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

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This concept is currently outdated, as we know  that the pathology of the tricuspid valve, primitive or secondary,  sometimes isolated, brings with it a poor prognosis if not treated.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)