Anatomy of the Tricuspid Valve, Pathophysiology of Functional Tricuspid Regurgitation, and Implications for Percutaneous Therapies

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Key points

  • The tricuspid valve is a complex dynamic structure whose function depends on the harmony of several different components: annulus, leaflets, chordae, papillary muscles, and right ventricle.

  • Several nonvalvular structures, such as the coronary sinus ostium, the conduction system, the membranous septum, and the right coronary artery are in close relationship with the tricuspid annulus.

  • Annulus dilation and leaflet tethering due to right ventricle remodeling are the 2 major pathophysiologic

Anatomy

Gross anatomy of the tricuspid valve and of the right heart is depicted in Figs. 1 and 2.

Pathophysiology of functional tricuspid regurgitation

Tricuspid regurgitation (TR) is known to be associated with increased morbidity and mortality.18, 19 There are many different etiologies of TR. Functional TR (fTR) is currently the most common form of TR in Western countries.20 fTR is a continuum and a dynamic process, extremely dependent on heart loading conditions.

Implications for percutaneous therapies

The spread of percutaneous transcatheter technologies has finally reached the tricuspid valve.3 Several important implications for these devices can be derived from tricuspid anatomy, pathophysiology, and surgical experience:

  • Tricuspid anatomy is huge. It is the biggest of the heart valves, bigger than the mitral, and it gets even bigger in the setting of severe TR. The issue is clear if the mean CT-measured area of a regurgitant tricuspid valve is compared with the cross-sectional area of an

Summary

The tricuspid valve presents complex anatomy and function, with many nearby structures that require careful consideration. The RV plays a crucial role in fTR, although its assessment remains to be fully clarified. Understanding the anatomy and the function of the tricuspid AV valve within the right heart is fundamental for the development of transcatheter tricuspid valve technologies. Careful preprocedural planning with 3-D echo and CT is crucial to tailor the treatment to specific patients and

Acknowledgments

The authors would like to thank Dr Teodora Nisi for the hand drawings.

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    Disclosure Statement: The authors have nothing to disclose.

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