Anatomic Relationship of the Complex Tricuspid Valve, Right Ventricle, and Pulmonary Vasculature: A Review

JAMA Cardiol. 2019 May 1;4(5):478-487. doi: 10.1001/jamacardio.2019.0535.

Abstract

Importance: Severe functional or secondary tricuspid regurgitation (TR) is associated with poor long-term outcomes in natural history studies as well as specific disease states. An understanding of the physiologic causes of the TR is lacking precluding a systematic approach to treatment.

Observations: The complex anatomic relationship between the tricuspid valve apparatus and structure of the right side of the heart lends insight into the functional changes seen with secondary TR. The association of these changes with changes in pulmonary vascular hemodynamics can lead to a cascade of events that result in disease progression.

Conclusions and relevance: Appreciating the role of pulmonary vascular hemodynamics on right ventricular and tricuspid valve morphology and function improves our understanding of the pathophysiology of secondary TR. The limitations of current therapeutic approaches for secondary TR have stimulated interest in improving outcomes with this morbid disease. Changes in timing or approach to intervention require a more comprehensive understanding of the pathophysiology.

Publication types

  • Review

MeSH terms

  • Disease Progression
  • Echocardiography, Three-Dimensional / methods
  • Female
  • Heart Failure / epidemiology
  • Heart Failure / etiology*
  • Heart Ventricles / anatomy & histology*
  • Heart Ventricles / diagnostic imaging
  • Hemodynamics / physiology
  • Humans
  • Lung / blood supply
  • Lung / physiology*
  • Male
  • Treatment Outcome
  • Tricuspid Valve / anatomy & histology*
  • Tricuspid Valve / diagnostic imaging
  • Tricuspid Valve / surgery
  • Tricuspid Valve Insufficiency / complications
  • Tricuspid Valve Insufficiency / physiopathology*