Fate and Management of Tricuspid Regurgitation Following Transcatheter Pulmonary Valve Replacement ∗

Tricuspid regurgitation (TR) is a common anomaly complicating left and right heart disease. In patients with congenital right heart anomalies, TR is highly prevalent, and when severe, it is associated with adverse clinical events (1). Multiple mechanisms can contribute to TR in these patients including: concomitant congenital anomaly of tricuspid leaflets, presence of pacemaker lead crossing the valve, and anomalies of the right ventricle and tricuspid annulus leading to functional TR. It is important to emphasize the heterogeneity of these mechanisms in individual patients. Functional TR, as an example, can result from the variable combination of annulus dilation, right ventricular (RV) dilation, deformation, and/or systolic dysfunction, which can be attenuated by compensatory leaflet growth to prevent valve regurgitation (2). These factors are important as they can influence the likelihood of valve repair (3), thus helping to guide an eventual decision to repair, replace, or leave the valve untouched. There is an increasing role for newer imaging modalities (3-dimensional echocardiography and cardiac magnetic resonance) to assess those variables and guide therapeutic management.

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