title: Outcome of significant functional tricuspid regurgitation late after mitral valve replacement for predominant rheumatic mitral stenosis.
abstract: Significant tricuspid regurgitation (TR) can contribute to increased morbidity and mortality in patients undergoing mitral valve surgery for mitral stenosis. The aim of this study was to evaluate the association between the severity of preoperative functional TR and late adverse outcomes in patients undergoing mitral valve replacement (MVR). The study group comprised 68 patients (54 women, 14 men; mean age 45 +/-10 years) with rheumatic mitral stenosis (MS) who had undergone MVR without tricuspid valve surgery between 4 and 13 years (mean 8.1 +/-2.6 years) before their last clinical examination. All patients underwent a complete preoperative and late postoperative color-Doppler echocardiographic examination. The severity of TR was assessed echocardiographically by using color-Doppler flow images and flow direction in the inferior vena cava or hepatic veins. Patients were classified into 2 groups; 42 with mild (62%) and 26 with significant (38%) TR. Patients with significant TR showed longer preoperative symptomatic period and more atrial fibrillation than those with mild TR. All patients had medical treatment. Functional capacity and NYHA class of the patients in both groups improved significantly after MVR. Freedom from symptomatic heart failure (functional class III or IV) was higher (86% vs 54%) and the need for hospitalization was significantly lower for the mild TR group. Significant preoperative functional TR diagnosed by echocardiography was associated with an adverse outcome. Therefore, further studies are needed to evaluate the effect of concomitant tricuspid valve repair on the late outcome of patients undergoing mitral valve surgery in order to prevent significant late morbidity.
authors.affiliation: Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey. aycaboyaci@yahoo.com
authors.forename: Ayca
authors.initials: A
authors.lastname: Boyaci
authors.forename: V
authors.initials: V
authors.lastname: Gokce
authors.forename: Serkan
authors.initials: S
authors.lastname: Topaloglu
authors.forename: Sule
authors.initials: S
authors.lastname: Korkmaz
authors.forename: Siber
authors.initials: S
authors.lastname: Goksel
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology; D001794:Blood Pressure; D002303:Cardiac Output, Low / Q000209:etiology; D018618:Echocardiography, Doppler, Color; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011651:Pulmonary Artery / Q000503:physiopathology; D020127:Recovery of Function; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology