What are the guideline sources, guidelines and references for Tricuspid regurgitation ?
Guideline sources The following summarized guidelines for the evaluation and management of tricuspid regurgitation (TR) are prepared by our editorial team based on guidelines from the European Society of 1 Cardiology (ESC/EACTS 2021) and the American Heart Association (AHA/ACC 2021). 2 Calculator Calculator Calculator Cardiac Anesthesia Risk Evaluati NYHA functional classification f Revised C Guidelines 1. Diagnostic investigations Transthoracic echocardiography: obtain TTE in patients with TR to evaluate the presence and severity of TR, determine the etiology, measure the sizes of right-sided chambers and IVC, assess RV systolic function, estimate pulmonary artery systolic pressure, and characterize any associated left-sided heart disease. B https://web.pathway.md/diseases/recPhkVo8yoMVbOjS 1/3 6/24/23, 4:09 PM Tricuspid regurgitation Pathway 2. Diagnostic procedures Cardiac catheterization: consider obtaining invasive measurement of the cardiac index, right- sided diastolic pressures, pulmonary artery pressures, and pulmonary vascular resistance, as well as right ventriculography in patients with TR, if clinical and noninvasive data are discordant or inadequate. C 3. Medical management Pharmacotherapy: Consider offering diuretics in patients with signs and symptoms of right-sided HF attributable to severe TR (stages C and D). C Consider treating the primary causes of HF (such as pulmonary vasodilators to reduce elevated pulmonary artery pressures, guideline-directed medical therapy for HF with reduced LV ejection fraction or rhythm control of AF) in patients with signs and symptoms of right-sided HF attributable to severe secondary TR (stages C and D). C 4. Therapeutic procedures Transcatheter tricuspid valve intervention: consider performing transcatheter intervention in symptomatic inoperable patients with secondary severe TR at a heart valve center with expertise in the treatment of tricuspid valve disease. C 5. Surgical interventions Indications for surgery, asymptomatic patients: As per AHA/ACC 2021 guidelines, consider performing isolated tricuspid valve surgery in asymptomatic patients with severe primary TR (stage C) and progressive RV dilation or systolic dysfunction. C As per EACTS/ESC 2021 guidelines, consider performing surgery in asymptomatic or mildly symptomatic patients with isolated severe primary TR and RV dilatation being appropriate candidates for surgery. C Indications for surgery, symptomatic patients: As per AHA/ACC 2021 guidelines, perform tricuspid valve surgery in patients with severe TR (stages C and D) undergoing left-sided valve surgery. B Show 3 more As per EACTS/ESC 2021 guidelines, perform surgery in patients with severe primary B or secondary TR undergoing left-sided valve surgery. B Show 4 more https://web.pathway.md/diseases/recPhkVo8yoMVbOjS 2/3 6/24/23, 4:09 PM Tricuspid regurgitation Pathway 6. Specific circumstances Patients with tricuspid stenosis: perform surgery in symptomatic patients with severe tricuspid stenosis and in patients with severe tricuspid stenosis undergoing left-sided valve intervention. B Pregnant patients (before pregnancy): obtain clinical evaluation and TTE in female patients with suspected valve disease contemplating pregnancy. B Show 5 more Pregnant patients (during pregnancy): obtain monitoring of pregnant patients with severe valve disease (stages C-D) in a tertiary-care center with a dedicated heart valve team of cardiologists, surgeons, anesthesiologists, and maternal-fetal medicine obstetricians with expertise in the management of high-risk cardiac conditions during pregnancy. B Show 5 more Patients undergoing non-cardiac surgery: Obtain preoperative echocardiography in patients with clinically suspected moderate or greater degrees of valvular regurgitation undergoing non-cardiac surgery. B Perform valvular intervention before elective non-cardiac surgery to reduce perioperative risk if possible, depending on the urgency and risk of the noncardiac procedure, in patients meeting standard indications for intervention for VHD (replacement and repair) based on symptoms and disease severity. B References 1. Alec Vahanian, Friedhelm Beyersdorf, Fabien Praz et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology ESC and the European Association for Cardio-Thoracic Surgery EACTS . Eur Heart J. 2021;ehab395. Open 2. Catherine M Otto, Rick A Nishimura, Robert O Bonow et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg. 2021 Aug;162 2):e183-e353. Open https://web.pathway.md/diseases/recPhkVo8yoMVbOjS 3/3