Beyond multivalvular disease: imaging-guided diagnosis and management of combined functional mitral and tricuspid regurgitation

Combined functional mitral and tricuspid regurgitation (FMR and FTR) is now recognized not just as the coexistence of two valvular lesions, but as a distinctive clinical syndrome signalling advanced biventricular dysfunction. These lesions, although secondary to myocardial and atrial remodelling, exert a significant haemodynamic burden and perpetuate a vicious cycle of chamber dilatation, pulmonary hypertension, and symptom persistence. Medical therapy remains foundational, but many patients require sequential or combined transcatheter interventions. Optimal management requires an integrated diagnostic strategy, informed by imaging, to guide the timing and targeting of interventions for each valve.