Tricuspid valve disease has long been ignored as a surrogate for the left atrioventricular valve (the mitral valve) and mainly a benign, indolent disease.
This concept is currently outdated, as we know that the pathology of the tricuspid valve, primitive or secondary, sometimes isolated, brings with it a poor prognosis if not treated. To date, the complexity is recognized not only of the valve itself, but also of its pathophysiology and the environment of the right heart and its interaction with the left heart. In order to better define the therapeutic path of a patient suffering from tricuspid valve disease, we have tried to offer a comprehensive overview to the reader, starting from historical considerations (Chapter 1) about the vision of the circulatory system and from the evidence accumulated over the centuries until the recognition of the continuum between signs and symptoms related to the valve.
As the basis of a modern approach to the understanding of the valve itself, we have traced the embryological and morphogenetic stages towards the anatomo-clinical correlates (Chapter 2). Subsequently, the epidemiology and clinical approach to tricuspid valve disease (Chapter 3) were illustrated, followed by the diagnostic procedure, state-of-the-art imaging techniques (Chapter 4) and more advanced techniques (Chapter 5). In particular, I thought it was necessary to dedicate a chapter to the pathology of the tricuspid valve secondary (functional) to left heart disease (Chapter 6), probably the most frequent form encountered by the clinicians. We have not neglected to discuss about tricuspid valve infections (Chapter 7), with particular reference to the microbiology, diagnosis and treatment.
We considered it necessary that the role of the valve in congenital adult disease should also be addressed (Chapter 8), whether in natural history, modified by surgery or as an acquired disease. Neoplastic pathology may also involve the valve and the pathologist provides (Chapter 9) the knowledge and systematization of the most frequent primary and secondary tumors. Coming to the therapeutic act, after dealing with special pathology of the valve, (Chapter 10) we present the pharmacological approach, a necessary act, sometimes as a sole therapeutic option and sometimes propedeutic to surgery.
Tricuspid valve plays an absolutely primary role in two aspects of the advanced treatment of refractory heart failure, namely its clinical and prognostic impact on ventricular care systems (LVAD) and cardiac transplantation (Chapter 11) has been discussed. The last two chapters are dedicated to non-medical treatment, with a particular focus on indications, risk selection and stratification as well as adequate surgical techniques (Chapter 12) and new perspectives of intervention through transcatheter techniques (Chapter 13).
Overall, there is a need for an integrated and multidisciplinary approach to a complex nosological entity that is itself interdependent on pathophysiological systems, which the clinician, cardiologist, cardiac surgeon, internist and researcher cannot ignore.
(Imprint: Nova Medicine and Health)
Author(s): Giacomo Bianchi, M.D., Ph.D.
Series: Cardiology Research and Clinical Developments
Edition: 1
Publisher: Nova Science Publishers, Inc.
Year: 2019
Language: English
Commentary: decrypted from 85BCD44969B15ED9DBAFEB9B06D178CF source file
Pages: 302
City: Massa
Tags: The Tricuspid Valve | Surgical Treatment of Functional Tricuspid Valve Disease
Contents
Preface
Chapter 1
The Tricuspid Valve: From the “Forgotten” Valve to the “Fulcrum” of the Right Heart Historical Perspective
Abstract
Historical Perspective
References
Chapter 2
The Functional Anatomy and Pathology of the Tricuspid Valve: Morphogenesis, Normal and Pathological Anatomy
Abstract
Introduction
Tricuspid Valve Morphogenesis
Structural Components
Cardiac Development with Reference to the Right Atrioventricular Valve
Early Cardiac Development
Patterning of Cardiac Valve Territory
Cardiac Valve Morphogenesis
The Normal Tricuspid Valve
Components of the Tricuspid Valve
Tricuspid Leaflets and Commissures
Tendinous Chords and Papillary Muscles
The Pathological Tricuspid Valve
Tricuspid Valve Regurgitation
Tricuspid Valve Stenosis
Conclusion
References
Chapter 3
The Diseased Tricuspid Valve: Epidemiology and Clinical Approach to the Tricuspid Valve Disease
Abstract
Introduction
Tricuspid Stenosis
Epidemiology
Etiology
Pathophysiology
Clinical Manifestations
Prognosis
Tricuspid Regurgitation
Epidemiology
Etiology
Pathophysiology
Clinical Manifestations
Prognosis
Clinical Approach to Tricuspid Valve Disease
Conclusion: When to Suspect Tricuspid Valve Disease
References
Chapter 4
Non-Invasive Imaging of the Tricuspid Valve – Ultrasounds: Transthoracic and Transesophageal Echocardiography
Abstract
Introduction
Trans-Thoracic Echocardiography of the Tricuspid Valve
Anatomic Assessment of the Tricuspid Valve
Doppler Evaluation of the Tricuspid Valve
Trans-Esophageal Echocardiography of the Tricuspid Valve
Transesophageal Echocardiographic Views for the Tricuspid Valve
Transesophageal Doppler Evaluation of the Tricuspid Valve
