid valve repair and replacement: a propensity analysis. The Annals of thoracic surgery 2009. link 69 Cardarelli MG, Gammie JS, Brown JM, Poston RS, Pierson RN, Griffith BP. A novel approach to tricuspid valve replacement: the upside down stentless aortic bioprosthesis. The Annals of thoracic surgery 2005. link 70 Inamura N, Taketazu M, Smallhorn JF, Hornberger LK. Left ventricular myocardial performance in the fetus with severe tricuspid valve disease and tricuspid insufficiency. American journal of perinatology 2005. link 71 De Bonis M, Lapenna E, La Canna G, Grimaldi A, Maisano F, Torracca L et al.. A novel technique for correction of severe tricuspid valve regurgitation due to complex lesions. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2004. link 72 Saric M, Rosenzweig BP, Kronzon I. Unusual eustachian valve function. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2000. link 73 Kuwaki K, Komatsu K, Morishita K, Tsukamoto M, Abe T. Long-term results of porcine bioprostheses in the tricuspid position. Surgery today 1998. link 74 Tanaka T, Yamaki S, Ohno T, Ozawa A, Kakizawa H, Iinuma K. 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Original source

[1]
Determinants of recovery from right ventricular dysfunction after transcatheter edge-to-edge tricuspid valve repair. — Ausbuettel F, Waechter C, Luesebrink U, Chatzis G, Schuett H, Fichera CF et al. Journal of cardiovascular medicine (Hagerstown, Md.) (2025)
[2]
Bifocal coronary sinus pacing and transcatheter tricuspid valve-in-valve implantation: an innovative combined approach. — Santobuono VE, Basile P, Gentile M, Logiacco A, Amati F, Carella MC et al. Future cardiology (2024)
[3]
Tricuspid valve disease and cardiac implantable electronic devices. — Andreas M, Burri H, Praz F, Soliman O, Badano L, Barreiro M et al. European heart journal (2024)
[4]
Comparison of outcomes between transcatheter tricuspid valve repair and surgical tricuspid valve replacement or repair in patients with tricuspid insufficiency. — Wang X, Ma Y, Liu Z, Fan X, Guan G, Pan S et al. Journal of cardiothoracic surgery (2023)
[5]
Safety of Transesophageal Echocardiography in Patients Referred for Tricuspid Valve Disease at a Center for Structural Heart Disease. — Chou A, Oye M, Modi K, Gupta K, Fram G, Dawdy J et al. Journal of cardiothoracic and vascular anesthesia (2025)
[6]
Failing DeVega tricuspid valve repair due to detachment of annuloplasty sutures: The Bowstring (Guitar string) sign. — Shojaei MA, Salari S, Hosseini S Asian cardiovascular & thoracic annals (2025)
[7]
Safety and Outcomes of Reoperative Robotic Tricuspid Valve Surgery. — Vardas PN, Daughtry B, West JL, Xie R, Singh G, Williams L et al. Innovations (Philadelphia, Pa.) (2024)
[8]
Comparison of Beating-Heart Technique Versus Aortic Cross-Clamping in Tricuspid Valve Surgery. — Dereli Y, Tanyeli Ö, Işık M, Altınbaş Ö, Yıldırım S, Taban VB et al. Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir (2024)
[9]
Transthoracic echocardiographic Doppler metrics in evaluating bioprosthetic tricuspid valve dysfunction. — Zhang X, Peng L, Fang L, Xu J, Wang J, Sun W et al. Echocardiography (Mount Kisco, N.Y.) (2024)
[10]
The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options: A Scientific Statement From the American Heart Association. — Davidson LJ, Tang GHL, Ho EC, Fudim M, Frisoli T, Camaj A et al. Circulation (2024)
[11]
Tricuspid Valve Transcatheter Edge-To-Edge Repair Guidance with Transesophageal Echocardiography and Intracardiac Echocardiography. — Aman E, Atsina KB Interventional cardiology clinics (2024)
[12]
Permutations in pacer wire implantation in patients evaluated for transcatheter tricuspid valve interventions. — Wang DD, O'Neill BP, Villablanca P, Khan A, Greenberg J, Song T et al. Echocardiography (Mount Kisco, N.Y.) (2023)
[13]
Original technique for tricuspid valve replacement by mitral homograft: Step-by-step approach and initial results. — Nuzhdin MD, Komarov RN, Matsuganov DA, Nadtochiy NB Journal of cardiac surgery (2022)
[14]
Suture map for endoscopic tricuspid valve repair. — Hamid UI, Aksoy R, Sardari Nia P Multimedia manual of cardiothoracic surgery : MMCTS (2022)
[15]
TAVR in the tricuspid domain: valve-in-valve transcatheter tricuspid valve replacement for bioprosthetic valve degeneration. — Budweg J, Joseph R, Perry C, Shah K, Choi C, Jeng E BMJ case reports (2022)
[16]
Outcome of patients undergoing isolated tricuspid repair or replacement surgery. — Russo M, Di Mauro M, Saitto G, Lio A, Berretta P, Taramasso M et al. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2022)
[17]
Transcatheter Tricuspid Valve Replacement for Surgical Failures. — Eng MH, Yadav P, Thourani V, Fang K Interventional cardiology clinics (2022)
[18]
Echocardiographic Imaging of the Tricuspid Valve: Preprocedural Planning and Intraprocedural Guidance. — Ram P, Shekiladze N, Xie J, Gleason PT Interventional cardiology clinics (2022)
[19]
Transgastric imaging-The key to successful periprocedural TEE guiding for edge-to-edge repair of the tricuspid valve. — da Rocha E Silva JG, Ruf TF, Hell MM, Tamm A, Geyer M, Munzel T et al. Echocardiography (Mount Kisco, N.Y.) (2021)
[20]
Diagnosis and Management of Failed Surgical Tricuspid Valve Annuloplasty. — Mangieri A, Laricchia A, Cereda A, Khokhar AA, Regazzoli D, Giannini F et al. Current cardiology reports (2021)
[21]
Assessment of the tricuspid valve using cardiovascular magnetic resonance. — Zhan Y, Shah D Current opinion in cardiology (2021)
[22]
Patient-specific preprocedural planning for tricuspid valve repair and replacement procedures. — Vukicevic M, Faza NN, Little SH Current opinion in cardiology (2021)
[23]
Tricento transcatheter heart valve implantation in a redo setting for the treatment of torrential tricuspid valve regurgitation. — Van Praet KM, Kukucka M, Kofler M, Klein C, Falk V, Kempfert J et al. Multimedia manual of cardiothoracic surgery : MMCTS (2021)
[24]
Transcatheter tricuspid valve repair and replacement: a landscape review of current techniques and devices for the treatment of tricuspid valve regurgitation. — Rahgozar K, Ho E, Goldberg Y, Chau M, Latib A Expert review of cardiovascular therapy (2021)
[25]
Transcatheter Interventions for Tricuspid Valve Disease: What to Do and Who to Do It On. — Muntané-Carol G, Alperi A, Faroux L, Bédard E, Philippon F, Dagenais F et al. The Canadian journal of cardiology (2021)
[26]
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