Tricuspid Valve Disease: A Comprehensive Guide to Evaluation and Management (Contemporary Cardiology)

This book provides a comprehensive overview of the physiology, pathophysiology, diagnosis, medical and surgical management, and future therapies for tricuspid valve disease. It is divided into two sections. The first section covers the basics of the tricuspid valve, including anatomy, epidemiology, and clinical diagnosis with individual chapters focused on hemodynamics, echocardiography, MRI, and CT assessment. The second section examines current treatments for tricuspid valve disease including both surgical and medical management. It discusses special clinical scenarios of tricuspid valve pathology such as tricuspid regurgitation in patients with ICD and pacemaker implants and the role of tricuspid valve disease in patients with heart failure and LVAD therapy. Tricuspid Valve Disease: A Comprehensive Guide to Evaluation and Management is an essential resource for general cardiologists, interventional cardiologists, cardiac surgeons, and innovators in the field of structural heart disease. Contents 6 Contributors 8 Part I: Tricuspid Valve Basics 11 Chapter 1: Anatomy of the Tricuspid Valve 12 Introduction 12 Embryology of the Tricuspid Valve 12 Tricuspid Valve Leaflets 14 Tricuspid Valve Annulus 16 Tricuspid Tensor Apparatus 17 Adjacent Structures 19 Implications for Tricuspid Valve Intervention 20 Conclusion 21 References 21 Chapter 2: Epidemiology, Pathophysiology, and Natural History of Tricuspid Valve Regurgitation and Stenosis 23 Epidemiology of Tricuspid Valve Regurgitation 23 Epidemiology of Tricuspid Valve Stenosis 25 Pathophysiology of Tricuspid Regurgitation 26 Pathophysiology of Tricuspid Valve Stenosis 30 Natural History of Tricuspid Regurgitation 31 References 32 Chapter 3: Assessment and Management of Tricuspid Valve Regurgitation 34 Physical Exam in Tricuspid Regurgitation 34 Medical Management of Tricuspid Regurgitation 36 References 37 Chapter 4: Hemodynamic Assessment of Tricuspid Valve Disease 39 Introduction 39 Anatomy and Physiology of the Tricuspid Valve 39 Diseases of the Tricuspid Valve 41 Tricuspid Stenosis 41 Cardiac Catheterization 41 Doppler Echocardiography 42 Treatment of Tricuspid Stenosis 43 Tricuspid Regurgitation 43 Cardiac Catheterization 44 Doppler Echocardiography 44 Treatment of Tricuspid Regurgitation 45 References 46 Chapter 5: Echocardiographic Assessment of Tricuspid Valve Disease 48 Tricuspid Valve Anatomy for Echo Imaging 48 Tricuspid Leaflet Variation 48 Standard 2D TTE Views 49 Standard 2D TEE Views 55 3D Views 55 Annulus Sizing 57 Assessing Mechanism of Tricuspid Regurgitation or Stenosis and Severity 58 Tricuspid Regurgitation 58 Native Primary Tricuspid Regurgitation 59 Native Secondary Tricuspid Regurgitation 62 Echocardiographic Assessment of Tricuspid Regurgitation Severity 64 Native Tricuspid Stenosis 66 Prosthetic Tricuspid Disease 67 Imaging for Tricuspid Valve Intervention 68 Emerging Therapies 68 Transcatheter Tricuspid Valve Interventions 68 Heterotopic Transcatheter Valves 69 Transcatheter Tricuspid Valve Annuloplasty Devices 69 Edge-to-Edge Repair with the MitraClip Device 70 Transcatheter Valve Replacement 70 Future Directions 71 References 71 Chapter 6: MRI Assessment of the Tricuspid Valve and Right Heart 75 Introduction 75 CMR Pulse Sequences and Strain: General Principles 76 Steady-State Free Precession 77 GRE Imaging 78 Phase Contrast Mapping 78 CMR-Derived Strain 78 CMR Assessment in Tricuspid Valve and Right Heart Disease 79 Right Atrium Anatomy, Size, and Function 79 Tricuspid Valve Anatomy and Function 80 Right Ventricle Anatomy, Size, and Function 81 Right Atrial Pathology 83 Right Atrial Dysfunction 83 Tricuspid Valve Pathology 83 Tricuspid Valve Regurgitation 83 CMR in Transcatheter Tricuspid Valve Interventions 84 Tricuspid Valve Stenosis 85 Right Ventricle Pathology 85 Ischemic Heart Disease 85 Pulmonary Hypertension and Left-Sided Heart Failure 