Jolien Roos-Hesselink is Professor of Cardiology at the Erasmus MC in Rotterdam, The Netherlands. She is director of the Department of Adult Congenital Heart Disease. Her clinical work and research involves adult congenital heart disease, pregnancy in cardiac patients and aortic disease.
She has authored and co-authored over 200 scientific publications and mentored 15 PhD students. She is incoming-chair of the ESC working group on Adult Congenital Heart Disease. She participated in the Taskforce for writing ESC-guidelines on Pregnancy and cardiac disease (chairperson), and on Endocarditis.
At the moment she is principal investigator of a multicentre study investigating bicuspid aortic valve disease and Turner syndrome and she is founder and principal investigator of the Registry on Pregnancy and Cardiac Disease (ROPAC) on behalf of the European Society of Cardiology.
|When and why to intervene on the tricuspid valve in systemic RV|
The anatomic right ventricle is capable of sustaining the systemic circulation in the short to medium term, but concerns exist on its functioning in long run. Regurgitation of the tricuspid valve in the systemic circulation may develop due to failing of the ventricle and some degree of tricuspid regurgitation is common in patients with atrial repair of TGA. In patients with ccTGA tricuspid valve abnormalities are common, with an Ebstein-like thickening and shortening of the cords and, in some patients, apical displacement of the septal and mural leaflets. It is often difficult to assess whether tricuspid regurgitation is a cause or effect of right ventricular dilatation and dysfunction. It is progressive with age and has a negative effect on prognosis. If and when to intervene on this tricuspid regurgitation is still a matter of debate and no strict guidelines are available. In selected cases valve operation may be justified in order to reduce volume loading and prevent further deterioration in ventricular function. It is important to wait not too long. Especially when the ventricular function is still good, surgical intervention for severe TR is justified even in asymptomatic patients. However, in case of severe diminished ventricular function, an operation is not attratctive and will probably not improve outcome. In ccTGA valve replacement is indicated and repair is mostly not feasible, because the valve is frequently morphologically abnormal.