Table 22. Stages of TR
Stage Definition Valve Anatomy
A At risk of TR Primary:
• Mild rheumatic change
• Mild prolapse
• Other (eg, IE with vegetation, early
carcinoid deposition, radiation)
• Intra-annular RV pacemaker or
ICD lead
• Postcardiac transplant (biopsy related)
Functional:
• Normal
• Early annular dilation
B Progressive TR Primary:
• Progressive leaflet deterioration/
destruction
• Moderate-to-severe prolapse, limited
chordal rupture
Functional:
• Early annular dilation
• Moderate leaflet tethering
C Asymptomatic severe TR Primary:
• Flail or grossly distorted leaflets
Functional:
• Severe annular dilation (>40 mm or
21 mm/m
2
)
• Marked leaflet tethering
D Symptomatic severe TR Primary:
• Flail or grossly distorted leaflets
Functional:
• Severe annular dilation (>40 mm or
>21 mm/m
2
)
• Marked leaflet tethering
TV Disease
30
