{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T18:32:13Z","timestamp":1791052333024,"version":"4.1.0"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"1021","license":[{"start":{"date-parts":[[2010,10,18]],"date-time":"2010-10-18T00:00:00Z","timestamp":1287360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Right-sided cardiac valvular disease has traditionally been considered less clinically important than mitral or aortic valve pathology. However, detectable tricuspid regurgitation (TR) is common and recent data suggest that significant TR can lead to functional impairment and reduced survival, particularly in patients with concomitant left-sided valvular disease. The tricuspid valve is a complex anatomical structure and advances in three dimensional echocardiography and cardiac MRI have contributed to a greater understanding of tricuspid valve pathology. These imaging techniques are invaluable in determining the aetiology and severity of TR, and provide an assessment of right ventricular function and pulmonary artery pressure. TR is more prevalent in women and those with a history of myocardial infarction and heart failure. It also occurs in about 10% of patients with rheumatic heart disease. Chronic severe TR may have a prolonged clinical course culminating in the development of fatigue and poor exercise tolerance due to a reduced cardiac output. Approximately 90% of cases of TR are secondary to either pulmonary hypertension or intrinsic right ventricular pathology and about 10% are due to primary tricuspid valve disease. Primary causes such as Ebstein\u2019s anomaly, rheumatic disease, myxomatous changes, carcinoid syndrome, endomyocardial fibrosis, and degenerative disease have characteristic morphological features readily identifiable by echocardiography. Ascertaining an accurate right ventricular systolic pressure is important in separating primary from secondary causes as significant TR with a pressure &amp;lt;40\u2005mm\u2002Hg implies intrinsic valve disease. Cardiac MRI may be indicated in those with inadequate echocardiographic images and is also the gold standard for the evaluation of right ventricular function and morphology. The assessment of leaflet morphology, annular dimensions, and pulmonary artery pressure are particularly important for determining subsequent management. Along with appropriate treatment of the underlying cause of TR and pulmonary hypertension, management guidelines indicate a move towards more aggressive treatment of TR. In those undergoing left-sided valve surgery, tricuspid valve repair is universally recommended in the presence of severe coexistent TR; in those with isolated severe TR, surgery is recommended in the presence of symptoms or progressive right ventricular dilatation or dysfunction.<\/jats:p>","DOI":"10.1136\/pgmj.2009.090886","type":"journal-article","created":{"date-parts":[[2010,10,19]],"date-time":"2010-10-19T02:06:03Z","timestamp":1287453963000},"page":"648-655","source":"Crossref","is-referenced-by-count":27,"title":["Tricuspid regurgitation: contemporary management of a neglected valvular lesion"],"prefix":"10.1093","volume":"86","author":[{"given":"Richard Bruce","family":"Irwin","sequence":"first","affiliation":[{"name":"Manchester Heart Centre, Manchester Royal Infirmary , Manchester , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Luckie","sequence":"additional","affiliation":[{"name":"Manchester Heart Centre, Manchester Royal Infirmary , Manchester , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajdeep S","family":"Khattar","sequence":"additional","affiliation":[{"name":"Manchester Heart Centre, Manchester Royal Infirmary , Manchester , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2010,10,18]]},"reference":[{"key":"2023041909141058600_b1","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1093\/oxfordjournals.eurheartj.a014963","article-title":"Importance of the right ventricle in valvular heart disease","volume":"17","author":"Nagel","year":"1996","journal-title":"Eur Heart J"},{"key":"2023041909141058600_b2","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1378\/chest.103.1.226","article-title":"Prevalence and severity of Doppler-detected valvular regurgitation and estimation of right-sided cardiac pressures in patients with normal two-dimensional echocardiograms","volume":"103","author":"Lavie","year":"1993","journal-title":"Chest"},{"key":"2023041909141058600_b3","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.euje.2006.07.010","article-title":"3D geometry of a normal tricuspid annulus during systole: A comparison study with the mitral annulus using real-time 3D echocardiography","volume":"8","author":"Kwan","year":"2007","journal-title":"Eur J Echocardiogr"},{"key":"2023041909141058600_b4","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1510\/icvts.2006.132381","article-title":"Assessment of tricuspid valve annulus size, shape and function using real-time three-dimensional