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Table 21. Diagnosis, Medical Therapy, and Surgery
in Patients With TR
Recommendations
COR LOE
Diagnosis
TTE is indicated to evaluate severity of TR, determine
etiolog y, measure size of right-sided chambers and inferior
vena cava (IVC), assess RV systolic function, estimate
pulmonary artery systolic pressure (PASP), and characterize
any associated le-sided heart disease.
I C
Invasive measurement of PA pressures and pulmonary vascular
resistance can be useful in patients with TR when clinical and
noninvasive data regarding their values are discordant.
IIa C
CMR or real-time 3D echocardiography may be considered
for assessment of RV systolic function and systolic and
diastolic volume in patients with severe TR (stages C and D)
and suboptimal 2D echocardiograms.
IIb C
Exercise testing may be considered for the assessment of
exercise capacity in patients with severe TR with no or
minimal symptoms (stage C).
IIb C
Medical erapy
Diuretics can be useful for patients with severe TR and signs
of right-sided HF (stage D).
IIa C
Medical therapies to reduce elevated PA pressures and/or
pulmonary vascular resistance might be considered in patients
with severe functional TR (stages C and D).
IIb C
Surgery
TV surgery is recommended for patients with severe TR (stages
C and D) undergoing le-sided valve surgery.
I C
TV repair can be beneficial for patients with mild, moderate,
or greater functional TR (stage B) at the time of le-sided
valve surgery with either 1) TA dilation or 2) prior evidence
of right HF.
IIa B
TV surgery can be beneficial for patients with symptoms due
to severe primary TR that are unresponsive to medical therapy
(stage D).
IIa C
TV repair may be considered for patients with moderate
functional TR (stage B) and PHTN at the time of le-sided
valve surgery.
IIb C
TV surgery may be considered for asymptomatic or minimally
symptomatic patients with severe primary TR (stage C) and
progressive degrees of moderate or greater RV dilation and/or
systolic dysfunction.
IIb C
Reoperation for isolated TV repair or replacement may be
considered for persistent symptoms due to severe TR (stage D)
in patients who have undergone previous le-sided valve
surgery and who do not have severe PHTN or significant RV
systolic dysfunction.
IIb C
Tricuspid Regurgitation
