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J Thorac Cardiovasc Surg 2003;125:S9-S11
© 2003 The American Association for Thoracic Surgery

Editorials

Tricuspid insufficiency

Robert Frater, MD

From the Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, NY.

Received for publication Nov 21, 2000. Accepted for publication Nov 27, 2000. Address for reprints: Robert W. M. Frater, MD, Department of Cardiothoracic Surgery, Montefiore Medical Center, 1575 Blondell Ave, Suite 125, Bronx, NY 10467.

The first 300 words of the full text of this article appear below.


   Introduction
 
In the days when late cases of rheumatic valvular disease formed the bulk of the valvular abnormalities encountered, surgeons were commonly obliged to deal with functional tricuspid insufficiency, in which the tricuspid valve leaked during systole in the presence of structurally normal leaflets and chordae. Nowadays, the average North American surgeon encounters tricuspid insufficiency infrequently. The publication of an article on a method of measurement to aid in the performance of tricuspid annuloplasty serves as a stimulus to review some of the lessons that were learned in the past.

Repair for functional tricuspid insufficiency, in isolation or combined with left-sided valve surgery, carries a much higher risk for 30-day mortality and long-term survival than isolated mitral or aortic surgery. As such, it is a marker for late neglected valvular disease.Go 1

The lesson that gross tricuspid insufficiency cannot be ignored when performing left-sided valve surgery was learned long ago.Go 2 Despite correction of the left-sided pathologic condition, tricuspid insufficiency may persist or recur and produce persistent continued morbidity.Go 3 Simon and associates,Go 4 in an elegant study using right ventricular angiography before and 1 year after surgery, showed that impaired contraction of the atrioventricular orifice was the mechanism of the insufficiency and that this persisted in half the cases at 1 year, even in some patients in whom the right-sided pressures had returned substantially toward normal. The decision to repair all cases of gross functional tricuspid insufficiency is easy. (It does not even need special studies: the accessibility of jugular veins and the liver make detection of gross insufficiency easy at the bedside; it is, after all, systolic reversal of blood flow in the cavae that produces the signs and symptoms of gross insufficiency.)

What should the surgeon do when, at the time of surgery, the tricuspid insufficiency is only moderate, when it is . . . [Full Text of this Article]






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