Echocardiographic and hemodynamic evaluation of carpentier tricuspid valvuloplasty.
To study the long-term results of tricuspid valvuloplasty, pre- and postoperatively (39 +/- 11 months), echocardiographic and catheterization data were collected in 37 patients (mean age, 58 +/- 8 years). Because of severe mitral stenosis, all patients received a porcine heterograft in the mitral position and underwent reconstructive tricuspid surgery with Carpentier rings (#32, n = 12; #34, n = 15; #36, n = 10). Sizing was performed by measuring the anterior leaflet area using an obturator. In nine patients, tricuspid leaflets were slightly shrunken at the insertion site of the chordae tendineae. Postoperative echocardiography and right heart catheterization were performed with simultaneous pressure recordings in the right ventricle and right atrium. A significant clinical improvement was noted in 24 patients, and this correlated with significant hemodynamic improvement. In eight patients, no clinical improvement was observed. Patients were divided into subgroups according to echocardiographic and hemodynamic criteria. Group A (n = 17) was composed of patients with significant improvement of hemodynamics, without detectable tricuspid valve dysfunction. Group B (n = 11) was composed of patients with slight-to-moderate tricuspid incompetence, detected by contrast echocardiography. In nine of these patients, the size of the RA and the diameter of the IVC were significantly smaller than preoperatively. In patients of Group C, echocardiography and catheterization data showed a slight-to-moderate tricuspid stenosis with a mean diastolic pressure gradient of 3.9 +/- 1.4 mm Hg (max 6.2 mm Hg, min 2.4 mm Hg). Although the area of the anterior tricuspid leaflet was slightly underestimated, we determined that long-term results of tricuspid valve annuloplasty with a Carpentier ring were encouraging.
Lambertz
H
H
Department of Internal Medicine I and Cardiovascular Surgery, Klinikum of the Rheinisch-Westfalische Technische Hochschule, Pauwelsstr. 1, 5100 Aachen, Federal Republic of Germany.
Zander
M
M
Flachskampf
F A
FA
Minale
C
C
Bardos
P
P
Messmer
B J
BJ
Effert
S
S