Tricuspid regurgitation (TR) is the most common tricuspid valve disease. Tricuspid regurgitation refers to a failure in the normal closure of the tricuspid valve due to congenital abnormalities or acquired diseases, causing blood to flow back from the right ventricle to the right atrium. Tricuspid regurgitation occurs in 65% to 85% of the population [1, 2]. In its mild form, the disease is very common and generally benign, while moderate or severe cases may lead to irreversible myocardial injury and adverse consequences [3]. An epidemiological study in the United States has shown that the prevalence of moderate and more severe TR among the overall population is about 0.55%. However, the prevalence increases significantly with age, and the probability increases to 4% for people aged over 75 [4].
Current guidelines prefer concurrent tricuspid valve repair in surgical interventions for left heart-related disease, even if the TR is mild to moderate; whereas isolated tricuspid valve surgery requires careful consideration, especially in cases with late reoperation and a history of left heart valve surgery [5,6]. The interventional therapy of TR has been developed alongside those for aortic valve diseases and mitral regurgitation. Notably, the rapid development of instruments and technologies for mitral valve interventional therapy in recent years has led to the development of a number of tricuspid valve instruments and technologies, including: transcatheter edge-to-edge repair, annular contraction, regurgitant area blockade, chordae tendineae intervention, ectopic valve replacement and in-situ valve replacement [6].
Most tricuspid valve intervention devices are in the clinical study stage. At present, only three products in the world have been CE certified and approved for clinical application, including two for transcatheter edge-to-edge repair.
尽管经导管三尖瓣介入治疗开展较晚，目前还处于起步阶段，经导管缘对缘三尖瓣修复已目前国际上最为广泛应用的三尖瓣反流介入治疗方式[1]，其早期临床研究的实验结果证明了该技术的可行性与有效性[2]。与传统开胸手术相比，经导管三尖瓣缘对缘修复的方式，为继发性三尖瓣反流的患者带来一种有希望的介入替代方式[1]。
参考文献
[1] Lavie CJ, Hebert K, Cassidy M. Prevalence and severity of Doppler-detected valvular regurgitation and estimation of right-sided cardiac pressures in patients with normal two-dimensional echocardiograms. Chest 1993;103:226–231.
[2] Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 1999;83:897–902.
[3] Mani Arsalan, Thomas Walther, Robert L.Smith,II, Paul A.Grayburn, Tricuspid regurgitation diagnosis and treatment, European Heart Journal, Volume 38, Issue 9, 1 March 2017, Pages 634–638, https://doi.org/10.1093/eurheartj/ehv487].
[4] Topilsky Y, Maltais S, Medina Inojosa J, et al. Burden of tricuspid regurgitation in patients diagnosed in the community setting[J]. JACC Cardiovasc Imaging, 2019, 12 (3) : 433-442 DOl:10.1016/j.jcmg.2018.06.014.
[5] Vahanian A, Beyersdorf F, Praz F, et al; ESC/EACTS Scientific Document Group; ESC Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2021 Aug 28:ehab395. doi: 10.1093/eurheartj/ehab395.
[6] 结构性心脏病年度报告2021
参考文献
[1] Overtchouk, P.,Piazza, N., Granada, J., Soliman, O., Prendergast, B., & Modine,T.(2020).Advances in transcatheter mitral and tricuspid therapies. BMC Cardiovascular Disorders, 20(1). https://doi.org/10.1186/s12872-019-01312-3
[2] Besler,C.,Orban, M.,Rommel,K.,Braun,D.,Patel, M.,& Hagl, C.et al.(2018).Predictors of Procedural and Clinical Outcomes in Patients With Symptomatic Tricuspid Regurgitation Undergoing Transcatheter Edge-to-Edge Repair.JACC:Cardiovascular Interventions,11(12), 1119-1128. https://doi.org/10.1016/j.jcin.2018.05.002
