Author + information
- V. Subbarao Boppana, MD,
- Luna Bhatta, MD and
- Kan Liu, MD, PhD∗ ()
- ↵∗State University of New York, 90 Presidential Plaza, Syracuse, New York 13202.
Functional tricuspid regurgitation (TR) has been considered worthy of repair because of its possible impact on clinical outcomes (1,2). Nonetheless, no consensus has been reached on the indications and timing of surgeries. Also, the accurate assessment of TR severity remains challenging. In the July 2012 issue of iJACC, Ling et al. (3) provided very helpful information on the evaluation of TR and right ventricular (RV) dysfunction. In Case 1, they discussed TR in the setting of left ventricular (LV) dysfunction and mitral regurgitation (MR). We hope to point out that significantly reversible TR could occur in patients with both chronic and acute cardiomyopathies, with or without MR, which needs special attention before treatment decisions are made.
Case 1, a 53-year-old woman with diabetes and dyslipidemia, developed new-onset heart failure. Cardiac catheterization ruled out ischemia. Echocardiography revealed decreased LV ejection fraction (LVEF: 11%), severe MR/TR, and dilated tricuspid valve annulus. After 6-month medical treatment, repeated echocardiography showed improved LVEF (45%) and significantly decreased MR and TR severity (Fig. 1, Online Videos 1 and 2).
Case 2, a 69-year-old woman who developed Takotsubo cardiomyopathy, echocardiography demonstrated LV outflow tract obstruction and severe MR and TR. After aggressive fluid resuscitation and beta-blockers, she improved symptomatically. Repeated echocardiography 4 weeks later revealed that LV function had normalized, MR had resolved, and the severity of TR had significantly decreased (Fig. 2).
In patients with chronic/acute cardiomyopathies (± MR), increased LV filling pressure could increase pulmonary venous pressure, resulting in secondary RV volume/pressure overload. The regurgitant volume of TR might increase dynamically despite unchanged effective regurgitant orifice area, thus exaggerating TR severity on echocardiographic assessment. Meanwhile, functional TR from various chronic and acute cardiomyopathies may significantly reverse either by itself or after medical treatment. Thus, integrated analysis on both cardiac imaging and clinical data of functional TR is requested before surgical decisions are made.
For supplementary videos and their legends, please see the online version of this article.
- American College of Cardiology Foundation
- Nath J.,
- Foster E.,
- Heidenreich P.A.
- Ling L.F.,
- Marwick T.H.