TV Disease
Table 23. 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 IVC, assess
RV systolic function, estimate 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
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