Skip to main content
SpringerLink
Log in

Right Ventricle and Functional Tricuspid Regurgitation: An Unpredictable Interaction

  • Chapter
  • First Online:
Secondary Mitral Valve Regurgitation

  • 1031 Accesses

Abstract

The tricuspid valve (TV) lies in between the right atrium and the right ventricle (RV), consisting of annulus, leaflets, chords and papillary muscles. The RV appears triangular-shaped in a lateral viewed and crescent-shaped in a cross-section one. In normal conditions, the septum is concave toward the left ventricle (LV) in both systole and diastole and the RV volume is larger than the LV volume, Although its mass is one-third of the LV. The strict relationship between the tricuspid valve apparatus and the RV underlies the physiological mechanism of TV functioning, so, the RV plays an important role in case of functional tricuspid regurgitation (FTR). Nevertheless the systematic assessment of RV is still not performed mainly due to lack of standardization. Hence, new echocardiographic guidelines have been recently proposed to standardized the RV assessment using trans-thoracic 2D echocardiography. Three-D-echocardiography and magnetic resonance imaging (MRI) are more useful to measure volumes and ejection fraction; in particular, MRI is able to provide a tissue evaluation. Today, surgical strategies are directed mainly to the annulus with fluctuating results, because FTR in not due only to the annulus but also to the RV that is difficult to assess, being its evolution unpredictable and complicated by the interaction with LV.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Antoniali F, Braile DM, Potério GMB, et al. Proporção entre os segmentos do anel da valva tricúspide normal: um parâmetro para realização da anuloplastia valvar. Rev Bras Cir Cardiovasc. 2006;21:262–71.

    Article  Google Scholar 

  2. Calafiore AM, Bartoloni G, Al Amri H, Iacò AL, Abukhudair W, Lanzaro Iadanza B, Di Mauro M. Functional tricuspid regurgitation and the right ventricle: what we do not know is more than we know. Expert Rev Cardiovasc Ther. 2012;10:1351–66.

    Article  CAS  PubMed  Google Scholar 

  3. Fukuda S, Saracino G, Matsumura Y, et al. Three-dimensional geometry of the tricuspid annulus in healthy subjects and in patients with functional tricuspid regurgitation a real-time, 3-dimensional echocardiographic study. Circulation. 2006;114(Suppl I):I-492–8.

    Google Scholar 

  4. Ton-nu T-T, Levine RA, Handshumacker MD, et al. Geometric determinants of functional tricuspid regurgitation insights from 3-dimensional echocardiography. Circulation. 2006;114:143–9.

    Article  PubMed  Google Scholar 

  5. Dupont MVM, Dragean CA, Coche EE. Right ventricle function assessment by MDCT. AJR Am J Roentgenol. 2011;196:77–86.

    Article  PubMed  Google Scholar 

  6. Geva T, Powell AJ, Crawford EC, et al. Evaluation of regional differences in right ventricular systolic function by acoustic quantification echocardiography and cine magnetic resonance imaging. Circulation. 1998;98:339–45.

    Article  CAS  PubMed  Google Scholar 

  7. Ho SY, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart. 2006;92 Suppl 1:i2–13.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Dell’Italia LJ. The right ventricle: anatomy, physiology, and clinical importance. Curr Probl Cardiol. 1991;16:653–720.

    PubMed  Google Scholar 

  9. Lorenz CH, Walker ES, Morgan VL, Klein SS, Graham Jr TP. Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J Cardiovasc Magn Reson. 1999;1:7–21.

    Article  CAS  PubMed  Google Scholar 

  10. Fredericksson AG, Zajac J, Ericksson J, et al. 4D blood flow in the human right ventricle. Am J Physiol Heart Circ Physiol. 2011. doi:10.1152/ajpheart.00622.2011.

    Google Scholar 

  11. Redington AN, Gray HH, Hodson ME, et al. Characterisation of the normal right ventricular pressure-volume relation by biplane angiography and simultaneous micromanometer pressure measurements. Br Heart J. 1988;59:23–30.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Sheehan F, Redington A. The right ventricle: anatomy, physiology and clinical imaging. Heart. 2008;94:1510–5.

