Skip to main content
SpringerLink
Log in

Tricuspid Valve Surgery in Right Heart Failure

  • Chapter
Surgical Management of Congestive Heart Failure

Part of the book series: Contemporary Cardiology ((CONCARD))

  • 624 Accesses

Abstract

Tricuspid valve disease is often found in combination with other valvular pathology. Tricuspid regurgitation (TR), the most common tricuspid valvular condition, is commonly asymptomatic, although progressive, in nature. With time, it may lead to right ventricular (RV) enlargement, annular dilatation, and systolic dysfunction. Clinical symptoms and the degree of RV impairment usually determine whether medical or surgical therapy is most appropriate. However, operative intervention should be carefully considered; there is an unusually high mortality rate associated with tricuspid valve surgery, ranging from 19 to 25% (1–3). In this chapter, we review the pathophysiology and surgical therapy of the tricuspid valve for the management of RV failure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Jamieson WR, Edwards FH, Schwartz M, Bero JW, Clark RE, Grover FL. Risk stratification for cardiac valve replacement. National Cardiac Surgery Database. Database Committee of the Society of Thoracic Surgeons. Ann Thorac Surg 1999;67:943–951.

    Article  PubMed  CAS  Google Scholar 

  2. King RM, Schaff HV, Danielson GK, et al. Surgery for tricuspid regurgitation late after mitral valve replacement. Circulation 1984;70(3 part 2):I193–I197.

    PubMed  CAS  Google Scholar 

  3. Kaul TK, Ramsdale DR, Mercer JL. Functional tricuspid regurgitation following replacement of the mitral valve. Int J Cardiol 1991;33:305–313.

    Article  PubMed  CAS  Google Scholar 

  4. Khonsari S. Surgery of the Tricuspid Valve. Cardiac Surgery: Safeguards and Pitfalls in Operative Technique. Lippincott-Raven, Philadelphia, PA: 1997, pp. 105–112.

    Google Scholar 

  5. Isner JM, Roberts WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary heart disease. Frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol 1978;42:885–894.

    Article  PubMed  CAS  Google Scholar 

  6. D’Arcy B, Nanda NC. Two-dimensional echocardiographic features of right ventricular infarction. Circulation 1982;65:167–173.

    PubMed  CAS  Google Scholar 

  7. Korr KS, Levinson H, Bough EW, et al. Tricuspid valve replacement for cardio-genic shock after acute right ventricular infarction. JAMA 1980;244:1958–1960.

    Article  PubMed  CAS  Google Scholar 

  8. Louie EK, Lin SS, Reynertson SI, Brundage BH, Levitsky S, Rich S. Pressure and volume loading of the right ventricle have opposite effects on left ventricular ejection fraction. Circulation 1995;92:819–824.

    PubMed  CAS  Google Scholar 

  9. Louie EK, Bieniarz T, Moore AM, Levitsky S. Reduced atrial contribution to left ventricular filling in patients with severe tricuspid regurgitation after tricuspid valvulectomy: a Doppler echocardiographic study. J Am Coll Cardiol 1990; 16:1617–1624.

    Article  PubMed  CAS  Google Scholar 

  10. Lorell B, Leinbach RC, Pohost GM, et al. Right ventricular infarction. Clinical diagnosis and differentiation from cardiac tamponade and pericardial constriction. Am J Cardiol 1979;43:465–471.

    Article  PubMed  CAS  Google Scholar 

  11. Lopez-Sendon J, Coma-Canella I, Gamallo C. Sensitivity and specificity of hemo-dynamic criteria in the diagnosis of acute right ventricular infarction. Circulation 1981;64:515–525.

    PubMed  CAS  Google Scholar 

  12. Lundin L, Hansson HE, Landelius J, Oberg K. Surgical treatment of carcinoid heart disease. J ThoracCardiovasc Surg 1990;100:552–561.

    CAS  Google Scholar 

  13. Lundin L, Landelius J. Echocardiography for carcinoid heart disease. Ann NY AcadSci 1994;733:437–445.

    Article  CAS  Google Scholar 

  14. Goldstein JA, Vlahakes GJ, Verrier ED, et al. Volume loading improves low cardiac output in experimental right ventricular infarction. J Am Coll Cardiol 1983;2:270–278.

    Article  PubMed  CAS  Google Scholar 

  15. Topol EJ, Goldschlager N, Ports TA, et al. Hemodynamic benefit of atrial pacing in right ventricular myocardial infarction. Ann Intern Med 1982;96:594–597.

