title: Echocardiographic-based treatment of functional tricuspid regurgitation.
abstract: OBJECTIVE
  Functional tricuspid regurgitation (FTR) worsens over time, and its natural history is unfavorable. An aggressive surgical strategy, using the echocardiographic systolic dimensions of the tricuspid annulus (sysTA), can be helpful to reduce the detrimental late effects of FTR.
  
  
  METHODS
  From March 2006 to February 2008, 298 patients, with at least FTR grade 1+, underwent mitral valve surgery. Of these 298 patients, 167 underwent tricuspid repair (treated group [T], moderate-or-greater FTR in 108 and mild in 59, with sysTA > 24 mm) and 137 did not (untreated group [UT], moderate-or-greater FTR in 16 and mild in 115; 81 with sysTA > 24 mm and 34 with sysTA of ≤ 24 mm). The 256 survivors underwent echocardiographic examination at a mean follow-up of 13 ± 8 months.
  
  
  RESULTS
  Preoperatively, at discharge, and at the follow-up examination, the mean FTR grade was 1.11 ± 0.32, 0.87 ± 0.49, and 1.03 ± 0.57 (P = NS) in the UT group and 2.11 ± 0.92, 0.45 ± 0.36, and 0.48 ± 0.32 (P < .001) in the T group. A total of 24 patients had FTR grade 2 or greater, 16 (14.5%) in the UT group and 8 (5.5%) in the T group (P = .026). In the UT group, 10 of 16 patients had sysTA of 25 to 28 mm and 6 of 10 had sysTA greater than 28 mm. No patient with mild FTR and sysTA of 24 mm or less had an increased FTR grade. Globally, 12 patients (10.9%) had an increased FTR grade in the UT group versus none in the T group (P < .001). Patients with postoperative atrial fibrillation had less residual FTR if annuloplasty had been performed (1.6 ± 0.7 vs 0.91 ± 0.63, P = .005).
  
  
  CONCLUSIONS
  An aggressive strategy for FTR correction, using the sysTA, was able to reduce the FTR grade 1 year after surgery, but mitral surgery alone could not.
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia. calafiore@unich.it
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Calafiore
authors.forename: Angela L
authors.initials: AL
authors.lastname: Iacò
authors.forename: Antonella
authors.initials: A
authors.lastname: Romeo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Scandura
authors.forename: Rocco
authors.initials: R
authors.lastname: Meduri
authors.forename: Egidio
authors.initials: E
authors.lastname: Varone
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*