Volume rendering of TV, seen en face from the right ventricle ( E ) and the right atrium ( F ), displaying all three leaflets in a unique view. D, Volume rendering of TV apparatus with the cropping plane corresponding to the apical four-chamber view, allowing a comprehensive visualization of TV apparatus (leaflets, chordae, papillary muscles) and the moderator band. Two-dimensional apical four-chamber ( A ), right ventricular inflow ( B ), and subcostal ( C ) views of the TV. Visualization of tricuspid valve (TV) by two- and three-dimensional echocardiography. In 14% of patients, tricuspid regurgitation may occur in the absence of structural tricuspid valve alterations, pulmonary hypertension, or left heart dysfunction ( Fig. In the majority of patients, tricuspid regurgitation is not related to any primary valve pathology and is defined as “functional.” Functional tricuspid regurgitation is frequently observed in the advanced stage of left-sided valvular heart disease or myocardial disease. Severe tricuspid regurgitation has been reported in 23% to 37% of patients after mitral valve replacement for rheumatic valve disease. Tricuspid regurgitation is frequently present in patients with mitral valve disease, and more than one third of patients with mitral stenosis have at least moderate tricuspid regurgitation. Overall, the prevalence of significant tricuspid regurgitation was 4.3 times greater in females than in males. Using echocardiography, the Framingham Heart Study investigators found a prevalence of moderate or severe tricuspid regurgitation of 0.8% and an increased prevalence with aging. Therefore, it is important that clinicians consider assessing the severity of tricuspid regurgitation, understand its pathophysiology, choose appropriate imaging techniques, and refer patients for timely intervention to prevent clinical deterioration and subsequent adverse consequences. Today, diagnostic techniques and appropriate management strategies for patients with tricuspid regurgitation are established and continually refined. With respect to heart valve diseases, until recently tricuspid valve regurgitation has received less attention than aortic or mitral valve lesions and therefore has been referred to as the “forgotten valve.” Although trivial or mild tricuspid regurgitation may be detected in 80% to 90% of normal subjects undergoing modern echocardiography and is usually benign, hemodynamically significant tricuspid regurgitation can lead to debilitating symptoms and is associated with poor prognosis in a number of cardiovascular diseases. ![]() Epidemiology, Etiology, and Natural History of Tricuspid Regurgitation
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