86 Congenital Heart Disease 87 Limitations of MRI 90 References 91 Chapter 7: Computed Tomography Assessment of the Tricuspid Valve and the Right Heart 96 Introduction 96 The Role of CT in the Assessment of the Right Heart: General Principles 97 Utility of CT in Assessment of Right Heart 98 CT Acquisition Techniques to Optimize Right Heart Visualization 98 Assessment of Right Ventricular Size and Function 99 MDCT Assessment of the Tricuspid Annulus 101 Assessment of Right Ventricular Strain with CT 102 Utility of CT in Emerging Transcatheter Tricuspid Valve Interventions 102 CT Imaging of Transcutaneous Spacer Devices 105 CT Imaging of Transcutaneous Annular Reduction Devices 105 CT Imaging of Heterotopic Caval Valve Implantation 108 CT Imaging of Orthotopic Transcatheter Tricuspid Valve Implantation 109 References 110 Chapter 8: Carcinoid Heart Disease 114 Case Presentation 115 Incidence and Epidemiology of Carcinoid Heart Disease 115 Pathophysiology of Carcinoid Heart Disease 116 Surveillance and Diagnosis of Carcinoid Heart Disease 118 Imaging 118 Management of Carcinoid Heart Disease 120 Carcinoid Crisis 121 Surgery 121 Bioprosthetic Valve Deterioration 122 Percutaneous Interventions in Carcinoid Heart Disease 122 References 123 Part II: Current Management of Tricuspid Valve Disease 125 Chapter 9: The Surgical Management of Tricuspid Valve Disease 126 Introduction 126 Historical Perspective 127 Tricuspid Valve Anatomy 127 Tricuspid Valve Pathophysiology and Clinical Features 128 Tricuspid Regurgitation 128 Tricuspid Stenosis 129 Indications for Tricuspid Valve Surgery 130 Primary Tricuspid Regurgitation 131 Secondary Tricuspid Regurgitation 132 Tricuspid Stenosis 132 Surgical Exposure 133 Tricuspid Valve Repair 133 Surgical Planning 134 Ring-Based Annuloplasty Techniques 134 Suture-Based Annuloplasty 135 Leaflet Repair Techniques 135 Chordal Replacement Techniques 136 Leaflet Reconstruction 136 Other Surgical Repair Strategies 137 Intraoperative Assessment of Valve Repair 137 Acute Complications of Tricuspid Valve Repair 137 Tricuspid Valve Replacement 137 Recurrent Tricuspid Regurgitation 138 Minimally Invasive Tricuspid Valve Surgery 139 Conclusion 139 References 140 Chapter 10: Evaluation and Management of Tricuspid Regurgitation in Patients with Cardiac Implantable Electronic Devices 142 Introduction 142 Mechanisms of Lead-Induced Tricuspid Regurgitation 143 Diagnosis of Tricuspid Valve Dysfunction Associated with CIED Leads 145 Treatment of Lead-Related Tricuspid Regurgitation 145 Transvenous Lead Extraction to Treat Lead-Related Tricuspid Regurgitation 146 Future Directions Including Leadless Pacemakers and his Bundle Pacing 147 Conclusion 147 References 148 Chapter 11: Tricuspid Valve: A Heart Team Approach 152 The Heart Team Evolves for Tricuspid Valve Disease Management 152 An Overview of the Multidisciplinary Team for the Tricuspid Valve 154 The Core Members of the TV-MDHT 154 Interventional Cardiologist 154 Cardiothoracic Surgeon 155 Interventional Imaging 155 Advanced Practice Providers: The Valve Clinicians 156 Valve Program/Nurse Coordinator 156 Research Coordinators 157 Heart Failure Specialists 157 Referring Provider 157 Patient and Family 158 The Extended Team Members of the TV-MDHT 158 Electrophysiologist 158 Vascular Specialists 158 Hepatologist 158 Pulmonary Hypertension Specialist 159 Pharmacist 159 The Heart Team Collaboration 159 Community Awareness 160 References 161 Part III: Future Management of Tricuspid Valve Disease 164 Chapter 12: Tricuspid Valve Disease: Annuloplasty-Based Therapies 165 Direct Ring Annuloplasty Devices 166 Suture Annuloplasty Devices 170 References 173 Chapter 13: Transcatheter Tricuspid Valve Intervention: Coaptation-Based Strategies 175 Introduction 175 Pre-procedural Imaging and Assessment 176 Coaptation-Based Devices 177 TriClip 177 PASCAL 180 FORMA 180 Experimental Devices 181 Cerclage-TR Block 181 Mistral 182 CroíValve 182 Conclusion 182 References 183 Index 186