title: Progression of isolated tricuspid regurgitation late after left-sided valve surgery. Clinical features and mechanisms.
abstract: BACKGROUND
  Severe tricuspid regurgitation (TR) sometimes develops late after left-sided valve surgery without left heart failure, pulmonary hypertension or rheumatic tricuspid valve. The purpose of the present study was to investigate clinical characteristics and mechanisms of severe isolated TR late after left-sided valve surgery.
  
  
  RESULTS
  A total of 372 consecutive patients who underwent left-sided valve surgery between 1990 and 2003 and who were followed up with echocardiography for at least 5 years, were retrospectively investigated. The mean follow-up period was 9.4 years. Clinical background, preoperative and postoperative echocardiographic parameters were evaluated. Among the 372 patients, severe isolated TR was detected in 23 patients, which developed at a mean of 8.6 years after surgery. Twenty-two of 23 patients had undergone mitral valve surgery. Multivariate logistic regression analysis identified the presence of preoperative atrial fibrillation and preoperative ejection fraction as independent determinants for the development of severe isolated TR. In patients with severe isolated TR, the tricuspid annular diameter and the right atrial area were already enlarged early after surgery and both of these increased prior to TR progression.
  
  
  CONCLUSIONS
  Severe isolated TR developing late after mitral valve surgery is not uncommon, thus it is important to recognize this disease entity. Annular dilatation was the main cause of isolated TR and serial echocardiographic data are important to detect progression of isolated TR and to assess its mechanisms.
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan. izumi-ch@tenriyorozu.jp
authors.forename: Chisato
authors.initials: C
authors.lastname: Izumi
authors.forename: Makoto
authors.initials: M
authors.lastname: Miyake
authors.forename: Shuichi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Hayato
authors.initials: H
authors.lastname: Matsutani
authors.forename: Sumiyo
authors.initials: S
authors.lastname: Hashiwada
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Kuwano
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Hayashi
authors.forename: Seiko
authors.initials: S
authors.lastname: Nakajima
authors.forename: Masataka
authors.initials: M
authors.lastname: Nishiga
authors.forename: Koji
authors.initials: K
authors.lastname: Hanazawa
authors.forename: Jiro
authors.initials: J
authors.lastname: Sakamoto
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kondo
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tamura
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kaitani
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D013318:Stroke Volume; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D014463:Ultrasonography