title: Leaving Moderate Tricuspid Valve Regurgitation Alone at the Time of Pulmonary Valve Replacement: A Worthwhile Approach.
abstract: BACKGROUND
  Pulmonary valve disruption in patients with tetralogy of Fallot and congenital pulmonary stenosis often results in pulmonary insufficiency, right ventricular dilation, and tricuspid valve regurgitation. Management of functional tricuspid regurgitation at the time of subsequent pulmonary valve replacement remains controversial. Our aims were to (1) analyze tricuspid valve function after pulmonary valve replacement through midterm follow-up and (2) determine the benefits, if any, of concomitant tricuspid annuloplasty.
  
  
  METHODS
  Thirty-five patients with tetralogy of Fallot or congenital pulmonary stenosis were analyzed. All patients had been palliated in childhood by disrupting the pulmonary valve, and all patients had at least moderate tricuspid valve regurgitation at the time of subsequent pulmonary valve replacement. Preoperative and serial postoperative echocardiograms were analyzed. Pulmonary and tricuspid regurgitation, along with right ventricular dilation and dysfunction were scored as 0 (none), 1 (mild), 2 (moderate), and 3 (severe). Right ventricular volume and area were also calculated. Comparisons were made between patients who underwent pulmonary valve replacement alone and those who underwent concomitant tricuspid valve annuloplasty.
  
  
  RESULTS
  At 1 month after pulmonary valve replacement, there were significant reductions in pulmonary valve regurgitation (mean 3 vs 0.39, p < 0.0001), tricuspid valve regurgitation (mean 2.33 vs 1.3, p < 0.0001), and in right ventricular dilation, volume, and area. There was no difference in the degree of tricuspid regurgitation 1 month postoperatively between patients who underwent concomitant tricuspid annuloplasty and those who underwent pulmonary valve replacement alone (mean 1.31 vs 1.29, p = 0.81). However, at latest follow-up (mean 7.0 ± 2.8 years), the degree of tricuspid regurgitation was significantly higher in the concomitant annuloplasty group (mean 1.87 vs 1.12, p = 0.005).
  
  
  CONCLUSIONS
  In patients with at least moderate tricuspid valve regurgitation, significant improvement in tricuspid valve function and right ventricular size occurs in the first postoperative month after pulmonary valve replacement, irrespective of concomitant tricuspid valve annuloplasty. The tricuspid valve appears to function better over the midterm if annuloplasty is not performed.
authors.affiliation: Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: bkogon@emory.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Kogon
authors.affiliation: Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Makoto
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Bahaaldin
authors.initials: B
authors.lastname: Alsoufi
authors.affiliation: Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Kirk
authors.initials: K
authors.lastname: Kanter
authors.affiliation: Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Rollins School of Public Health, Atlanta, Georgia.
authors.forename: Matt
authors.initials: M
authors.lastname: Oster
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult