The clinical detection and quantification of tricuspid valve disease, although important, is not entirely accurate. Diagnostic evaluation is based on echocardiography, and color flow Doppler is useful for quantifying
tricuspid regurgitation. Echocardiography provides information on heart chamber dimensions, right ventricular function, and the degree of
pulmonary hypertension. In addition, tricuspid
stenosis can be accurately assessed using mean and end-diastolic pressure gradient measurements. The treatment options for tricuspid
stenosis include balloon valvuloplasty and
surgical valve repair. Functional
tricuspid regurgitation associated with left
heart disease may require surgical attention during an operation to treat the left
heart disease. Severe
tricuspid regurgitation usually requires surgery to be performed in association with mitral valve surgery. Mild-to-moderate
tricuspid regurgitation requires surgery when annular dilatation or severe
pulmonary hypertension is present. The surgical options include tricuspid valve repair, with or without an annuloplasty ring. In patients with a primary anatomic
deformity of the tricuspid valve, replacement of the valve with a
bioprosthesis or mechanical valve may be considered. Intermediate and long-term results favor annuloplasty valve repair over valve replacement. Pulmonary valve disease is predominantly congenital, and generally takes the form of
pulmonary stenosis.
Pulmonary regurgitation often results from surgical or balloon valvuloplasty and is associated with deleterious long-term sequelae. The recent development of percutaneous valve replacement was a major advance.