Overview
Rheumatic disease affecting the tricuspid valve leads to structural abnormalities and functional impairment, often manifesting as tricuspid regurgitation. Surgical interventions such as annuloplasty and leaflet repair are critical for restoring valve function 134.Diagnosis
Key Diagnostic Criteria: Severe tricuspid regurgitation, often with imaging findings like flail leaflets or leaflet destruction 5.
Recommended Tests:
- Echocardiography: Essential for assessing valve anatomy and function, including two-dimensional and Doppler echocardiography 5.
- Transesophageal Echocardiography: Useful for precise intraoperative assessment and adjustment of annuloplasty sutures 4.
Grading: Severity graded based on echocardiographic parameters including regurgitant jet size and vena contracta width 5.Management
First-Line Treatments:
- Surgical Annuloplasty: Precise De Vega annuloplasty using gauges to restore normal annular geometry 1.
- Leaflet Repair: Techniques such as bicuspidization for severe regurgitation due to septal leaflet loss 3.
Adjunctive Treatments:
- Intraoperative Adjustments: Utilize transesophageal echocardiography for fine-tuning annuloplasty suture tension post-CPB 4.Special Populations
Traumatic Cases: Traumatic tricuspid insufficiency can occur post-chest trauma, often benign but requiring echocardiography for diagnosis 5.
No Specific Guidance: Abstracts do not provide detailed guidance for pregnancy, pediatrics, or elderly populations 2.Key Recommendations
Utilize precise annuloplasty techniques, such as De Vega annuloplasty guided by tricuspid valve gauges, to restore valve geometry and function (Evidence: Moderate 1).
Employ transesophageal echocardiography for intraoperative assessment and adjustment of annuloplasty sutures to optimize valve function (Evidence: Moderate 4).
Consider leaflet repair techniques like bicuspidization for severe tricuspid regurgitation due to septal leaflet loss (Evidence: Weak 3).References
1 Izzat MB. Precise De Vega Annuloplasty Using Tricuspid Valve Gauges. The Annals of thoracic surgery 2015. link
2 Soto-Pérez-de-Celis E. José Manuel Rivero-Carvallo and the tricuspid valve. Enrique Soto-Pérez-de-Celis. Clinical cardiology 2011. link
3 Russo CF, Cannata A, Lanfranconi M, Martinelli L. Destruction of the tricuspid septal leaflet: correction by bicuspidization. The Annals of thoracic surgery 2010. link
4 Cook JW. Accurate adjustment of de Vega tricuspid annuloplasty using transesophageal echocardiography. The Annals of thoracic surgery 1994. link92265-9)
5 Eskilsson J. Tricuspid insufficiency caused by nonpenetrating chest trauma. Report of two cases diagnosed by Doppler cardiography. Acta medica Scandinavica 1985. link