title: Rheumatic tricuspid valve disease: an evidence-based systematic overview.
abstract: OBJECTIVE
  Right-sided valve abnormalities are less common than their left-sided counterparts. Furthermore, whilst organic rheumatic involvement of the tricuspid valve is not uncommon, it receives less attention than left-sided heart valves. An evidence-based systematic overview was carried out to assess the epidemiology, diagnosis and management of organic rheumatic tricuspid valve disease (RTVD) over the past half century.
  
  
  METHODS
  A computed search spanning more than four decades was conducted to identify articles on various aspects of RTVD. The bibliographies of all relevant articles were also searched.
  
  
  RESULTS
  A total of 2,497 rheumatic heart disease patients (mean age 25.5 years; female:male ratio 1.3:1) was included. RTVD was detected in 193 patients (7.7%). Echocardiography was used to detect tricuspid valve involvement in all patients. Associated mitral valve disease was present in 99.3% of the patients with RTVD. A total of 1,092 patients (mean age 45.4 years) was included from six studies on surgical correction of the tricuspid valve. Of these patients, 278 (25.4%) underwent tricuspid valve replacement, while 814 (74.5%) had tricuspid valve repair. The in-hospital mortality was 9.9%, and late mortality 33.2%
  
  
  CONCLUSIONS
  RTVD is not uncommon among patients with rheumatic heart disease, but attracts less attention and might, therefore, be overlooked. Echocardiography is the most common diagnostic tool. Although indications for surgical intervention are not well defined, valve repair may have a better outcome than replacement.
authors.affiliation: Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Fateh Ali Tipoo
authors.initials: FA
authors.lastname: Sultan
authors.forename: Sherif E
authors.initials: SE
authors.lastname: Moustafa
authors.forename: Jamil
authors.initials: J
authors.lastname: Tajik
authors.forename: Tahlil
authors.initials: T
authors.lastname: Warsame
authors.forename: Usha
authors.initials: U
authors.lastname: Emani
authors.forename: Mohsen
authors.initials: M
authors.lastname: Alharthi
authors.forename: Farouk
authors.initials: F
authors.lastname: Mookadam
mesh_terms: D000328:Adult; D015150:Echocardiography, Doppler; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D014261:Tricuspid Valve / Q000601:surgery*