echocardiography","volume":"5","author":"Anwar","year":"2006","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"2023041909141058600_b5","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/S0002-9149(98)01064-9","article-title":"Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Study)","volume":"83","author":"Singh","year":"1999","journal-title":"Am J Cardiol"},{"key":"2023041909141058600_b6","doi-asserted-by":"crossref","first-page":"3584","DOI":"10.1161\/CIRCULATIONAHA.105.539775","article-title":"Rheumatic and nonrheumatic valvular heart disease: epidemiology, management, and prevention in Africa","volume":"112","author":"Essop","year":"2005","journal-title":"Circ"},{"key":"2023041909141058600_b7","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/S0167-5273(99)00167-9","article-title":"Juvenile tricuspid stenosis and rheumatic tricuspid valve disease: an echocardiographic study","volume":"72","author":"Goswami","year":"1999","journal-title":"Int J Cardiol"},{"key":"2023041909141058600_b8","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1067\/mhj.2002.123575","article-title":"Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction","volume":"144","author":"Koelling","year":"2002","journal-title":"Am Heart J"},{"key":"2023041909141058600_b9","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.jacc.2003.09.036","article-title":"Impact of tricuspid regurgitation on long-term survival","volume":"43","author":"Nath","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"2023041909141058600_b10","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/j.ahj.2007.11.010","article-title":"Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations","volume":"155","author":"Kwak","year":"2008","journal-title":"Am Heart J"},{"key":"2023041909141058600_b11","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.echo.2006.09.013","article-title":"Echocardiography-based spectrum of severe tricuspid regurgitation: the frequency of apparently idiopathic tricuspid regurgitation","volume":"20","author":"Mutlak","year":"2007","journal-title":"J Am Soc Echocardiogr"},{"key":"2023041909141058600_b12","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/S0022-5223(94)70188-1","article-title":"Traumatic tricuspid valve insufficiency: experience in thirteen patients","volume":"108","author":"Van Son","year":"1994","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023041909141058600_b13","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/00000441-198602000-00008","article-title":"Case report: chronic tricuspid regurgitation and bifascicular block due to blunt chest trauma","volume":"291","author":"Perlroth","year":"1986","journal-title":"Am J Med Sci"},{"key":"2023041909141058600_b14","first-page":"566","article-title":"Evidence for rheumatic valve disease in patients with severe tricuspid regurgitation long after mitral valve surgery: the role of 3D echo reconstruction","volume":"12","author":"Henein","year":"2003","journal-title":"J Heart Valve Dis"},{"key":"2023041909141058600_b15","doi-asserted-by":"crossref","first-page":"e84","DOI":"10.1161\/CIRCULATIONAHA.106.176857","article-title":"ACC\/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease)","volume":"114","author":"Bonow","year":"2006","journal-title":"Circ"},{"key":"2023041909141058600_b16","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1161\/01.CIR.0000156449.49998.51","article-title":"Tricuspid valve tethering predicts residual tricuspid regurgitation after tricuspid annuloplasty","volume":"111","author":"Fukuda","year":"2005","journal-title":"Circ"},{"key":"2023041909141058600_b17","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1136\/hrt.2006.095281","article-title":"Management of Tricuspid Valve Regurgitation","volume":"93","author":"Antunes","year":"2007","journal-title":"Heart"},{"key":"2023041909141058600_b18","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.jtcvs.2004.01.035","article-title":"Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets","volume":"128","author":"Messika-Zeitoun","year":"2004","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023041909141058600_b19","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1136\/hrt.66.4.295","article-title":"Reduced exercise capacity in patients with tricuspid regurgitation after successful mitral valve replacement for rheumatic mitral valve disease","volume":"66","author":"Groves","year":"1991","journal-title":"Br Heart J"},{"key":"2023041909141058600_b20","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.jtcvs.2003.11.048","article-title":"Late incidence and predictors of persistent or recurrent heart failure in patients with mitral prosthetic valves","volume":"128","author":"Ruel","year":"2004","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023041909141058600_b21","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1002\/bjs.1800760239","article-title":"Pulsatile varicose veins associated with tricuspid regurgitation","volume":"76","author":"Hollins","year":"1989","journal-title":"Br J Surg"},{"key":"2023041909141058600_b22","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1016\/S0140-6736(95)92871-5","article-title":"Systolic propulsion of the eyeballs in tricuspid regurgitation","volume":"346","author":"Naylor","year":"1995","journal-title":"Lancet"},{"key":"2023041909141058600_b23","first-page":"377","volume-title":"Valvular Heart Disease","author":"Ewy","year":"2000","edition":"3rd edn"},{"key":"2023041909141058600_b24","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.amjcard.2006.01.082","article-title":"Determinants of the severity of tricuspid regurgitation","volume":"98","author":"Kim","year":"2006","journal-title":"Am J Cardiol"},{"key":"2023041909141058600_b25","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1164\/rccm.200604-547OC","article-title":"Tricuspid annular displacement predicts survival in pulmonary hypertension","volume":"174","author":"Forfia","year":"2006","journal-title":"Am J Respir Crit Care Med"},{"key":"2023041909141058600_b26","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1111\/j.1540-8175.2007.00365.x","article-title":"Right heart function and scleroderma: insights from tricuspid annular plane systolic excursion","volume":"24","author":"Lee","year":"2007","journal-title":"Echocardiography"},{"key":"2023041909141058600_b27","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s10554-004-1097-7","article-title":"Routine breath-hold gradient echo MRI-derived right ventricular mass, volumes and function: accuracy, reproducibility and coherence study","volume":"20","author":"Beygui","year":"2004","journal-title":"Int J Cardiovasc Imaging"},{"key":"2023041909141058600_b28","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S0002-8703(97)70212-6","article-title":"Transthoracic three-dimensional echocardiographic reconstruction of left and right ventricles: in vitro validation and comparison with magnetic resonance imaging","volume":"133","author":"Pini","year":"1997","journal-title":"Am Heart J"},{"key":"2023041909141058600_b29","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1007\/s10554-006-9206-4","article-title":"Value of assessment of tricuspid annulus: real-time three-dimensional echocardiography and magnetic resonance imaging","volume":"23","author":"Anwar","year":"2007","journal-title":"Int J Cardiovasc Imaging"},{"key":"2023041909141058600_b30","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1161\/01.CIR.0000107842.29467.C5","article-title":"Role of cardiac magnetic resonance angiography in the diagnosis of major aortopulmonary collateral arteries and partial anomalous pulmonary venous drainage","volume":"109","author":"Prasad","year":"2004","journal-title":"Circ"},{"key":"2023041909141058600_b31","doi-asserted-by":"crossref","first-page":"2955","DOI":"10.1161\/01.CIR.91.12.2955","article-title":"Assessment of left-to-right intracardiac shunting by velocity-encoded, phase-difference magnetic resonance imaging: a comparison with oximetric and indicator dilution techniques","volume":"91","author":"Hundley","year":"1995","journal-title":"Circ"},{"key":"2023041909141058600_b32","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s00330-006-0327-x","article-title":"Chronic thromboembolic pulmonary hypertension - assessment by magnetic resonance imaging","volume":"17","author":"Kreitner","year":"2007","journal-title":"Eur Radiol"},{"key":"2023041909141058600_b33","first-page":"230","article-title":"Guidelines on the management of valvular heart disease. The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology","volume":"28","author":"Vahanian","year":"2007","journal-title":"Eur Heart J"},{"key":"2023041909141058600_b34","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1136\/hrt.2008.152793","article-title":"Factors associated with development of late significant tricuspid regurgitation after successful left-sided surgery","volume":"95","author":"Song","year":"2009","journal-title":"Heart"},{"key":"2023041909141058600_b35","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.athoracsur.2004.06.057","article-title":"Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair?","volume":"79","author":"Dreyfus","year":"2005","journal-title":"Ann Thorac Surg"},{"key":"2023041909141058600_b36","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/S0022-5223(19)36074-X","article-title":"Immediate tricuspid valve replacement for endocarditis. Indications and results","volume":"91","author":"Stern","year":"1986","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023041909141058600_b37","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.amjcard.2006.03.047","article-title":"Prediction of outcome in patients undergoing surgery for severe tricuspid regurgitation following mitral valve surgery and role of tricuspid annular systolic velocity","volume":"98","author":"Kwon","year":"2006","journal-title":"Am J Cardiol"},{"key":"2023041909141058600_b38","first-page":"20","article-title":"Tricuspid valve replacement subsequent to previous open heart surgery","volume":"5","author":"Hornick","year":"1996","journal-title":"J Heart Valve