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Advocacy for more consideration of the secondary tricuspid regurgitation
  1. Erwan Donal1,
  2. Elena Galli2,
  3. Auriane Bidaut2
  1. 1 Cardiologie & Universite Rennes 1, CHU Rennes & INSERM 1099, Rennes, France
  2. 2 Cardiology, CHU Rennes, Rennes, France
  1. Correspondence to Pr Erwan Donal, Service de Cardiologie - Hôpital Pontchaillou – CHU, Rennes F 35033, France; erwan.donal{at}

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The tricuspid valve is the largest orifice among the four cardiac valves. Secondary tricuspid regurgitation (TR) is not a disease of the leaflets but the consequence of loading conditions and of right chambers remodelling (figure 1). Prevalence of TR in the general population is equivalent to the one of aortic stenosis.1

Figure 1

Vicious circle of the secondary tricuspid regurgitation.

The prevalence is high and the presence and severity sometimes unexpected. If age, gender, atrial arrhythmias or history of left heart surgery is associated with the risk of developing TR,2 not every single patient with atrial fibrillation and some degree of heart failure might one day have severe TR. The pathophysiology of secondary TR remains incompletely understood. The anatomy of the tricuspid valve apparatus is complicated to understand with many variabilities among patients. Secondary TR is highly load-dependent and diuretics might mask the TR for some time. Therefore, it sometimes remains challenging to understand why one patient develops TR and not others despite having …

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  • Contributors AB and EG helped ED significantly in writing this editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Patient consent for publication Not required.

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