Correction of Tricuspid Regurgitation in Pulmonary Arterial Hypertension
Abstract
BACKGROUND: Pulmonary hypertension is a contraindication to correction of tricuspid regurgitation.
CASE SUMMARY: A 75-year-old Italian woman with previous episodes of right heart failure was diagnosed with World Health Organization (WHO) functional class IV pulmonary arterial hypertension (PAH) complicated by torrential tricuspid regurgitation. After 6 months of treatment with diuretic agents, macitentan, and tadalafil, she improved to WHO functional class III, with a pulmonary vascular resistance (PVR) decreasing from 5.4 to 3 Wood units. She then underwent transcatheter valve repair. One year later, she was in WHO functional class I with a PVR of 2.2 Wood units.
DISCUSSION: Right heart failure with a moderate increase in PVR in PAH may be caused by severe tricuspid insufficiency. Transtricuspid valve repair under optimized medical treatment may then be successful.
TAKE-HOME MESSAGE: Severe tricuspid regurgitation in PAH may be the dominant cause of right heart failure and is amenable to transcatheter repair under optimal medical therapy.
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