Dis"},{"key":"2023041909141058600_b39","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/S1010-7940(00)00598-4","article-title":"Outcome following isolated tricuspid valve replacement","volume":"19","author":"Mangoni","year":"2001","journal-title":"Eur J Cardiothorac Surg"},{"issue":"12 Suppl S","key":"2023041909141058600_b40","doi-asserted-by":"crossref","first-page":"5S","DOI":"10.1016\/j.jacc.2004.02.037","article-title":"Clinical classification of pulmonary hypertension","volume":"43","author":"Simonneau","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"2023041909141058600_b41","doi-asserted-by":"crossref","first-page":"2250","DOI":"10.1161\/CIRCULATIONAHA.109.192230","article-title":"ACCF\/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association","volume":"119","author":"McLaughlin","year":"2009","journal-title":"Circulation"},{"key":"2023041909141058600_b42","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1161\/01.CIR.0000029100.82385.58","article-title":"Survival in primary pulmonary hypertension: the impact of epoprostenol therapy","volume":"106","author":"McLaughlin","year":"2002","journal-title":"Circ"},{"key":"2023041909141058600_b43","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/S0735-1097(02)02012-0","article-title":"Long-term intravenous epoprostenol infusion in primary pulmonary hypertension: prognostic factors and survival","volume":"40","author":"Sitbon","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2023041909141058600_b44","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/j.ahj.2007.02.037","article-title":"A meta-analysis of trials of pulmonary hypertension: a clinical condition looking for drugs and research methodology","volume":"153","author":"Macchia","year":"2007","journal-title":"Am Heart J"},{"key":"2023041909141058600_b45","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1161\/CIRCULATIONAHA.105.592386","article-title":"Pulmonary vascular disease in adults with congenital heart disease","volume":"115","author":"Diller","year":"2007","journal-title":"Circ"},{"key":"2023041909141058600_b46","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1016\/S0003-4975(03)00828-2","article-title":"Pulmonary endarterectomy: experience and lessons learned in 1,500 cases","volume":"76","author":"Jamieson","year":"2003","journal-title":"Ann Thorac Surg"},{"key":"2023041909141058600_b47","first-page":"6","article-title":"La anuloplastia selective, reguable y permanente","volume":"25","author":"DeVega","year":"1972","journal-title":"Rev Esp Cardiol"},{"key":"2023041909141058600_b48","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.jtcvs.2003.11.019","article-title":"Tricuspid valve repair: durability and risk factors for failure","volume":"127","author":"McCarthy","year":"2004","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2023041909141058600_b49","doi-asserted-by":"crossref","first-page":"I577","DOI":"10.1161\/CIRCULATIONAHA.105.001263","article-title":"Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes","volume":"114","author":"Tang","year":"2006","journal-title":"Circ"},{"key":"2023041909141058600_b50","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1016\/j.athoracsur.2006.06.016","article-title":"Midterm outcomes of tricuspid valve repair versus replacement for organic tricuspid disease","volume":"82","author":"Singh","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"2023041909141058600_b51","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1510\/icvts.2007.159277","article-title":"Should the tricuspid valve be replaced with a mechanical or biological valve?","volume":"6","author":"Kunadian","year":"2007","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"2023041909141058600_b52","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1016\/j.athoracsur.2005.11.005","article-title":"Long-term clinical results of tricuspid valve replacement","volume":"81","author":"Chang","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"2023041909141058600_b53","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.amjcard.2008.09.106","article-title":"Comparison of the outcome of porcine bioprosthetic versus mechanical prosthetic replacement of the tricuspid valve in the Ebstein anomaly","volume":"103","author":"Brown","year":"2009","journal-title":"Am J Cardiol"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/86\/1021\/648\/50022727\/postgradmedj-86-648.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/86\/1021\/648\/50022727\/postgradmedj-86-648.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T09:36:16Z","timestamp":1681896976000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/86\/1021\/648\/7019366"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,10,18]]},"references-count":53,"journal-issue":{"issue":"1021","published-online":{"date-parts":[[2010,10,18]]},"published-print":{"date-parts":[[2010,11,1]]}},"URL":"https:\/\/doi.org\/10.1136\/pgmj.2009.090886","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2010,11]]},"published":{"date-parts":[[2010,10,18]]}}}