The Rediscovered Tricuspid Valve: Structure, Function and Clinical Significance in Health and Disease


Giacomo Bianchi, MD, PhD (Editor)
Ospedale del Cuore – Fondazione ”G. Monasterio”, via Aurelia Sud, Massa, Italy

Series: Cardiology Research and Clinical Developments
BISAC: MED010000

Tricuspid valve disease has long been ignored as a surrogate for the left atrioventricular valve (the mitral valve) and mainly a benign, indolent disease.

This concept is currently outdated, as we know that the pathology of the tricuspid valve, primitive or secondary, sometimes isolated, brings with it a poor prognosis if not treated. To date, the complexity is recognized not only of the valve itself, but also of its pathophysiology and the environment of the right heart and its interaction with the left heart. In order to better define the therapeutic path of a patient suffering from tricuspid valve disease, we have tried to offer a comprehensive overview to the reader, starting from historical considerations (Chapter 1) about the vision of the circulatory system and from the evidence accumulated over the centuries until the recognition of the continuum between signs and symptoms related to the valve.

As the basis of a modern approach to the understanding of the valve itself, we have traced the embryological and morphogenetic stages towards the anatomo-clinical correlates (Chapter 2). Subsequently, the epidemiology and clinical approach to tricuspid valve disease (Chapter 3) were illustrated, followed by the diagnostic procedure, state-of-the-art imaging techniques (Chapter 4) and more advanced techniques (Chapter 5). In particular, I thought it was necessary to dedicate a chapter to the pathology of the tricuspid valve secondary (functional) to left heart disease (Chapter 6), probably the most frequent form encountered by the clinicians. We have not neglected to discuss about tricuspid valve infections (Chapter 7), with particular reference to the microbiology, diagnosis and treatment.

We considered it necessary that the role of the valve in congenital adult disease should also be addressed (Chapter 8), whether in natural history, modified by surgery or as an acquired disease. Neoplastic pathology may also involve the valve and the pathologist provides (Chapter 9) the knowledge and systematization of the most frequent primary and secondary tumors. Coming to the therapeutic act, after dealing with special pathology of the valve, (Chapter 10) we present the pharmacological approach, a necessary act, sometimes as a sole therapeutic option and sometimes propedeutic to surgery.

Tricuspid valve plays an absolutely primary role in two aspects of the advanced treatment of refractory heart failure, namely its clinical and prognostic impact on ventricular care systems (LVAD) and cardiac transplantation (Chapter 11) has been discussed. The last two chapters are dedicated to non-medical treatment, with a particular focus on indications, risk selection and stratification as well as adequate surgical techniques (Chapter 12) and new perspectives of intervention through transcatheter techniques (Chapter 13).

Overall, there is a need for an integrated and multidisciplinary approach to a complex nosological entity that is itself interdependent on pathophysiological systems, which the clinician, cardiologist, cardiac surgeon, internist and researcher cannot ignore.
(Imprint: Nova Medicine and Health)

Table of Contents

Table of Contents


Chapter 1. The Tricuspid Valve: From the “Forgotten” Valve to the “Fulcrum” of the Right Heart Historical Perspective
(Giacomo Bianchi, MD, PhD, Adult Cardiac Surgery Department, Ospedale del Cuore, Fondazione “G. Monasterio”, Massa, Italy)

Chapter 2. The Functional Anatomy and Pathology of the Tricuspid Valve: Morphogenesis, Normal and Pathological Anatomy
(Giacomo Bianchi, MD, PhD, and Angela Pucci, MD, PhD, Adult Cardiac Surgery Department, Ospedale del Cuore, Fondazione “G. Monasterio”, Massa, Italy, and others)

Chapter 3. The Diseased Tricuspid Valve: Epidemiology and Clinical Approach to the Tricuspid Valve Disease
(Chiara Borrelli, MD, Alessandra Burini, MD, Enrica Manzato, MD, Cristina Zucchinetti, MD, and Claudio Passino, MD, PhD, Scuola Superiore Sant’Anna, Pisa, Italy, and others)

Chapter 4. Non-Invasive Imaging of the Tricuspid Valve – Ultrasounds: Transthoracic and Transesophageal Echocardiography
(Giulia Elena Mandoli, MD, Alberto Giannoni, MD, PhD, Chiara Borrelli, MD, Matteo Cameli, MD, PhD, Department of Cardiovascular Disease, University of Siena, Siena, Italy, and others)

Chapter 5. Advanced Imaging and Functional Tools for Tricuspid Valve Assessment: Cardiac MRI, Ct-Scan and Cardiopulmonary Exercise Test
(Giovanni Donato Aquaro, MD, PhD, Alberto Clemente, MD, Daniele Caratozzolo, MD, and
Claudio Passino, MD, PhD, Magnetic Resonance Imaging Unit, Fondazione “G. Monasterio”, Pisa, Italy, and others)

Chapter 6. Functional Disease: Tricuspid Valve in Left-Sided Heart Disease
(Giovanni Benfari, MD, Andrea Rossi, MD, and Francesco Grigioni, MD, PhD, Section of Cardiolgy, Department of medicine, University of Verona, Italy, and others)

Chapter 7. Tricuspid Valve Endocarditis: Epidemiology, Treatment and Outcomes
(Enrico Tagliaferri, MD, Department of Infectious Disease, University of Pisa, Pisa, Italy)

Chapter 8. Tricuspid Valve Disease in Adults with Congenital Heart Disease in Natural or Modified History
(Elisa Barberi, MD, and Vitali Pak, MD, Pediatric Intensive Care Unit, Ospedale del Cuore, Fondazione Toscana “G. Monasterio”, Massa, Italy, and others)

Chapter 9. Neoplastic Disorders Involving the Right Heart and the Tricuspid Valve
(Angela Pucci MD, PhD, Histopathology Department, Pisa University Hospital, Pisa, Italy)

Chapter 10. Pharmacological Treatment of Tricuspid Regurgitation
(Alberto Aimo MD, Luigi Francesco Saccaro, MD, Valentina Galfo, MD, Lucio Teresi, MD, and
Michele Emdin, MD, PhD, Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy)

Chapter 11. Tricuspid Valve in the Failing Heart: The Role of Tricuspid Valve during Mechanical Circulatory Support and in Heart Transplantation
(Ciro Mastroianni, MD, PhD, Antonio Nenna, MD, Mariafrancesca Fiorentino, MD, Sofia Martin-Suarez, MD, Massimo Chello, MD, and Antonio Loforte, MD, PhD, Cardiovascular Surgery, Università Campus Bio-Medico, Rome, Italy, and others)

Chapter 12. Surgical Treatment of Functional Tricuspid Valve Disease: Surgeon’s Perspective – Indications, Risk Stratification and Outcomes
(Giacomo Bianchi, MD, PhD, Rafik Margaryan, MD, PhD, and Marco Solinas, MD, Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana “G. Monasterio”, Massa, Italy)

Chapter 13. Novel Transcatheter Therapies for Treating Tricuspid Regurgitation
(Mizuki Miura, MD, Francesco Maisano, MD, PhD, Oscar Cuevas, MD, Mara Gavazzoni, MD, Alberto Pozzoli, MD, and Maurizio Taramasso, MD, PhD, Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland)




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