Interventional procedure overview of caval valve implantation for tricuspid regurgitation

Indications and current treatment

The tricuspid valve sits between the right atrium and right ventricle of the heart. TR occurs because the tricuspid valve does not close properly during systole. It can result in blood refluxing back into the right atrium (leading to haemodynamically significant TR) and the 2 main caval veins (the SVC and IVC). This makes the heart work harder and, if severe, can lead to heart failure. TR can mainly be because of a problem with the valve anatomy itself. But it is more commonly secondary to an underlying cardiac problem that causes tricuspid annular dilatation or leaflet tethering. The valve leaflets and chords may be normal but, because of the annulus dilatation, the valve leaflets fail to close properly and regurgitation of blood occurs.

People with mild TR do not usually have symptoms. If the regurgitation is severe, there may be fatigue and weakness, active pulsing in the neck veins, an enlarged liver, ascites, peripheral oedema and renal impairment. Pulmonary hypertension may develop.

Treatment may not be needed if there are no or mild symptoms. There are no specific medicines for treating TR itself, but symptoms of heart failure are managed with medicines such as diuretics and angiotensin-converting enzyme inhibitors. Medicines to reduce pulmonary artery pressure, pulmonary vascular resistance or both, may be used when there is severe functional TR and severe pulmonary hypertension.

People with severe symptoms may have surgery to repair or replace the tricuspid valve. Isolated tricuspid valve surgery is rarely done because it is associated with high morbidity and mortality. More commonly, it is done at the same time as surgery to the valves on the left side of the heart (mitral and aortic). Transcatheter tricuspid valve interventions (tricuspid valve repair and replacement) are an alternative for managing TR.