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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the impact and management of tricuspid valve disease. Although much attention in clinical practice and research on patients with valvular heart disease has focused on disorders of the mitral and aortic valves, tricuspid regurgitation can also be associated with significant morbidity and mortality.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EEdward B. Savage, MD, Cleveland Clinic Florida, Weston, Florida, USA, discussed the impact and management of tricuspid valve (TV) disease. Although much attention in clinical practice and research on patients with valvular heart disease has focused on disorders of the mitral and aortic valves, tricuspid regurgitation (TR) can also be associated with significant morbidity and mortality.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ENath et al. [\u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2004] reported that 1-year survival in patients with no, mild, moderate, and severe TR (n=5223) was 91.7%, 90.3%, 78.9%, and 63.9%, respectively. TR severity was associated with worse survival regardless of left ventricular ejection fraction or pulmonary artery pressure.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EMatsunaga et al. [\u003Cem\u003ECirculation\u003C\/em\u003E 2005] evaluated 70 patients with mitral regurgitation (MR) \u22641+ after repaired functional ischemic MR. Among 21 patients with preoperative TR, 4 of 9 (44%) who had TR repair and 8 of 12 (67%) without TR repair had residual postoperative TR. At \u0026lt;1 year, only 25% had moderate or higher TR but at \u0026gt;3 years, 74% had moderate or higher TR (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Among patients with recurrent ischemic MR, 64% with moderate or higher MR and 42% with no or mild MR had moderate or higher late TR.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/30\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Progression of TR after Repaired Functional Ischemic MR.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1218368996\u0022 data-figure-caption=\u0022Progression of TR after Repaired Functional Ischemic MR.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/30\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/30\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/30\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12878\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EProgression of TR after Repaired Functional Ischemic MR.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EMR=mitral regurgitation; TR=tricuspid regurgitation\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from E. Savage, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EAmong 167 patients without organic TV disease treated with mitral valve (MV) surgery who had moderate or less functional TR preoperatively, 41.9% were treated for TR and 58.1% were not treated [Shi KH et al. \u003Cem\u003EHeart Surg Forum\u003C\/em\u003E 2012]. Five-year Kaplan-Meier survival was 85.3% in the treated group versus 64.7% in the no-treatment group (p=0.001).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThese studies demonstrate that functional TR is progressive, moderately severe and severe TR reduces survival, and repair of left-sided valvular lesions alone may not be sufficient.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EA review of 17 studies concluded that preoperative pulmonary hypertension does not predict late TR and tricuspid annular dilation probably is the most important factor for late TR [Bianchi G et al. \u003Cem\u003EInteract Cardiovasc Thorac Surg\u003C\/em\u003E 2009]. The analysis suggested that patients undergoing MV surgery should have TR repair when TR is severe or, regardless of TR severity, when annular dimension is \u0026gt;21 mm\/m\u003Csup\u003E2\u003C\/sup\u003E or \u22653.5 cm by echocardiography, intraoperative tricuspid annulus diameter is \u0026gt;70 mm, preoperative atrial fibrillation (AF) is present, or a trans-tricuspid pacemaker lead is present.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EAccording to McCarthy and Sales et al. [\u003Cem\u003ECurr Treat Options Cardiovasc Med\u003C\/em\u003E 2010], risks for TR progression after MV surgery include dilated annulus, ischemic cardiomyopathy, and pulmonary hypertension. Risks for recurrent TR after TV annuloplasty include permanent pacing wires, AF, and right ventricular dysfunction with dilation and leaflet tethering. Benedetto et al. [\u003Cem\u003EJ Thorac Cardiovasc Surg\u003C\/em\u003E 2012] reported that prophylactic TV annuloplasty for dilated tricuspid annulus reduced TR progression, improved right ventricular remodeling, and improved functional outcomes (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/30\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Prophylactic Tricuspid Annuloplasty in Patients with Dilated Tricuspid Annulus Undergoing MV Surgery.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1218368996\u0022 data-figure-caption=\u0022Prophylactic Tricuspid Annuloplasty in Patients with Dilated Tricuspid Annulus Undergoing MV Surgery.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/30\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/30\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/30\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12879\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EProphylactic Tricuspid Annuloplasty in Patients with Dilated Tricuspid Annulus Undergoing MV Surgery.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003ELA=left atrial; MV=mitral valve; PASP=pulmonary artery systolic pressure; RV=right ventricular; TA=tricuspid annulus; TR=tricuspid regurgitation; TV=tricuspid valve.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReprinted with permission from \u003Cem\u003EJ Thorac Cardiovasc Surg\u003C\/em\u003E 2012;143(4):844. Galbut DL et al. Bilateral internal throacic artery grafting improves long-term survival in patients with reduced ejection fraction.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EDreyfus et al. [\u003Cem\u003EAnn Thorac Surg\u003C\/em\u003E 2005] performed tricuspid annuloplasty in patients undergoing MV repair if tricuspid annular diameter was greater than twice the normal size (\u226570 mm). TR increased more than 2 grades in 2% of patients with tricuspid repair versus 48% of patients without tricuspid repair, demonstrating that TV annuloplasty based on tricuspid dilation improves functional status irrespective of TR grade. Chan et al. [\u003Cem\u003EAnn Thorac Surg\u003C\/em\u003E 2009] found that actuarial freedom from heart failure (HF) was improved in patients who had tricuspid repair with MV replacement (5-year, 95.3%; 10-year, 92.8%) versus patients without tricuspid repair (5-year, 89.2%; 10-year, 71.2%).\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EEvidence shows that TR can be progressive and significantly decreases survival. TR should be treated before severe right HF symptoms develop. Tricuspid repair should be considered in patients with pulmonary hypertension, \u0026gt;2+ TR, or annular dilation if other heart surgery is planned.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/12\/30.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznd4d\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznd4d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}