Functional tricuspid regurgitation in rheumatic mitral valve disease patients with and without tricuspid annuloplasty: a three-dimensional echocardiography study with one year follow up.

Abstract

The aim of this study is to analyze the clinical and echocardiographic determinants of functional tricuspid regurgitation (TR) before and after surgical intervention of rheumatic mitral valve disease, with focus on effectiveness of different methods of tricuspid valve annuloplasty (TAP). Three-dimensional echocardiographic images were obtained in 170 patients with mitral valve rheumatic disease before and 1year after mitral valve replacement, with and without concomitant TAP. Together with standard cardiac chamber quantification, multiplanar reconstruction images of the tricuspid valve (TV) apparatus were analyzed in the septal-lateral and antero-posterior directions, end-diastolic TV annular diameter, TV tenting height and tenting area were measured. By multivariate logistic regression, septal-lateral TV tenting area (p < 0.001) were independently correlated with preoperative FTR severity while postoperative septal-lateral TV annular diameter (p < 0.001) independently determined residual TR at 1-year follow-up. Both ring and suture TAP groups had postoperative reduction of S-L TV diameters, but isolated MVR group had an 11% increase in S-L TV diameters. Compared with TAP of size 26mm and 28mm rings group, suture TAP group had more common significant residual TR (29% vs. 3%, p = 0.001). Our study demonstrated that ring annuloplasty could provide effective reduction of the TV annulus and prevent postoperative TR progression, and for rheumatic mitral valve disease patients with mild functional TR, prophylactic TAP concomitant with MVR might be considered to address the postoperative TV annulus dilation.