title: Does lowering pulmonary arterial pressure eliminate severe functional tricuspid regurgitation? Insights from pulmonary thromboendarterectomy.
abstract: OBJECTIVE
  Because pulmonary thromboendarterectomy (PTE) can result in an immediate reduction in pulmonary artery (PA) pressure, we sought to evaluate the effect of PTE on severe tricuspid regurgitation (TR) without tricuspid annuloplasty.
  
  
  BACKGROUND
  Few data exist regarding the frequency and magnitude of functional TR improvement after reduction in PA pressure.
  
  
  METHODS
  We identified 27 patients with severe TR, defined by a regurgitant index (RI) >33%, who underwent PTE. The RI, tricuspid annular diameter (TAD), apical displacement of leaflet coaptation, and estimated PA systolic pressure were determined on pre- and post-PTE echocardiograms. Patients were stratified based on resolution (RI < or =33%) or persistence (RI >33%) of severe TR.
  
  
  RESULTS
  Comparing pre- and post-PTE echocardiography results, severe TR resolved in 19 of 27 (70%) patients. This group had a more effective PA systolic pressure reduction after PTE (49 +/- 20 mm Hg vs. 32 +/- 16 mm Hg by echocardiography, p = 0.075, and 37 +/- 16 mm Hg vs. 16 +/- 13 mm Hg by catheter measurement, p = 0.004). No difference was observed in TAD, apical displacement of the tricuspid valve, or other features compared with the group with persistent severe TR. There was a trend toward longer hospital stays in the group with persistent severe TR (19 +/- 15 days vs. 14 +/- 9 days; p = 0.55).
  
  
  CONCLUSIONS
  After significant PA pressure reduction by PTE, severe functional TR with a dilated annulus may improve without annuloplasty despite dilated tricuspid annulus diameters.
authors.affiliation: Division of Cardiology, University of California-San Diego Medical Center, San Diego, California, USA. hmsmd1@hotmail.com
authors.forename: H Mehrdad
authors.initials: HM
authors.lastname: Sadeghi
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Kimura
authors.forename: Ajit
authors.initials: A
authors.lastname: Raisinghani
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Blanchard
authors.forename: Ehtisham
authors.initials: E
authors.lastname: Mahmud
authors.forename: Peter F
authors.initials: PF
authors.lastname: Fedullo
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Jamieson
authors.forename: Anthony N
authors.initials: AN
authors.lastname: DeMaria
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D006328:Cardiac Catheterization; D002302:Cardiac Output / Q000502:physiology; D004452:Echocardiography; D004691:Endarterectomy; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D015995:Prevalence; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012720:Severity of Illness Index; D013599:Systole / Q000502:physiology; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*