    PubMed  CAS  Google Scholar 

  16. Cohn LH. Tricuspid regurgitation secondary to mitral valve disease: when and how to repair. J Card Surg 1994;9(2 suppl):237–241.

    Article  PubMed  CAS  Google Scholar 

  17. Reed GE, Boyd AD, Spencer FC, Engelman RM, Isom OW, Cunningham JN. Operative management of tricuspid regurgitation. Circulation 1976;54(6 suppl):III96–III98.

    PubMed  CAS  Google Scholar 

  18. Bex JP, Lecompte Y. Tricuspid valve repair using a flexible linear reducer. J Card Surg 1986;1:151–159.

    Article  PubMed  CAS  Google Scholar 

  19. Kay JH. Surgical treatment of tricuspid regurgitation. Ann Thorac Surg 1992;53:1132–1133.

    Article  PubMed  CAS  Google Scholar 

  20. Minale C, Lambertz H, Messmer BJ. New developments for reconstruction of the tricuspid valve. J Thorac Cardiovasc Surg 1987;94:626–631.

    PubMed  CAS  Google Scholar 

  21. De Vega NG. [Selective, adjustable and permanent annuloplasty. An original technic for the treatment of tricuspid insufficiency]. Rev Esp Cardiol 1972;25:555–556.

    PubMed  Google Scholar 

  22. Carpentier A, Deloche A, Hanania G, et al. Surgical management of acquired tricuspid valve disease. J ThoracCardiovasc Surg 1974;67:53–65.

    CAS  Google Scholar 

  23. Duran CG, Ubago JL. Clinical and hemodynamic performance of a totally flexible prosthetic ring for atrioventricular valve reconstruction. Ann Thorac Surg 1976; 22:458–463.

    Article  PubMed  CAS  Google Scholar 

  24. McCarthy JF, Cosgrove DM. Tricuspid valve repair with the Cosgrove-Edwards annuloplasty system. Ann Thorac Surg 1997;64:267–268.

    Article  PubMed  CAS  Google Scholar 

  25. Rabago G, Fraile J, Martinell J, Artiz V. Technique and results of tricuspid annuloplasty. J Card Surg 1986; 1:247–253.

    Article  PubMed  CAS  Google Scholar 

  26. Bonow RO, Carabello B, de Leon AC Jr, et al. Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). Circulation 1998;98:1949–1984.

    PubMed  CAS  Google Scholar 

  27. Boskovic D, Elezovic I, Simin N, Rolovic Z, Josipovic V. Late thrombosis of the Björk-Shiley tilting disc valve in the tricuspid position. Thrombolytic treatment with streptokinase. J Thorac Cardiovasc Surg 1986;91:1–8.

    PubMed  CAS  Google Scholar 

  28. Jegaden O, Perinetti M, Barthelet M, et al. Long-term results of porcine biopros-theses in the tricuspid position. Eur J Cardiothorac Surg 1992;6:256–260.

    Article  PubMed  CAS  Google Scholar 

  29. McGrath LB, Chen C, Bailey BM, Fernandez J, Laub GW, Adkins MS. Early and late phase events following bioprosthetic tricuspid valve replacement. J Card Surg 1992;7:245–253.

    Article  PubMed  CAS  Google Scholar 

  30. Treasure T. Which prosthetic valve should we choose? Curr Opin Cardiol 1995;10:144–149.

    Article  PubMed  CAS  Google Scholar 

  31. Braunwald E. Valvular heart disease: tricuspid, pulmonic, and multivalvular disease: tricuspid stenosis. In: Braunwald E., Zipes DP, Libby P. eds. Heart Disease. A Textbook of Cardiovascular Medicine, 6th ed. WB Saunders, Philadelphia, PA, 2001, pp. 1643–1722.

    Google Scholar 

  32. Gibson R, Wood P. The diagnosis of tricuspid stenosis. Br Heart J 1955; 17:552–562.

    Article  PubMed  CAS  Google Scholar 

  33. Kitchen A, Turner R. Diagnosis and treatment of tricuspid stenosis. Br Heart J 1964;26:354–379.

    Article  Google Scholar 

  34. Ribeiro PA, Al Zaibag M, Al Kasab S, et al. Percutaneous double balloon valvo-tomy for rheumatic tricuspid stenosis. Am J Cardiol 1988;61:660–662.

