Haemodynamic changes after tricuspid valve surgery. A recatheterization study in forty-five patients.

Abstract

Changes of the central haemodynamics at rest and during exercise were evaluated in 45 patients who underwent tricuspid valve surgery. Tricuspid valve disease was associated with left heart valvular lesions in 42 patients, while isolated tricuspid valve lesions were present in 3 patients. The pre-operative evaluation showed marked impairment of cardiac function expressed by cardiomegaly, low physical working capacity, hypokinetic central circulation, elevated right atrial pressure and pulmonary hypertension in the majority of patients. Nineteen patients underwent tricuspid valve replacement and 26 tricuspid annuloplasty. The left heart valvular lesions were corrected by prosthetic valve replacement in all patients but one, who underwent mitral commissurotomy. The Björk-Shiley tilting disc valve prosthesis was used for all valve replacements. At postoperative evaluation the patients were classified in 3 groups: (1) Group TVR- 19 patients with well-functioning tricuspid valve prostheses; (2) Group TAP - 16 patients with good functional results in tricuspid annuloplasty; and (3) Group TAP-Failure - 10 patients in whom significant tricuspid incompetence was observed. The overall response to surgery in groups TVR and TAP was about the same, leading to an increase in working capacity and cardiac output and a decrease in heart volume, right atrial pressure and pulmonary hypertension. In the TAP-failure group, this response was limited to an increase in cardiac output and mainly attributable to the corrected left heart lesions. Sustained pulmonary hypertension, failing left ventricular myocardium, residual left heart lesions and anatomical tricuspid valve changes were the likely causes of TAP-failure, which could not be predicted from the pre-operative evaluation.