Significant tricuspid valve (TV) regurgitation (primary or secondary) is associated with increased morbidity and mortality.
Unfortunately, residual tricuspid regurgitation after TV repair is quite common, occurring early post-operatively in 15-20% of patients. These unsatisfactory results suggest a limited knowledge of the complex morphology of the valve and an incomplete understanding of the pathophysiological mechanisms.
This symposium was intended to elucidate the anatomy and pathophysiology of the TV, which was appropriately named in the past the “forgotten” valve. In addition, the clinical aspects of the diseased TV and the surgical approaches were widely discussed.
Dr G Thiene (Padua, Italy) discussed the complexity of the anatomy, along with the morphological changes that occur in different pathological conditions and produce valve dysfunction. Secondary (or functional) tricuspid regurgitation, which occurs in conjunction with left-sided valve diseases, is characterised by the absence of leaflet abnormalities, while the annulus becomes larger, more planar and circular.
In addition to annular dilatation, tethering of the morphologically normal leaflets restricts the motion of the leaflets and decreases coaptation, as pointed out by Dr F Flachskampf (Erlangen, Denmark). The deformations of the TV observed in the less common primary (or structural) tricuspid regurgitation (congenital anomalies, endocarditis, trauma, rheumatic disease, carcinoid syndrome etc) were described by Dr P Trigo Trindade (Zurich, Switzerland).
Finally, Mr U O von Oppell (Cardiff, GB) reported the results of TV annuloplasty, recognising the limitations of the procedure and identifying the determinants of recurrent or residual tricuspid regurgitation.