Lidocaine combined with low-dose esketamine for movement-evoked pain after hepatectomy: a double-blind randomised controlled trial.

Tricuspid regurgitation (TR) is a common condition associated with poor outcomes. Two main scenarios are distinguished: TR associated with significant untreated left-sided valve disease that dominates the clinical presentation and TR occurring in the absence of significant left-sided valve disease as a main valve lesion. This review focuses on the second scenario. The primary goals of TR management are to avoid underdiagnosis and ensure timely referral and treatment. However, despite its prognostic impact, TR has long been overlooked and frequently managed conservatively. More recently, surgical and transcatheter treatment options have expanded, increasing the need for accurate risk stratification, anatomical assessment, and multidisciplinary decision-making. Interdisciplinary collaboration and expertise in the surgical and interventional treatment of tricuspid valve (TV) disease, imaging assessment and guidance, electrophysiology, as well as optimized heart failure (HF) medication are essential to ensure appropriate diagnostic work-up and management of this particularly complex patient population. Accordingly, both the 2025 European Society of Cardiology (ESC)/European Association of Cardio-Thoracic Surgery (EACTS) guidelines for the management of valvular heart disease (VHD) and the 2025 American College of Cardiology Expert Consensus Decision Pathway encourage early referral of patients with TR to heart valve centres (HVCs) with expertise in diagnosis and management, including access to complex interventions. Several reviews and consensus documents have addressed TR diagnosis and treatment. Yet, consistent implementation of recommended diagnostic pathways, and clear definition of the roles of general practice or heart valve clinics vs. expert HVCs, remains essential to prevent misdiagnosis and delayed referral (). Accordingly, we propose a standardized, stepwise framework for the evaluation of TR, supported by practical algorithms and examination-specific protocols for routine practice. A checklist of essential investigations is provided in . Checklist of examinations for the evaluation of patients with moderate or severe tricuspid regurgitation according to clinical setting