title: Significant tricuspid regurgitation is a marker for adverse outcome in patients undergoing percutaneous balloon mitral valvuloplasty.
abstract: OBJECTIVE
  This study examined the association between the presence of tricuspid regurgitation and immediate and late adverse outcomes in patients undergoing balloon mitral valvuloplasty.
  
  
  BACKGROUND
  Significant tricuspid regurgitation has an adverse impact on morbidity and mortality in patients undergoing mitral valve surgery for mitral stenosis.
  
  
  METHODS
  We studied 318 consecutive patients (mean [+/- SD] age 54 +/- 15 years) who underwent balloon mitral valvuloplasty and had color Doppler echocardiographic studies before the procedure. Patients were classified into three groups: 221 with no or mild (69%), 60 with moderate (19%) and 37 with severe (12%) tricuspid regurgitation. Clinical follow-up ranged from 6 to 62 months.
  
  
  RESULTS
  Before mitral valvuloplasty, increasing degrees of tricuspid regurgitation were associated with a smaller initial mitral valve area (p < 0.05), higher echocardiographic score (p < 0.05), lower cardiac output (p < 0.01) and higher pulmonary vascular resistance (p < 0.01). Although the initial success rate did not differ significantly between groups, patients with a higher degree of tricuspid regurgitation had less optimal results, as reflected by a smaller absolute increase in mitral valve area (1.02 vs. 0.9 vs. 0.7 cm2, p < 0.01). The estimated 4-year event-free survival rate (freedom from death, mitral valve surgery, repeat valvuloplasty and heart failure) was lower for the group with severe tricuspid regurgitation (68% vs. 58% vs. 35%, p < 0.0001). At 4 years, 94% of patients with mild tricuspid regurgitation were alive compared with 90% and 69%, respectively, of patients with moderate or severe tricuspid regurgitation (p < 0.0001). Cox proportional analysis identified tricuspid regurgitation as an independent predictor of late outcome (p < 0.001).
  
  
  CONCLUSIONS
  Patients with mitral stenosis and severe tricuspid regurgitation undergoing mitral valvuloplasty have advanced mitral valve and pulmonary vascular disease, suboptimal immediate results and poor late outcome.
authors.affiliation: Cardiac Catheterization Laboratory, Massachusetts General Hospital, Boston 02114.
authors.forename: A
authors.initials: A
authors.lastname: Sagie
authors.forename: E
authors.initials: E
authors.lastname: Schwammenthal
authors.forename: J B
authors.initials: JB
authors.lastname: Newell
authors.forename: L
authors.initials: L
authors.lastname: Harrell
authors.forename: T B
authors.initials: TB
authors.lastname: Joziatis
authors.forename: A E
authors.initials: AE
authors.lastname: Weyman
authors.forename: R A
authors.initials: RA
authors.lastname: Levine
authors.forename: I F
authors.initials: IF
authors.lastname: Palacios
mesh_terms: D000328:Adult; D000368:Aged; D002302:Cardiac Output; D002404:Catheterization; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D011652:Pulmonary Circulation; D015996:Survival Rate; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D014655:Vascular Resistance