References

1. Said SM, Burkhart HM, Dearani JA. Surgical management of congenital (non-Ebstein) tricuspid valve regurgitation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu . 2012;15(1):46-60.

2. Reddy VM, McElhinney DB, Brook MM, Silverman NH, Stanger P, Hanley FL. Repair of congenital tricuspid valve abnormalities with artificial chordae tendineae. Ann Thorac Surg . 1998;66(1):172-176.

3. Lewis MJ, Ginns JN, Ye S, Chai P, Quaegebeur JM, Bacha E, et al. Postoperative tricuspid regurgitation after adult congenital heart surgery is associated with adverse clinical outcomes. J Thorac Cardiovasc Surg . 2016;151(2):460-465.

4. Said SM, Dearani JA, Burkhart HM, Connolly HM, Eidem B, Strensrud PE, et al. Management of tricuspid regurgitation in congenital heart disease: is survival better with valve repair?. J Thorac Cardiovasc Surg . 2014;147(1):412-417.

5. Dreyfus J, Flagiello M, Bazire B, Eggenspieler F, Viau F, Riant E, et al. Isolated tricuspid valve surgery: impact of aetiology and clinical presentation on outcomes. Eur Heart J . 2020;41(45):4304-4317.

6. Kawsara A, Alqahtani F, Nkomo VT, Eleid MF, Pislaru SV, Rihal CS, et al. Determinants of Morbidity and Mortality Associated With Isolated Tricuspid Valve Surgery. J Am Heart Assoc . 2021;10(2):e018417

7. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation . 2021;143(5):e35-e71.

8. Fender EA, Zack CJ, Nishimura RA. Isolated tricuspid regurgitation: outcomes and therapeutic interventions. Heart. 2018 May;104(10):798-806.

9. Lee H, Kim J, Oh SS, Yoo JS. Long-term clinical and hemodynamic outcomes of edge-to-edge repair for tricuspid regurgitation. Ann Thorac Surg . 2021;112(3):803-808.

Figure 1. Transesophageal echocardiogram depicting severe regurgitation and flail anterior leaflet of the tricuspid valve (arrow).

Figure 2. Continuous wave color flow Doppler through the tricuspid valve illustrating the classic triangular “dagger-shaped” Doppler pattern in severe tricuspid regurgitation.

Figure 3. Transesophageal echocardiographic evaluation of severe tricuspid regurgitation demonstrating right atrial and ventricular enlargement with septally directed eccentric regurgitant jet and prolapse of anterior leaflet of the tricuspid valve (arrow). RA, right atrium. RV, right ventricle.

Figure 4. Intraoperative transesophageal echocardiogram following completion of tricuspid valve repair and weaning from cardiopulmonary bypass, depicting mild tricuspid regurgitation.