Clinical and Echocardiographic Outcomes of Tricuspid Regurgitation After Percutaneous Transmitral Commissurotomy: Prospective Cohort

Abstract

PURPOSE: The gap in evidence in the management of multivalvular lesions can be addressed by providing more data on clinical and echocardiographic outcomes after percutaneous transmitral commissurotomy (PTMC) in patients with concomitant significant tricuspid regurgitation (TR) at baseline. METHODS: This is a single-center cohort study of adult Filipinos 19 years or older, admitted between January 2019 and October 2020 due to severe mitral stenosis with moderate to severe TR subjected to PTMC. The outcome post-PTMC was divided into 2 groups: significant TR, which included the progression of moderate to severe TR or persistence of severe TR, and insignificant TR group, which included those with mild TR, regression of moderate to mild TR, severe to moderate, or persistence of moderate TR. The clinical and echocardiographic parameters of these groups were compared at baseline, at 24 hours, 1 month, and 6 months postprocedure. The numerical data between significant and nonsignificant TR were compared using nonparametric Mann–Whitney U test and categorical data using the χ2 test. RESULTS: Thirty-eight patients with significant mitral stenosis and TR post-PTMC were analyzed. At 24 hours post-PTMC, the significant TR group had significantly higher right atrial volume index (42.3 vs 26.1, P = 0.004), right ventricular dimension (RVD) mid (3.81 vs 2.92, P = 0.001), systolic pulmonary arterial pressure (60.5 vs 38.5, P = 0.003), and right ventricular outflow tract (2.8 vs 2.2, P = 0.001) and lower mitral valve (MV) planimetry (1.25 vs 1.58, P = 0.009). At 1 month, RVD mid (3.4 vs 2.8, P = 0.02) and tricuspid valve (TV) annulus (3.35 vs 2.76, P = 0.10) were significantly higher in the significant TR group. At 6 months, right atrial volume index (59 vs 24.7, P = 0.001), RVD mid (4 vs 2.73, P = 0.006), and TV annulus (4.5 vs 2.67, P = 0.001) were significantly higher in the significant TR group. The insignificant TR group on the sixth month had significantly improved functional class New York Heart Association I (32 vs 5 P = 0.019). CONCLUSION: Percutaneous transmitral commissurotomy improved functional class and echocardiographic parameters of systolic pulmonary arterial pressure, MV planimetry, and MV gradient on short-term follow-up on both groups of TR. The majority of outcomes after the procedure had insignificant TR. However, those with significant TR had higher RVD mid and TV annulus from 24 hours to 6 months when compared with the insignificant TR group. KEYWORDS: rheumatic heart disease, mitral stenosis, percutaneous transmitral commissurotomy, tricuspid regurgitation