Regression of significant tricuspid regurgitation after mitral balloon valvotomy for severe mitral stenosis.
BACKGROUND
Significant tricuspid regurgitation (TR) is occasionally associated with severe mitral stenosis and has an adverse impact on morbidity and mortality in patients undergoing mitral valve surgery. However, the effect of successful mitral balloon valvotomy (MBV) on significant TR is not fully elucidated. The aim of this study was to investigate TR after MBV in patients with severe mitral stenosis.


METHODS
We analyzed the data of 53 patients with significant TR (grade > or =2, on a 1 to 3 scale) from the mitral balloon valvotomy database at our hospital. Patients were evaluated by Doppler echocardiography before valvotomy and at follow-up 1 to 13 years after MBV. Patients were divided into group A (27 patients), in whom TR regressed by > or =1 scale, and group B (26 patients), in whom TR did not regress.


RESULTS
The Doppler-determined pulmonary artery systolic pressure was initially higher and decreased at follow-up more in group A (from 70.7 +/- 23.8 to 36.5 +/- 8.3 mm Hg; P < .0001) than in group B (from 48.7 +/- 17.8 to 41.6 +/- 13.1 mm Hg; P = NS). Compared with patients in group B, patients in group A were younger (25 +/-10 vs 35 +/- 11 years; P < .005), had higher prevalence of functional TR (85% vs 8%; P < .0001), and had lower incidence of atrial fibrillation (7% vs 38%; P < .005). Significant decrease in right ventricular end-diastolic dimension after MBV was noted in group A but not in group B. The mitral valve area at late follow-up was larger in group A than in group B (1.8 +/- 0.3 vs 1.6 +/- 0.3 cm2; P < .05).


CONCLUSIONS
Regression of significant TR after successful MBV in patients with severe mitral stenosis was observed in patients who had severe pulmonary hypertension. This improvement in TR occurred even in the presence of organic tricuspid valve disease.
Hannoush
Hwaida
H
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Fawzy
Mohamed Eid
ME
Stefadouros
Miltiadis
M
Moursi
Mohamed
M
Chaudhary
Mohammad A
MA
Dunn
Bruce
B
D000328:Adult; D001794:Blood Pressure; D002404:Catheterization; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000628:therapy*; D008297:Male; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011651:Pulmonary Artery / Q000502:physiology; D012074:Remission Induction; D012214:Rheumatic Heart Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D014261:Tricuspid Valve / Q000000981:diagnostic imaging; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging