title: Tricuspid regurgitation after cardiac transplantation: an old problem revisited.
abstract: Tricuspid regurgitation (TR) is the most common valvular abnormality after orthotopic heart transplantation (OHT), with a reported incidence of up to 84%, depending on the definition of significant regurgitation and surgical methods of OHT employed. While multiple etiologies are implicated in the development of TR after OHT, endomyocardial biopsy (EMB), performed to detect allograft rejection, is the single most important contributor to significant TR by causing anatomic disruption of the tricuspid valvular structure. Although the clinical course of TR is heterogeneous, hemodynamically significant regurgitation generally leads to progressive right-heart dysfunction and symptoms. In cases refractory to diuretic-based medical therapy, surgical correction of TR has been shown to effectively alleviate the condition and provide symptomatic and organ function improvement. Tricuspid valve repair and replacement are viable surgical options, the application of which often depends on the institution's experience and underlying valve pathology. A non-invasive surveillance technique to detect allograft rejection is on the horizon, and may reduce the number of EMBs performed as well as the procedure-related tissue damage that leads to TR.
authors.affiliation: Section of Heart Failure Transplantation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. hannam@ccf.org
authors.forename: Raymond Ching-Chiew
authors.initials: RC
authors.lastname: Wong
authors.forename: Zuheir
authors.initials: Z
authors.lastname: Abrahams
authors.forename: Mazen
authors.initials: M
authors.lastname: Hanna
authors.forename: Joseph
authors.initials: J
authors.lastname: Pangrace
authors.forename: Gozalo
authors.initials: G
authors.lastname: Gonzalez-Stawinski
authors.forename: Randall
authors.initials: R
authors.lastname: Starling
authors.forename: David
authors.initials: D
authors.lastname: Taylor
mesh_terms: D001706:Biopsy; D018450:Disease Progression; D006084:Graft Rejection / Q000175:diagnosis / Q000473:pathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D009206:Myocardium / Q000473:pathology; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000209:etiology* / Q000503:physiopathology* / Q000601:surgery