Repair of the Tricuspid Valve

As I become more informed, I am amazed at the wide divergent opinions among experts regarding the need to repair the tricuspid valve.  Could you tell me why there is so much varying opinion?  I realize there is current research being done by Dr. Patrick McCarthy, Dr. Young at CC and by others in England and at the Mayo Clinic.  However, their views differ from what I see done in my community which appears to be based on the old beliefs and old science. It would seem to me that if a person  who presented with atrial fib, biatrial enlargement, moderate to severe regur in both the MV and TV would benefit from a repair at the time of the repair/replacement of the MV.  In this case the TV was not addressed at the time of surgery because the surgeon believed that the TV would improve with adequate repair of the MV.  However, even at that time, the cardiologist's view was that the TV needed to be repaired to prevent chronic problems with peripheral edema etc.  Currently, there is signifiant peripheral edema, JVD, fatigue, poor activity tolerance etc.  A second opinion was sought from another cardiologist who said that the TV should be repaired asap.  Upon consult with another heart surgeon, his opinion was "no" and cited the old beliefs held about the TV. So, currently we are in a holding pattern.  It is difficult to use diuretics secondary to no parathyroids..so electrolytes are an issue.  A TEE is scheduled for Feb. and a right heart rest and exercise transthoracic echo for next month sometime.  I am considering sending all of this to Dr. McCarthy.  Wbat else could I pursue?

[CCF-M.D.-RCJ]

DottyCece,

Thanks for the post.

Q1:"Could you tell me why there is so much varying opinion?"

Whenever good date cannot guide us, then we rely on opinion.  And as you know, opinions are like elbows, everyone's got them.  So opinions will continue to vary until solid data about TV repair/replacement becomes available.

Q2:"Wbat else could I pursue?"

You said it yourself: "However, their views differ from what I see done in my community which appears to be based on the old beliefs and old science. "

Seek an opinion at a state-of-the-art center.  The decision to pursue re-do surgery is always a judgement call, and is even more so when you are talking about the tricuspid valve.

Good luck.