Tricuspid valve disease: updates on diagnostic imaging and intervention

Tricuspid regurgitation is associated with an increased risk of hospitalization and death. Many patients with severe tricuspid regurgitation are unable to undergo surgical intervention owing to prohibitive technical or clinical risk. The past two decades has seen an outburst of technological advances in the field of transcatheter tricuspid technologies, with numerous randomized, controlled trials assessing the safety and efficacy of various repair and replacement therapies for tricuspid regurgitation. However, crucial knowledge gaps persist, particularly in areas such as patient selection, anatomical eligibility and the haemodynamic effects of device implantation. In this Review, we outline the anatomical features of the tricuspid valve and the haemodynamic consequences of tricuspid regurgitation, and we summarize the imaging modalities used for diagnosis and management. Furthermore, we detail the current guideline-directed medical therapy for tricuspid regurgitation, as well as valve repair and replacement surgical procedures being tested in clinical trials. Finally, we highlight future technological innovations that promise to optimize diagnosis, patient selection and the device development process.