The tricuspid valve and the right heart: anatomical, pathological and imaging specifications

Transcatheter tricuspid valve repair/replacement is an emerging therapy for patients with symptomatic severe tricuspid regurgitation who are deemed inoperable. Accurate knowledge of the anatomy of the tricuspid valve and right ventricle is key to developing transcatheter techniques. In addition, it is important to understand the mechanistic concept of transcatheter tricuspid valve repair/replacement in order to select the patients who may benefit from it. The severity and mechanism of tricuspid regurgitation, right ventricular function, dimensions of the caval veins and the course of the right coronary artery in relation to the atrioventricular groove are important aspects to be evaluated before embarking on these procedures. The present article reviews current advances in transcatheter approaches for significant tricuspid regurgitation and the role of imaging modalities to characterise the anatomy of the tricuspid valve and right ventricle as well as the underlying pathophysiology of tricuspid regurgitation.