    Article  PubMed  Google Scholar 

  13. Redington AN, Rigby ML, Shinebourne EA, et al. Changes in the pressure-volume relation of the right ventricle when its loading conditions are modified. Br Heart J. 1990;63:45–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Lee FA. Hemodynamics of the right ventricle in normal and disease states. Cardiol Clin. 1992;10:59–67.

    CAS  PubMed  Google Scholar 

  15. Leng J. Right ventricle. In: Weyman AE, editor. Principle and practice of echocardiography. Philadelphia: Lippincott Williams & Wilkins; 1994. p. 901–21.

    Google Scholar 

  16. Petitjean C, Rougon N, Cluzel P. Assessment of myocardial function: a review of quantification methods and results using tagged MRI. J Cardiovasc Magn Reson. 2005;7:501–16.

    Article  PubMed  Google Scholar 

  17. Dibble CT, Lima JAC, Bluemke DA, et al. Regional left ventricular systolic function and the right ventricle. The multi-ethnic study of atherosclerosis-right ventricle study. Chest. 2011;140:310–6. doi:10.1378/chest.10.750.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Gomez A, Bialostozky D, Zajarias A, et al. Right ventricular ischemia in patients with primary pulmonary hypertension. J Am Coll Cardiol. 2001;38:1137–42.

    Article  CAS  PubMed  Google Scholar 

  19. Tomanek RJ. Response of the coronary vasculature to myocardial hypertrophy. J Am Coll Cardiol. 1990;15:528–33.

    Article  CAS  PubMed  Google Scholar 

  20. Sano M, Minamino T, Toko H, et al. p53-induced inhibition of Hif-1 causes cardiac dysfunction during pressure overload. Nature. 2007;446:444–8.

    Article  CAS  PubMed  Google Scholar 

  21. Hein S, Arnon E, Kostin S, et al. Progression from compen sated hypertrophy to failure in the pressure-overloaded human heart: structural deterioration and compensatory mechanisms. Circulation. 2003;107:984–91.

    Article  PubMed  Google Scholar 

  22. Olivetti G, Abbi R, Quaini F, et al. Apoptosis in the failing human heart. N Engl J Med. 1997;336:1131–41.

    Article  CAS  PubMed  Google Scholar 

  23. Wencker D, Chandra M, Nguyen K, et al. A mechanistic role for cardiac myocyte apoptosis in heart failure. J Clin Invest. 2003;111:1497–504.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Beltrami AP, Barlucchi L, Torella D, et al. Adult cardiac stem cells are multipotent and support myocardial regeneration. Cell. 2003;114:763–76.

    Article  CAS  PubMed  Google Scholar 

  25. Spinner EM, Shannon P, Buice D, et al. In vitro characterization of the mechanisms responsible for functional tricuspid regurgitation. Circulation. 2011;124:920–9.

    Article  PubMed  Google Scholar 

  26. Sadeghi HM, Kimura BJ, Raisinghani A, et al. Does lowering pulmonary arterial pressure eliminate severe functional tricuspid regurgitation? Insights from pulmonary thromboendarterectomy. J Am Coll Cardiol. 2004;44:126–32.

    Article  PubMed  Google Scholar 

  27. Spinner EM, Sundareswaran K, Dasi LP, Thourani VH, Oshinski J, Yoganathan AP. Altered right ventricular papillary muscle position and orientation in patients with a dilated left ventricle. J Thorac Cardiovasc Surg. 2011;141:744–9.

    Article  PubMed  Google Scholar 

  28. Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation. 2009;119:2718–25.

    Article  PubMed  Google Scholar 

  29. Spinner EM, Lerakis S, Higginson J, et al. Correlated of tricuspid regurgitation as determined by 3D echocardiography: pulmonary artery pressure, ventricle geometry, annular dilatation, and papillary muscle displacement. Circ Cardiovasc Imaging. 2012;5:43–50.