    Article  PubMed  CAS  Google Scholar 

  35. Arbulu A, Thorns NW, Wilson RF. Valvulectomy without prosthetic replacement. A lifesaving operation for tricuspid pseudomonas endocarditis. J Thorac Cardio-vascSurg 1972;64:103–107.

    CAS  Google Scholar 

  36. Arbulu A, Asfaw I. Tricuspid valvulectomy without prosthetic replacement. Ten years of clinical experience. J Thorac Cardiovasc Surg 1981;82:684–691.

    PubMed  CAS  Google Scholar 

  37. Arbulu A, Holmes RJ, Asfaw I. Surgical treatment of intractable right-sided infective endocarditis in drug addicts: 25 years experience. J Heart Valve Dis 1993;2:129–37; discussion 138–139.

    PubMed  CAS  Google Scholar 

  38. Karp RB. Acquired disease of the Tricupid Valve. In: Sabiston DC and Spencer FC, eds. Surgery of the Chest, 5th ed. W. B. Saunders, Philadelphia, PA, pp. 1667–1672.

    Google Scholar 

  39. Yee ES, Ullyot DJ. Reparative approach for right-sided endocarditis. Operative considerations and results of valvuloplasty. J Thorac Cardiovasc Surg 1988;96:133–140.

    PubMed  CAS  Google Scholar 

  40. Yankah AC, Musci M, Weng Y, et al. Tricuspid valve dysfunction and surgery after orthotopic cardiac transplantation. Eur J Cardiothorac Surg 2000;17:343–348.

    Article  PubMed  CAS  Google Scholar 

  41. Rees AP, Milani RV, Lavie CJ, Smart FW, Ventura HO. Valvular regurgitation and right-sided cardiac pressures in heart transplant recipients by complete Doppler and color flow evaluation. Chest 1993;104:82–87.

    Article  PubMed  CAS  Google Scholar 

  42. Votapka TV, Appleton RS, Pennington DG. Tricuspid valve replacement after orthotopic heart transplantation. Ann Thorac Surg 1994;57:752–754.

    Article  PubMed  CAS  Google Scholar 

  43. Stahl RD, Karwande SV, Olsen SL, Taylor DO, Hawkins JA, Renlund DG. Tricuspid valve dysfunction in the transplanted heart. Ann Thorac Surg 1995;59:477–480.

    Article  PubMed  CAS  Google Scholar 

  44. Lower RR, Shumway NE. Studies of the orthotopic homotransplantation of the canine heart. Ann Thorac Surg 1960; 11:18–23.

    CAS  Google Scholar 

  45. Shumway NE, Lower RR, Stofer RC. Transplantation of the heart. Adv Surg 1966;2:265–284.

    PubMed  CAS  Google Scholar 

  46. Stevenson LW, Dadourian BJ, Kobashigawa J, Child JS, Clark SH, Laks H. Mitral regurgitation after cardiac transplantation. Am J Cardiol 1987;60:119–122.

    Article  PubMed  CAS  Google Scholar 

  47. Angermann CE, Spes CH, Tammen A, et al. Anatomic characteristics and valvular function of the transplanted heart: transthoracic vs transesophageal echocar-diographic findings. J Heart Transplant 1990;9:331–338.

    PubMed  CAS  Google Scholar 

  48. Sievers HH, Weyand M, Kraatz EG, Bernhard A. An alternative technique for orthotopic cardiac transplantation, with preservation of the normal anatomy of the right atrium. Thorac Cardiovasc Surg 1991;39:70–72.

    Article  PubMed  CAS  Google Scholar 

  49. Sarsam MA, Campbell CS, Yonan NA, Deiraniya AK, Rahman AN. An alternative surgical technique in orthotopic cardiac transplantation. J Card Surg 1993;8:344–349.

    Article  PubMed  CAS  Google Scholar 

  50. Caves PK, Stinson EB, Billingham ME, Rider AK, Shumway NE. Diagnosis of human cardiac allograft rejection by serial cardiac biopsy. J Thorac Cardiovasc Surg 1973;66:461–466.

    PubMed  CAS  Google Scholar 

  51. Fowles RE, Mason JW. Endomyocardial biopsy. Ann Intern Med 1982;97:885–894.

    PubMed  CAS  Google Scholar 

  52. Braverman AC, Coplen SE, Mudge GH, Lee RT. Ruptured chordae tendineae of the tricuspid valve as a complication of endomyocardial biopsy in heart transplant patients. Am J Cardiol 1990;66:111–113.

    Article  PubMed  CAS  Google Scholar 

  53. Huddleston CB, Rosenbloom M, Goldstein JA, Pasque MK. Biopsy-induced tricuspid regurgitation after cardiac transplantation. Ann Thorac Surg 1994;57:832–836; discussion 836–837.

    Article  PubMed  CAS  Google Scholar 

  54. Lewen MK, Bryg RJ, Miller LW, Williams GA, Labovitz AJ. Tricuspid regurgitation by Doppler echocardiography after orthotopic cardiac transplantation. Am J Cardiol 1987;59:1371–1374.

    Article  PubMed  CAS  Google Scholar 

  55. Barlow JB. Mitral valve disease: a cardiologic-surgical interaction. Isr J Med Sci 1996;32:831–842, 843–844.

    PubMed  CAS  Google Scholar 

  56. Popcock, WA, Antunes MJ, Sareli P, Meyer TE. Late postoperative course and com-plicatons: emphasis on the “restriction-dilation” syndrome. In: Barlow JB, ed. Perspectives on the Mitral Valve. FA Davis, Philadelphia, PA, 1987, pp. 270–288.

    Google Scholar 

  57. Barlow JB. Aspects of tricuspid valve disease, heart failure and the “restriction-dilatation syndrome”. Rev Port Cardiol 1995;14:991–1004.

    PubMed  CAS  Google Scholar 

  58. Barlow JB. Aspects of mitral and tricuspid regurgitation. J Cardiol Suppl 1991; 25:3–33.

    PubMed  CAS  Google Scholar 

  59. Groves PH, Lewis NP, Ikram S, Maire R, Hall RJ. Reduced exercise capacity in patients with tricuspid regurgitation after successful mitral valve replacement for rheumatic mitral valve disease. Br Heart J 1991;66:295–301.

    Article  PubMed  CAS  Google Scholar 

  60. Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis 1992; 1:80–86.

    PubMed  CAS  Google Scholar 

  61. Groves PH, Ikram S, Ingold U, Hall RJ. Tricuspid regurgitation following mitral valve replacement: an echocardiographic study. J Heart Valve Dis 1993;2:273–278.

    PubMed  CAS  Google Scholar 

  62. Cohen SR, Sell JE, Mclntosh CL, Clark RE. Tricuspid regurgitation in patients with acquired, chronic, pure mitral regurgitation. II. Nonoperative management, tricuspid valve annuloplasty, and tricuspid valve replacement. J Thorac Cardiovasc Surg 1987;94:488–497.

    PubMed  CAS  Google Scholar 

  63. Goldman ME, Guarino T, Fuster V, Mindich B. The necessity for tricuspid valve repair can be determined intraoperatively by two-dimensional echocardiography. J Thorac Cardiovasc Surg 1987;94:542–550.

    PubMed  CAS  Google Scholar 

  64. Porter A, Shapira Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J Heart Valve Dis 1999;8:57–62.

    PubMed  CAS  Google Scholar 

  65. Braunwald NS, Ross J, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation 1967;35(4 suppl):I63–I69.

    PubMed  CAS  Google Scholar 

  66. Brilla C, Hammen M, Jaksch R, Unterberg R, Seboldt H, Karsch KR. [Effect of tricuspid annuloplasty in mitral/aortic valve replacement on the clinical aspects and global function of the right heart chamber]. Thorac Cardiovasc Surg 1988;36:122–126.

    PubMed  CAS  Google Scholar 

  67. Breyer RH, McClenathan JH, Michaelis LL, Mclntosh CL, Morrow AG. Tricuspid regurgitation. A comparison of nonoperative management, tricuspid annuloplasty, and tricuspid valve replacement. J Thorac Cardiovasc Surg 1976;72:867–874.

    PubMed  CAS  Google Scholar 

  68. Duran CM, Pomar JL, Colman T, Figueroa A, Revuelta JM, Ubago JL. Is tricus-pid valve repair necessary? J Thorac Cardiovasc Surg 1980;80:849–860.

    PubMed  CAS  Google Scholar 

  69. Staab ME, Nishimura RA, Dearani JA. Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients. J Heart Valve Dis 1999;8:567–574.

