Patient handout

Chronic tricuspid regurgitation

PRODUCTION

1. Your condition

This handout is for chronic tricuspid regurgitation. Your care team identified this based on: refractory peripheral edema / ascites / hepatic congestion.

Other reasons your team may use this plan: echo: severe/massive/torrential tr (vc ≥0.7 cm, eroa ≥0.40 cm², annulus ≥40 mm); holosystolic murmur at llsb increasing with inspiration (carvallo); transvalvular cied lead(s) with new/worsening tr.

3. When to call your provider

Contact your care team if any of the following happen:

Progressive RV dysfunction or cardiac cirrhosis → expedite TV intervention before inoperable — 2020 ACC/AHA VHD
Severe TR at planned left-sided valve surgery → concomitant TV surgery (Class I) — 2020 ACC/AHA VHD
Decompensated right HF/shock → ED + right-HF/shock pathway — 2022 ACC/AHA HF

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Severe TR in a patient undergoing left-sided valve surgery — Class I concomitant TV repair — 2020 ACC/AHA VHD
Isolated severe symptomatic primary TR with progressive RV dilatation/dysfunction — Class IIa surgery; refer before RV failure — 2020 ACC/AHA VHD
Carcinoid heart disease — somatostatin analog control + TV (and pulmonary valve) surgery; 5-HIAA + hormone load management — 2020 ACC/AHA VHD
Cardiac cirrhosis / congestive hepatopathy (rising bilirubin, MELD-XI) — hepatology co-management; prohibitive surgical risk if advanced — 2020 ACC/AHA VHD
Tricuspid IE (IVDU) with leaflet destruction — route to IE engine for antibiotic + surgical timing — 2020 ACC/AHA VHD

5. Follow-up

Re-route to left-heart / PH / AF / IE engines; transplant if end-stage RV

6. Sources

Guideline: 2020 ACC/AHA VHD Guideline + 2021 ESC/EACTS VHD Guideline