Anatomy of tricuspid valve for echocardiographers Dr. Stankovic (Belgrade, Serbia) start his “basic” lecture with the statement that although the nature tends to simplicity, there is an extra leaflet and the most complex valve structure on the right side of the heart. Its complexity made old anatomists believe that it is actually designed to be incompetent. In line with this, if we compare the information coming from the textbooks, most recent recommendations and respectful online educational resources, striking differences in tricuspide valve (TV) leaflets description are evident. This is noted not only among authors, but also between 2D and three-dimensional echocardiography studies. Dr. Stankovic elegantly showed us in detail with numerous images that complex anatomy of the TV and the right ventricle are important limitations for 2D imaging: usually only 2 leaflets can be seen in one view, and good imagination skills are needed for mental reconstruction of the valve. Alternatively, in clinically relevant cases, direct en face visualization of the TV should be attempted from the subcostal view or advanced echo techniques should be given priority. Assessment of tricuspid regurgitation – do we have enough data? Dr. Flachskampf (Uppsala, Sweden) gave an excellent overview of the echocardiographic tools available for the assessment of the severity of the tricuspid regurgitation (TR), generously illustrated by clinical cases. He concluded that we have enough data for the assessment of TR, and underlined the most clinically useful echo criteria, pointing out the importance of the typical hepatic veins Doppler profile, which is frequently overlooked in daily routine. Is it functional or organic tricuspid regurgitation? Dr. Boyaci (Ankara, Turkey) nicely presented causes and emphasized the role of echocardiography for making distinction between the organic and functional TR. In her comprehensive lecture she showed that detailed inspection of all the tricuspid valve complex components is necessary, and it sometimes involves the multimodality imaging. The reluctance of cardiac surgeons to operate on the patients with severe TR was raised as an issue during rich discussion. When to treat tricuspid regurgitation? Dr. De Bonis (Milano, Italy), a cardiac surgeon, gave an extraordinary well documented lecture which clearly pointed out from the beginning that “the one size does not fit all”. Patients with severe isolated TR and those with late TR following the mitral valve (MV) surgery should be surgically treated in the presence of symptoms or progressive right ventricular dysfunction. However, the best treatment of the latter is its prevention by addressing TR more aggressively and effectively during primary MV operation, since data revealed poor outcome of these patients if untreated on time. The surgical treatment in patients with functional TR depends on the presence/absence of the TV leaflets tethering. If tethering is present, additional procedures on top of the ring annuloplasty (including the valve replacement) are usually required.
Overall, this was an exciting session, with well-prepared and excellent speakers, fully packed with audience and with very interesting and educative discussion.
Tricuspid regurgitation: dark side of the regurgitations
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