eComment: Which functional tricuspid regurgitation should be surgically corrected?

7. Clinical bottom line TV insufficiency should be treated during left-sided valve surgery when TR annulus is dilated (G21 mmym ;)70 mm 2 intra-operatively; G3.5 cm at trans-thoracic echocardio-graphy (TTE) w18x) regardless of the absolute grade of regurgitation, in cases of preoperative AF, trans-tricuspid PMK lead and underlying rheumatic disease. Also, 'ring' annuloplasty techniques should be preferred over the 'non-ring' techniques. Sagie A. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. valve surgery for functional mitral regurgi-tation: should moderate-or-more tricuspid regurgitation be treated? a propensity score analysis. significant functional tricuspid regurgitation late after mitral valve replacement for predominant rheumatic mitral stenosis. Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery. regurgitation secondary to mitral valve disease: tricuspid annulus function as guide to tricuspid valve repair. Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes. Impact of the Maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time. Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations. reductive annuloplasty of the mitral and tricuspid valves in patients with end-stage ischemic dilated cardiomyopathy. Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyo-pathy. We thank Giacomo Bianchi and associates for their actual report w1x. Tricuspid regurgitation (TR) is common in patients with left-sided heart valve disease. It is well known that moderate or more functional TR should be repaired. Many investigators have recommended surgical treatment from moderate to severe TR and assumed that a mild degree of functional TR could be expected to diminish after surgical relief of left-sided valve pathology. But, correction of left-sided valvular disease does not automatically correct TR. Treatment of the mitral lesion alone only decreases the afterload. Neither does it correct tricuspid dilatation nor does it affect preload or right ventricular (RV) function w2x. Dilatation of the tricuspid annulus is progressive and may not be accompanied by TR initially, but eventually leads to it. The normal tricuspid valve (TV) annulus is saddle-shaped. It is known that with functional TR the annulus becomes larger, more planar, and circular. The flattening of the TV annulus that occurs with TR can potentially alter the normal papillary muscle-to-leaflet and annulus relationship. With flattening of the annulus, the low points of the annulus may be stretched away from the papillary muscles, thereby increasing tethering. …