    Article  PubMed  Google Scholar 

  30. Fukuda S, Gillinov AM, McCarthy PM, et al. Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty. Circulation. 2006;114(Suppl I):I-582–7.

    Google Scholar 

  31. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685–713.

    Article  PubMed  Google Scholar 

  32. Jiang L, Levine RA, Weyman AE. Echocardiographic assessment of right ventricular volume and function. Echocardiography. 1997;14:189–206.

    Article  PubMed  Google Scholar 

  33. Helbing WA, Bosch HG, Maliepaard C, Rebergen SA, van der Geest RJ, Hansen B, et al. Comparison of echocardiographic methods with magnetic resonance imaging for assessment of right ventricular function in children. Am J Cardiol. 1995;76:589–94.

    Article  CAS  PubMed  Google Scholar 

  34. Gopal AS, Chukwu EO, Iwuchukwu CJ, Katz AS, Toole RS, Schapiro W, et al. Normal values of right ventricular size and function by real-time 3-dimensional echocardiography: comparison with cardiac magnetic resonance imaging. J Am Soc Echocardiogr. 2007;20:445–55.

    Article  PubMed  Google Scholar 

  35. Jue J, Chung W, Schiller NB. Does inferior vena cava size predict right atrial pressures in patients receiving mechanical ventilation? J Am Soc Echocardiogr. 1992;5:613–9.

    Article  CAS  PubMed  Google Scholar 

  36. Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Hagendorff A, Monin JL, Badano L, Zamorano JL. European Association of Echocardiography. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010;11:307–32.

    Article  PubMed  Google Scholar 

  37. Calafiore AM, Iacò AL, Bivona A, et al. Echocardiographically based treatment of functional tricuspid regurgitation. J Thorac Cardiovasc Surg. 2011;142:308–13.

    Article  PubMed  Google Scholar 

  38. Kay JH, Maselli-Campagna G, Tsuji HK. Surgical treatment of tricuspid insufficiency. Ann Surg. 1965;162:53–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. De Bonis M, Lapenna E, La Canna G, et al. A novel technique for correction of severe tricuspid valve regurgitation due to complex lesions. Eur J Cardiothorac Surg. 2004;25:760–5.

    Article  PubMed  Google Scholar 

  40. Dreyfus GD, Raja SG, Chan KMJ. Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg. 2008;34:908–10.

    Article  PubMed  Google Scholar 

  41. Mutlak D, Aronson D, Lessik J, et al. Functional tricuspid regurgitation in patients with pulmonary hypertension: is pulmonary artery pressure the only determinant of regurgitation severity? Chest. 2009;135:115–21.

    Article  PubMed  Google Scholar 

  42. Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation: annulus, commissure, or leaflet procedure? J Thorac Cardiovasc Surg. 2010;139:1473–82.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia

    Michele Di Mauro MD, Angela L. Iacò MD, Ali Own MD & Antonio M. Calafiore MD

  2. Department of Heart Disease, University of L’Aquila, L’Aquila, Italy

    Michele Di Mauro MD & Daniela Clemente MD

Authors
  1. Michele Di Mauro MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angela L. Iacò MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ali Own MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniela Clemente MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio M. Calafiore MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio M. Calafiore MD .

Editor information

Editors and Affiliations

  1. GVM Care and Research Group, University of Palermo, Palermo, Italy

    Khalil Fattouch

  2. CHU Sart Tilman, University of Liège, Liège, Belgium

    Patrizio Lancellotti

  3. Hammersmith Hospital, Imperial College of London, London, United Kingdom

    Gianni D. Angelini

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Di Mauro, M., Iacò, A.L., Own, A., Clemente, D., Calafiore, A.M. (2015). Right Ventricle and Functional Tricuspid Regurgitation: An Unpredictable Interaction. In: Fattouch, K., Lancellotti, P., Angelini, G. (eds) Secondary Mitral Valve Regurgitation. Springer, London. https://doi.org/10.1007/978-1-4471-6488-3_19

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6488-3_19

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6487-6

  • Online ISBN: 978-1-4471-6488-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation