Predictor and Fate of Persistent Functional Tricuspid Regurgitation After Left Heart Surgery with Tricuspid Annuloplasty

Chung, Wook Jin; Hong, Geuru; Kang, Woong Chol; Lee, Sang Hak; Joung, Boyoung; Rim, Se Joong; Chang, Byung Chul; Chung, Namsik; Cho, Seung Yun

Abstract

BACKGROUND
Although persistent tricuspid regurgitation(TR) after tricuspid annuloplasty(TAP) concomitant with left heart valve surgery is regarded as grave prognostic outcome in patients with functional TR, only few studies have been reported about preoperative predictors. So we evaluated the prognostic predictors for persistent TR after left heart surgery with TAP.
MATERIALS AND METHODS
Twenty-six consecutive patients with rheumatic mitral stenosis and significant functional TR(â‰¥II/IV) were treated with left heart surgery with TAP between July 1999 and June 2001. Follow-up duration was 8.8 (9.7 months. Types of TAP were Pericardial strip (15 cases; 58%), De vega (9 cases; 35%) and Kay's (2 cases; 8%). All of them was examined by preoperative and post operative echocardiographic studies and clinical interviews. Besides routine echocardiographic parameters, dilatation, shape, fractional shortening(FS) and free wall motion of right ventricle(RV), dimensions and FS of tricuspid annulus and length and area of TR jet were analyzed.
RESULTS
Significant persistent TR(â‰¥II/IV) occurred in 8 cases(31%). RV dilatation more than left ventricle(p=0.003), spherical RV shape(p=0.02), hypokinetic or akinetic RV free wall motion(p=0.03) and TR jet area(p=0.01) was revealed to be significant predictors for persistent TR. Using multivariate analysis, one most significant prognostic predictors of persistent TR is RV dilatation more than left ventricle(p=0.048).
CONCLUSION
Dilatation of RV have a better predictability than area of TR jet on persistent functional TR after TAP concomitant with left heart valve surgery.