Article

Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyopathy.

Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy.
European Journal of Cardio-Thoracic Surgery (impact factor: 2.55). 04/2008; 33(4):600-6. DOI:10.1016/j.ejcts.2008.01.011 pp.600-6
Source: PubMed

ABSTRACT To assess the evolution of tricuspid regurgitation (TR) in dilated cardiomyopathy (DCM) patients submitted to mitral repair for functional mitral regurgitation (MR).
Ninety-one DCM patients (mean age 61+/-11.3) submitted to MV repair (+/-tricuspid repair) for functional MR were included. Preoperative EF was 30.9+/-6.5%, left ventricular (LV) end-diastolic volume 113+/-31.5 ml/m(2), LV end-systolic volume 81.8+/-26.7 ml/m(2), functional MR > or =3+/4+. TR was classified as < or =1+/4+ in 57 patients (62.6%), 2+/4+ in 21 (23%) and > or =3+/4+ in 13 (14.2%). Most of the patients were in NYHA class III or IV. A tricuspid annuloplasty was associated to mitral repair whenever preoperative TR was > or =3+. Therefore 13 patients (14.2%) underwent concomitant tricuspid annuloplasty whereas the remaining 78 (with preoperative TR < or =2+) did not.
At follow-up (mean 1.8+/-1.2 years), 12% of the patients (11/91) had still 3-4+ TR due to failure of the tricuspid repair or progression of untreated < or =2+ TR. Freedom from TR > or =3+ was 78+/-8.8% at 3.5 years. Among the 78 patients not submitted to tricuspid repair, 14 (18%) showed a progression of TR severity equal or greater than two grades. The multivariate analysis identified grade of TR at discharge (OR 5.4, p=0.01) and preoperative RV dysfunction (OR 19.6, p=0.02) as the only independent predictors of TR > or =3+/4+ at follow-up.
A significant number of patients submitted to mitral repair for functional MR present > or =3+ TR at follow-up as consequence of progression of untreated TR or failure of tricuspid repair. A more aggressive and effective treatment of functional TR in this setting should be pursued.

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    Article: Assessment of functional tricuspid regurgitation.
    Luigi P Badano, Denisa Muraru, Maurice Enriquez-Sarano
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    ABSTRACT: Functional tricuspid regurgitation (FTR) is characterized by structurally normal leaflets and is due to the deformation of the valvulo-ventricular complex. While mild FTR is frequent and usually benign, patients with severe FTR may develop progressive ventricular dysfunction and incur increased mortality. Therefore, FTR should not be ignored, should be appropriately diagnosed and quantified by Doppler echocardiography, and should be evaluated for corrective surgical procedures. At present, referral for surgical correction of FTR is often delayed until patients develop intractable heart failure. However, this strategy frequently translates in poor clinical outcome characterized by notable operative mortality and reduced long-term survival. Appropriate patient selection and proper timing for tricuspid valve (TV) repair or replacement are crucial for optimal outcome, but objective criteria for clinical decison-making remain poorly defined. In the present paper, we review the anatomy of the normal TV, the pathophysiology of FTR, the assessment of its severity and functional significance, and propose an algorithm for selecting patients for surgical treatment.
    European Heart Journal 01/2013; · 10.48 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

+/-tricuspid
 
13 patients
 
57 patients
 
78 patients
 
concomitant tricuspid annuloplasty
 
DCM patients
 
dilated cardiomyopathy
 
effective treatment
 
functional mitral regurgitation
 
functional MR
 
functional MR present
 
functional TR
 
NYHA class III
 
Preoperative EF
 
preoperative RV dysfunction
 
preoperative TR
 
TR severity equal
 
tricuspid annuloplasty
 
tricuspid regurgitation
 
untreated TR