Assessment of the Tricuspid Stenosis
Assessment of the Tricuspid Regurgitation
Transesophageal Echocardiography in Endocarditis, Venous Catheters and Pacemaker Lead Infections
3D Transesophageal Echocardiography
Transesophageal Echocardiography in Tricuspid Valve Surgery
Transesophageal Echocardiography during the Tricuspid Valve Percutaneous Interventions
Conclusion
References
Chapter 5
Advanced Imaging and Functional Tools for Tricuspid Valve Assessment: Cardiac MRI, CT-Scan and Cardiopulmonary Exercise Test
Abstract
Introduction
Cardiac Magnetic Resonance
Morphological and Functional Assessment
Myocardial Disease Assessment
CMR for Timing of Tricuspid Valve Surgery and for Outcomes Prediction
Cardiac Computed Tomography
Cardiopulmonary Exercise Test
CPET Imaging
References
Chapter 6
Functional Disease: Tricuspid Valve in Left-Sided Heart Disease
Abstract
Epidemiology and Clinical Setting
Pathophysiology
Right Ventricular Dilation and Dysfunction
Pulmonary Hypertension
Mitral Valve Prolapse
Left Ventricular-Right Ventricular Interdependence and Biventricular Failure
Tricuspid Regurgitation after Left Heart Valve Procedure
Clinical Presentation
Progression and Prognosis
References
Chapter 7
Tricuspid Valve Endocarditis: Epidemiology, Treatment and Outcomes
Abstract
Introduction
Epidemiology
Microbiology
Clinical Manifestations and Diagnosis
Blood Tests and Specific Cultures
Instrumental Diagnostic Tests
Electrocardiography
Chest X-Ray and Computed Tomography
Ultrasounds
Radionuclide Studies
Antibiotic Treatment
Indications for Surgical Treatment, Timing of intervention and Outcomes
Outcomes
Conclusion
References
Chapter 8
Tricuspid Valve Disease in Adults with Congenital Heart Disease in Natural or Modified History
Abstract
Introduction
Tricuspid Valve in ACHD
Embriology and Anatomy of the Tricuspid Valve
Etiology of Tricuspid Valve Disease
Tricuspid Valve Disease in ACHD
Patients with Ebstein's Anomaly
Tricuspid Valve Disease Caused by Previous Interventions
Systemic Right Ventricle in Congenitally Corrected Transposition of the Great Arteries (ccTGA) or Transposition of the Great Arteries (D-TGA) after Mustard/Senning Operation and Hypoplastic Left Heart Syndrome (HLHS).
Functional Tricuspid Valve Disease in ACHD
Clinical Presentations of the Adult Patient with Tricuspid Valve Disease
Symptoms
Physical Signs
Non-Invasive and Invasive Diagnostic Tools
Management of the Adult Patient with Tricuspid Valve Disease
Non-Surgical Therapy
Surgical Therapy
Tricuspid Valve Repair and Tricuspid Valve Replacement
Conclusion
References
Chapter 9
Neoplastic Disorders Involving the Right Heart and the Tricuspid Valve
Abstract
Introduction
Primary Right Heart Tumors
Cardiac Myxoma
Tricuspid Valve: Benign Tumors and Pseudo-Tumors
Papillary Fibroelastoma
Tricuspid Valve Myxomas
Tricuspid Valve Lipoma and Lipomatous Hamartoma
Tricuspid Valve Hemangioma
Tricuspid Valve Pseudotumors
Malignant Right Heart and Tricuspid Valve Tumors
Sarcomas
Lymphoma
Metastatic Right Heart Tumors
Conclusion
References
Chapter 10
Pharmacological Treatment of Tricuspid Regurgitation
Abstract
Introduction
Guideline Recommendations and Goals of Pharmacological Treatment
Treating Dysfunctional Ventricle(s)
Reducing Pulmonary and Peripheral Congestion and Avoiding Right Ventricular Underfilling
Relieving Pulmonary Hypertension
Which Role for Drug Therapy in Tricuspid Regurgitation?
References
Chapter 11
Tricuspid Valve in the Failing Heart: The Role of Tricuspid Valve during Mechanical Circulatory Support and in Heart Transplantation
Abstract
Introduction
Methods
Impact of Tricuspid Valve Surgery on Left Ventricular Assist Device Insertion
Tricuspid Regurgitation at the Time of LVAD Implant and Current Scenario
Short Term Outcomes
Long-Term Outcomes
Alternative Echocardiographic Measures
Surgical Approaches
Impact of Tricuspid Valve Surgery on Heart Transplantation
TR in the Donor Heart and Its Concomitant Treatment
Etiology of TR after HTx
Impact of Bicaval versus Biatrial Technique at Time of HTx
Biopsy Related TR
Surgical Approaches
Gaps in Evidence
Conclusion
References
Chapter 12
Surgical Treatment of Functional Tricuspid Valve Disease: Surgeon’s Perspective – Indications, Risk Stratification and Outcomes
Abstract
Introduction
“Functional” Tricuspid Regurgitation Is Not a Self-Limiting or Benign Disease
Risk Stratification in Functional Tricuspid Regurgitation. Role of Right Ventricular Function Assessment
Surgical Management of Tricuspid Valve Disease. Primary TR and Focus on Functional and Isolated Valve Disease
Primary Tricuspid Regurgitation
Functional TR at the Time of Left-Sided Heart Valve Surgery
Isolated Functional Tricuspid Regurgitation
Surgical Treatment for Functional Tricuspid Regurgitation
Conclusion
References
Chapter 13
Novel Transcatheter Therapies for Treating Tricuspid Regurgitation
Abstract
Introduction
Surgical Treatment
Transcatheter Tricuspid Valve Intervention
Tricuspid Leaflet Repair
Annuloplasty Devices
Caval Vein Implantation
Transcatheter Tricuspid Valve Replacement
Conclusion
References
About the Editor
Index
Blank Page
