Tricuspid Regurgitation (TR)
Considerations
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↑ risk of perioperative cardiovascular complications
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Hemodynamic consequences:
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Mild-moderate usually well tolerated with little consequence
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Severe TR may result in RV pressure/volume overload ➝ RV dysfunction, hepatomegaly, ascites, peripheral edema, cardiorenal syndrome
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Medication management
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Management of any comorbid diseases (e.g. pulmonary hypertension, endocarditis, carcinoid, rheumatic heart disease)
Anesthetic Goals
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Preload: normal to ↑, critical to avoid hypovolemia
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Rate: normal to high to sustain forward flow
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Rhythm: sinus
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Contractility: RV may need inotropic support if RV failure
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Afterload: maintain
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PVR: avoid any ↑ (avoid high airway pressures, hypercarbia, hypoxemia, hypothermia, acidosis)