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Isolated tricuspid regurgitation: outcomes and therapeutic interventions
Isolated tricuspid regurgitation (TR) can be caused by primary valvular abnormalities such as flail leaflet or secondary annular dilation as is seen in atrial fibrillation, pulmonary hypertension and left heart disease. There is an increasing recognition of a subgroup of patients with isolated TR in...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5931246/ https://www.ncbi.nlm.nih.gov/pubmed/29229649 http://dx.doi.org/10.1136/heartjnl-2017-311586 |
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author | Fender, Erin A Zack, Chad J Nishimura, Rick A |
author_facet | Fender, Erin A Zack, Chad J Nishimura, Rick A |
author_sort | Fender, Erin A |
collection | PubMed |
description | Isolated tricuspid regurgitation (TR) can be caused by primary valvular abnormalities such as flail leaflet or secondary annular dilation as is seen in atrial fibrillation, pulmonary hypertension and left heart disease. There is an increasing recognition of a subgroup of patients with isolated TR in the absence of other associated cardiac abnormalities. Left untreated isolated TR significantly worsens survival. Stand-alone surgery for isolated TR is rarely performed due to an average operative mortality of 8%–10% and a paucity of data demonstrating improved survival. When surgery is performed, valve repair may be preferred over replacement; however, there is a risk of significant recurrent regurgitation after repair. Existing society guidelines do not fully address the management of isolated TR. We propose that patients at low operative risk with symptomatic severe isolated TR and no reversible cause undergo surgery prior to the onset of right ventricular dysfunction and end-organ damage. For patients at increased surgical risk novel percutaneous interventions may offer an alternative treatment but further research is needed. Significant knowledge gaps remain and future research is needed to define operative outcomes and provide comparative data for medical and surgical therapy. |
format | Online Article Text |
id | pubmed-5931246 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-59312462018-05-04 Isolated tricuspid regurgitation: outcomes and therapeutic interventions Fender, Erin A Zack, Chad J Nishimura, Rick A Heart Review Isolated tricuspid regurgitation (TR) can be caused by primary valvular abnormalities such as flail leaflet or secondary annular dilation as is seen in atrial fibrillation, pulmonary hypertension and left heart disease. There is an increasing recognition of a subgroup of patients with isolated TR in the absence of other associated cardiac abnormalities. Left untreated isolated TR significantly worsens survival. Stand-alone surgery for isolated TR is rarely performed due to an average operative mortality of 8%–10% and a paucity of data demonstrating improved survival. When surgery is performed, valve repair may be preferred over replacement; however, there is a risk of significant recurrent regurgitation after repair. Existing society guidelines do not fully address the management of isolated TR. We propose that patients at low operative risk with symptomatic severe isolated TR and no reversible cause undergo surgery prior to the onset of right ventricular dysfunction and end-organ damage. For patients at increased surgical risk novel percutaneous interventions may offer an alternative treatment but further research is needed. Significant knowledge gaps remain and future research is needed to define operative outcomes and provide comparative data for medical and surgical therapy. BMJ Publishing Group 2018-05 2017-12-11 /pmc/articles/PMC5931246/ /pubmed/29229649 http://dx.doi.org/10.1136/heartjnl-2017-311586 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Review Fender, Erin A Zack, Chad J Nishimura, Rick A Isolated tricuspid regurgitation: outcomes and therapeutic interventions |
title | Isolated tricuspid regurgitation: outcomes and therapeutic interventions |
title_full | Isolated tricuspid regurgitation: outcomes and therapeutic interventions |
title_fullStr | Isolated tricuspid regurgitation: outcomes and therapeutic interventions |
title_full_unstemmed | Isolated tricuspid regurgitation: outcomes and therapeutic interventions |
title_short | Isolated tricuspid regurgitation: outcomes and therapeutic interventions |
title_sort | isolated tricuspid regurgitation: outcomes and therapeutic interventions |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5931246/ https://www.ncbi.nlm.nih.gov/pubmed/29229649 http://dx.doi.org/10.1136/heartjnl-2017-311586 |
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