p.38 抽出テキスト

...................................... Therefore, TTVI may be considered by the Heart Team at experienced Heart Valve Centres in symptomatic, inoperable, anatomically eligible patients in whom symptomatic or prognostic improvement can be expected. For detailed anatomical evaluation, TOE and CCT may be preferred owing to higher spatial resolution.448,449

8.3 Medical therapy

Diuretics are useful in the presence of right heart failure. To counterbalance the activation of the renin-angiotensin-aldosterone system associated with hepatic congestion, the addition of an aldosterone antagonist may be considered.247 Dedicated treatment of pulmonary hypertension is indicated in specific cases. Although data are limited, rhythm control may help to decrease tricuspid regurgitation and contain annular dilatation in patients with chronic AF.450 Importantly, in the absence of advanced RV dysfunction or severe pulmonary hypertension, none of the above-mentioned therapies should delay referral for surgery or transcatheter therapy.

9 Tricuspid stenosis

Tricuspid stenosis is often combined with tricuspid regurgitation and most frequently of rheumatic origin. It is therefore usually associated with left-sided valve lesions, particularly mitral stenosis. Other causes are rare, including congenital, carcinoid and drug-induced valve diseases, Whipple’s disease, endocarditis, and large right atrial tumour.

Management of tricuspid regurgitation

Need for left-sided valve surgery

Severe secondary TR N Y

N

Severity/aetiology of TR Severity/aetiology of TR

Severe primary TR Mild-moderate TR Severe primary or

secondary TR

Medical therapy TV repair or replacementb Evaluation of trans-

catheter therapya TV repair or replacementb

Severe RV/LV dysfunction or severe pulmonary

hypertension

Symptomatic

RV dilatation Symptomatic

RV dilatation TA dilatation

No concomitant

TV surgery Y

N

N

N Y N

N

Medical therapy

Appropriate for surgery according to the Heart Team

N Y

Y

Y

Y

Y

Figure 8 Management of tricuspid regurgitation. LV= left ventricle/left ventricular; RV= right ventricle/right ventricular; TA= tricuspid annulus; TR= tricuspid regurgitation; TV= tricuspid valve. aThe Heart Team with expertise in the treatment of tricuspid valve disease evaluates anatomical eligibility for transcatheter therapy including jet location, coaptation gap, leaflet tethering, potential interference with pacing lead. bReplacement when repair is not feasible. Downloaded from academic.oup.com/eurheartj/article/43/7/561/6358470 by guest on 07 October 2026