    PubMed  CAS  Google Scholar 

  70. Miller FA, Seward JB, Gersh BJ, Tajik AJ, Mucha P. Two-dimensional echocar-diographic findings in cardiac trauma. Am J Cardiol 1982;50:1022–1027.

    Article  PubMed  Google Scholar 

  71. Chirillo F, Totis O, Cavarzerani A, et al. Usefulness of transthoracic and transo-esophageal echocardiography in recognition and management of cardiovascular injuries after blunt chest trauma. Heart 1996;75:301–306.

    Article  PubMed  CAS  Google Scholar 

  72. Doty JR, Cameron DE, Elmaci T, Salomon NW. Penetrating trauma to the tricuspid valve and ventricular septum: delayed repair. Ann Thorac Surg 1999;67:252–253.

    Article  PubMed  CAS  Google Scholar 

  73. Soga J, Yakuwa Y, Osaka M. Carcinoid syndrome: a statistical evaluation of 748 reported cases. J Exp Clin Cancer Res 1999;18:133–141.

    PubMed  CAS  Google Scholar 

  74. Moertel CG. Karnofsky memorial lecture. An odyssey in the land of small tumors. J Clin Oncol 1987;5:1502–1522.

    PubMed  CAS  Google Scholar 

  75. Knott-Craig CJ, Schaff HV, Mullany CJ, et al. Carcinoid disease of the heart. Surgical management of 10 patients. J Thorac Cardiovasc Surg 1992;104:475–481.

    PubMed  CAS  Google Scholar 

  76. Oberg K, Persson U, Aim G, Eriksson B. Long-term treatment with alpha inter-ferons of patients with malignant carcinoid tumors: the 6 year experience. In: Stewart WE, Schellekens H, eds. The Biology of the Interferon System. Elsevier, Amsterdam, The Netherlands: 1989, pp. 361–384.

    Google Scholar 

  77. DiSesa VJ, Mills RM, Collins JJ. Surgical management of carcinoid heart disease. Chest 1985;88:789–791.

    Article  PubMed  CAS  Google Scholar 

  78. Connolly HM, Nishimura RA, Smith HC, Pellikka PA, Mullany CJ, Kvols LK. Outcome of cardiac surgery for carcinoid heart disease. J Am Coll Cardiol 1995; 25:410–416.

    Article  PubMed  CAS  Google Scholar 

  79. Schoen FJ, Hausner RJ, Howell JF, Beazley HL, Titus JL. Porcine heterograft valve replacement in carcinoid heart disease. J Thorac Cardiovasc Surg 1981;81:100–105.

    PubMed  CAS  Google Scholar 

  80. Robiolio PA, Rigolin VH, Wilson JS, et al. Carcinoid heart disease. Correlation of high serotonin levels with valvular abnormalities detected by cardiac catheteriza-tion and echocardiography. Circulation 1995;92:790–795.

    PubMed  CAS  Google Scholar 

  81. deRibrolles C. Techniques de correction de L’insuffisance trcuspidienne. In: Bex JP, ed. Pathologie de la valve tricuspide. Masson, Paris: 1981 pp. 24–34.

    Google Scholar 

  82. Boyd A, Engleman R, Isom OW, et al. Tricuspid annuloplasty, five and one-half years’ experience with 78 patients. J Thorac Cardiovasc Surg 1974;68:344.

    PubMed  CAS  Google Scholar 

  83. Grossman W, ed. Cardiac Catheterization and Angiography, 5th ed Lea and Febiger, Philadelphia, PA:1996.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN

    James P Greelish MD

  2. Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

    Bradley J. Phillips MD

  3. Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

    James C. Fang MD

  4. Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

    John G. Byrne MD

Authors
  1. James P Greelish MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bradley J. Phillips MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James C. Fang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John G. Byrne MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

    James C. Fang MD  & Gregory S. Couper MD  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Humana Press Inc.

About this chapter

Cite this chapter

Greelish, J.P., Phillips, B.J., Fang, J.C., Byrne, J.G. (2005). Tricuspid Valve Surgery in Right Heart Failure. In: Fang, J.C., Couper, G.S. (eds) Surgical Management of Congestive Heart Failure. Contemporary Cardiology. Humana Press. https://doi.org/10.1385/1-59259-842-0:097

Download citation

  • DOI: https://doi.org/10.1385/1-59259-842-0:097

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-034-2

  • Online ISBN: 978-1-59259-842-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation