Right ventricle assessment before tricuspid valve interventions

Abstract

In the latest ESC/EACTS Guidelines for the Management of Valvular Heart Disease, right ventricular dilatation and dysfunction, severe pulmonary hypertension and tricuspid annulus dilatation were reported to be the most important parameters to consider in patient selection for tricuspid valve interventions. Indeed, comprehensive right ventricular assessment is crucial in patients with severe tricuspid regurgitation who may benefit from transcatheter or surgical procedures. However, the only guideline parameter considered for intervention has been tricuspid annular dilatation in the presence of at least mild to moderate tricuspid regurgitation, with no other right ventricular markers used in the decision-making process for invasive treatment. Notably, challenges in the assessment of right ventricular function may limit establishing thresholds for defining right ventricular dysfunction. The aim of this review is to summarize current evidence on the prognostic significance of right ventricular function in patients with tricuspid regurgitation undergoing percutaneous or surgical interventions.

Fig. 1

Parameters for evaluating the function of the right ventricle in case of surgery or percutaneous approach in the treatment of the tricuspid valve. BD, basal diameter; EDA, end-diastolic area; EF, ejection fraction; ESA, end-systolic area; FAC, fractional area change; GLS, gold longitudinal strain; PAPi, pulmonary artery pulsatility index; PASP, pulmonary artery systolic pressure; RV, right ventricle; S’TDI, peak systolic velocity of tricuspid annulus by pulsed-wave DTI; TAPSE, tricuspid annular plane systolic excursion.