Tricuspid valve regurgitation; epidemiology, pathophysiology and treatment.

Tricuspid regurgitation (TR) is a common valvular pathology and is set to increase in prevalence alongside an ageing population. In contrast to pathology of the left-sided valves, however, current treatment options for TR remain sparse, are associated with significant risk, or the TR is simply left unaddressed. Large gaps remain in our collective understanding of the underlying mechanisms of disease and therefore, the individuals most likely to benefit from any therapeutic interventions. Previously regarded as a relatively benign entity, advances in our understanding of the natural history of TR over the past decade suggests that it may in fact be associated with significantly morbidity and mortality. This evolution has led to projections that TR may represent one of the most pressing unmet clinical needs of our time. Renewed interest in the tricuspid valve (TV), alongside the evolving landscape of transcatheter interventions, offer the potential for a dramatic shift in our collective approach to the diagnosis and management of TR. The aim of this thesis was to better understand the epidemiology, aetiology, and pathophysiology of TR, with the intention of providing a better platform to both diagnose and eventually treat TR. This thesis makes a significant contribution to the growing body of literature which highlights the poor outcomes in patients with TR, sheds light on the complexities of its pathophysiology and proposes novel options for how we might effectively reduce the burden of TR in our community. In future, our ability to affect the natural history of TR and improve patient outcomes will rely heavily on early recognition of TR, better understanding of the disease process, and the ideal timing and techniques for intervention