Can a better understanding of the ‘forgotten valve’ help patients with heart disease?

An illustration of a heart showing tricuspid valve

The tricuspid valve, on the right side of the heart, separates the upper and lower chambers, also known as the right atrium and right ventricle. The valve allows deoxygenated blood to flow through both of the chambers. The right ventricle pumps blood to the lungs, where it is oxygenated.

The tricuspid valve is anatomically susceptible to regurgitation. Tricuspid valve regurgitation (TR) is a condition in which the valve between the right ventricle and right atrium does not close properly. The malfunctioning valve allows blood to flow back into the heart's right atrium.

Trivial, or mild TR, is considered a normal echocardiographic finding and is found in virtually all healthy individuals. The prevalence of moderate and severe TR increases with age, and is often associated with significant left-sided heart disease and/or pulmonary hypertension. Moderate or severe TR can be tolerated for a period of time before right ventricular dilatation or dysfunction becomes clinically significant. However, severe TR, if left untreated, is associated with poor prognosis and increased mortality.

Data access has been approved for a research project aiming to identify echocardiographic parameters that are linked to negative clinical outcomes in patients with severe isolated tricuspid regurgitation. The project is being undertaken by Dr. Louis-Phillipe David as part of his postgraduate studies, under the supervision of Dr. Jasmine Grewal, Clinical Assistant Professor in the Faculty of Medicine at the University of British Columbia and Staff Cardiologist at St. Paul’s Hospital. It is hoped that the project will lead to improvements in patient selection for targeted tricuspid valve intervention.

“For a long time, the tricuspid valve was considered the forgotten valve,” says Dr. Louis-Phillpe David. ”The recent emergence in transcatheter options to treat tricuspid valve pathologies has contributed to the need for better understanding of the evolution and prognostic implications of such pathologies.”

The study will conduct a retrospective analysis of all patients with a diagnosis of severe tricuspid regurgitation on an echocardiography report between 2002 and 2018 at St Paul’s Hospital, Vancouver, BC. PopData will then link these patients with severe TR to the following data sets from the BC Ministry of Health: the Discharge Abstracts Database; Vital Events and Statistics Deaths; Medical Services Plan (MSP) Payment Information; and Consolidation files. This will provide Dr. David with data on the baseline characteristics and long-term outcomes of patients with isolated severe TR, in addition to information on patients with severe TR that do not meet criteria for isolated TR.

Dr. David believes that surgical intervention for TR is often performed when right ventricle dilatation and dysfunction might already have reached an irreversible stage. Furthermore, when assessing outcomes of patients with severe TR, it is unclear if the poorer prognosis is due to the tricuspid valve pathology itself or if TR acts as an adverse marker of the severity of the left-side pathology. Dr. David contends that current guidelines do not provide indications for surgical intervention on severe isolated TR and that the findings from this study would support surgery on these patients.