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The Right Ventricle in the Trans-Catheter Era: A Perspective for Planning Interventions

      Dysfunction of the right ventricle (RV) is common in patients with advanced left-sided valve disease and the significant impact of RV dysfunction on both short and long-term outcome is well established. However, considerations of RV function are largely absent in current management guidelines for valve disease and cardiac procedural risk models. As the indications and use of trans-catheter therapies rapidly expand for patients with acquired valvular disease, it is critical for clinicians to understand and consider RV function when making decisions for these patients. This review summarizes contemporary data on the assessment of RV function, the prognostic importance of baseline RV dysfunction on surgical and transcatheter procedures for acquired left-sided valvular disease, and the relative impact of these interventions on RV function. Baseline RV dysfunction is a powerful predictor of poor short- and long-term outcome after any therapeutic intervention for acquired left-sided cardiac valve disease. Surgical intervention for aortic or mitral valve disease is associated with a significant but transient decline in RV function, whereas trans-catheter procedures generally do not appear to have detrimental effects on either longitudinal or global RV function. Guidelines for therapy in patents with acquired left-sided valvular disease should account for RV dysfunction. Whereas surgical intervention in these patients leads to a predictable decline in RV function, trans-catheter therapies largely do not appear to have this effect. Further study is needed to determine the impact of these findings on current practice.

      Keywords

      Abbreviations:

      2D (two-dimensional), 3D (three-dimensional), AS (Aortic stenosis), CMR (Cardiac magnetic resonance imaging), EF (Ejection fraction), EtE (Edge-to-edge), FAC (Fractional area change), LV (Left ventricle), MPI (Myocardial performance index), MR (Mitral regurgitation), MS (Mitral stenosis), PH (Pulmonary Hypertension), RV (Right ventricle), SAVR (Surgical aortic valve replacement), S’ (Doppler-derived tricuspid lateral annular systolic velocity), TAPSE (Tricuspid annular plane systolic excursion), TAVR (Transcatheter aortic valve replacement), TMVR (Transcatheter mitral valve replacement), TTVr (Transcatheter tricuspid valve repair), TR (Tricuspid Regurgitation)
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      Linked Article

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          Left sided heart valve disease can lead to pressure-volume overload of right-sided cardiac structures and resultant pathology, including pulmonary artery hypertension, right ventricular dysfunction and dilation, and tricuspid valve annular dilation and regurgitation. Increased duration and severity of left-sided valve disease reduces the likelihood that left-sided valve correction will ameliorate the associated right-sided pathologies.1 In their review, “The Right Ventricle in the Trans-catheter Era: A Perspective for Planning Interventions”, Antevil and colleagues highlight that pre-existing right ventricular dysfunction is one of the strongest predictors of early and late mortality following either surgical or trans-catheter left-sided valve interventions.
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