Recent advances in multimodality imaging of the tricuspid valve

ABSTRACT

Introduction

The tricuspid valve (TV) and the right heart chambers are complex three-dimensional structures that are difficult to assess using tomographic imaging techniques. The progressive aging of the general population and the advancements in treating left-sided heart diseases by transcatheter procedures have contributed to the tricuspid regurgitation (TR) becoming a major public health problem associated with progression to refractory heart failure and poor outcome. Recent advances in multimodality cardiac imaging allow a better understanding of the pathophysiology of TR that may translate in better management of patients.

Areas covered

Three-dimensional echocardiography, cardiac magnetic resonance, and computed tomography provide complementary information to i. assess the TV complex; ii. identify the etiology and the mechanisms of TR; iii. evaluate its severity and hemodynamic consequences; iv. explore the remodeling of the right heart chambers; and v. properly plan, guide, and monitor the transcatheter interventions aimed to reduce the severity of TR.

Expert opinion

We need thorough understanding of both the TV and the right heart chamber geometry and function to understand the pathophysiology of TR. The integrated use of multimodality cardiac imaging is pivotal to assess patients with TR and to identify tailored and timely treatment of TR in properly selected patients.

KEYWORDS:

• 3D echocardiography
• cardiac magnetic resonance
• computed tomography
• echocardiography
• multimodality imaging
• tricuspid regurgitation
• tricuspid valve
• tricuspid valve interventions

Article Highlights

• Moderate/severe tricuspid regurgitation is associated with high morbidity and mortality.

• The most common form of TR is functional, secondary to right ventricular dilatation and dysfunction, pulmonary hypertension or left-sided diseases (ventricular-functional tricuspid regurgitation), or isolated annular dilatation in atrial fibrillation (atrial-functional tricuspid regurgitation).

• Three-dimensional echocardiography offers unique opportunities to assess the anatomy of the regurgitant tricuspid valve and reliably quantify the tricuspid apparatus geometry and the extent of right heart chamber remodeling.

• The information provided by multimodality imaging plays a pivotal role in the selection of patients with functional TR for tailored transcatheter treatment to repair the TV, which is an attractive and rapidly expanding option for high surgical risk patients currently explored in registries and clinical trials.

Declaration of Interest

D. Muraru and L.P. Badano have received speakers’ fees from GE Healthcare. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.