[Clinical relevance of tricuspid regurgitation after orthotopic heart transplantation].
Tricuspid regurgitation (TR) is common after heart transplantation (OHT). Some possible factors include: disturbed geometry of right atria anastomosis with subsequent impairment of the functional integrity of the valvular apparatus, asynchronous contraction of the donor and recipient atria compartment and damage of the sub-valvular apparatus during endomyocardial biopsy.


OBJECTIVE
To determine the incidence of subclinical and severe TR, to evaluate its clinical significance, and to assess the risk factors for TR in the heart transplantation population.


METHODS
OHT was performed in 436 patients between 1988 and 2002. 112 pts who died during the first 30 days after the operation were excluded from the analysis. TR was assessed using transthoracic color Doppler echocardiography. TR was graded from 1 to 4. Occurrence of TR in the postoperative period was assessed as early (during the first year after OHT) or late. The following clinical variables were assessed: preoperative transpulmonary gradient and pulmonary vascular resistance, number and grade of rejection episodes, postoperative echocardiographic parameters of right ventricular function, number of heart biopsies. Stepwise multivariate logistic regression was used to correlate the clinical factors with the occurrence of TR. Clinical status of the patients with TR was also evaluated.


RESULTS
TR of any grade was observed in all the patients after OHT. TR > or = 2 grade was determined in 285 pts (87.96%). Early occurrence of TR was observed in 80 pts (28.07%). The development of early TR was correlated with preoperative raised transpulmonary gradients, raised vascular resistance and early rejection greater or equal to grade 2 (according to ISHLT). Risk factors for late TR: number of rejection episode greater or equal to grade 2 (p<0.005) and the total number of heart biopsies (p<0.05). Recipients with moderate and severe TR revealed advanced NYHA status compared to those with trivial or mild TR.


CONCLUSIONS
1. Moderate to severe TR commonly occurs following heart transplantation. 2. Various factors contribute to TR after OHT, the prevalence of which may be lowered by early treatment of rejection and reduction of the number of biopsies performed.
Sobczyk
Dorota
D
Klinika Chirurgii Serca, Naczyń i Transplantologii, Instytut Kardiologii, Collegium Medicum, Uniwersytet Jagielloński, Kraków. dorotasobczyk@yahoo.com
Sadowski
Jerzy
J
Górkiewicz-Kot
Izabela
I
Przybyłowski
Piotr
P
Wróbel
Krzysztof
K
Piatek
Jacek
J
Wierzbicki
Karol
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D014184:Transplantation, Homologous; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D014463:Ultrasonography