Results of mitral valve replacement, with special reference to the functional tricuspid insufficiency.

Abstract

(1) Surgical results of mitral valve replacement were studied especially in reference to the functional tricuspid insufficiency observed in 31 patients with advanced mitral diseases.(2) Eighteen patients were complicated with right heart failure manifested by hepatomegaly, oliguria and ascites at the time of admission, and 13 patients did not reveal this manifestation. Cardiothoracic ratios were 70% in the former and 66% in the latter, the pulmonary artery pressures 73.5mm.Hg and 66.5mm.Hg, and the right atrial pressures 16.2mm.Hg and 7.5mm.Hg, respectively.(3) Mitral valves were replaced with Starr-Edwards' prostheses in all cases. Isolated mitral valve replacement was performed in 17 patients, mitral valve replacement combined with tricuspid annuloplasty in 7 patients and simultaneous mitral and tricuspid valve replacement in 7 patients. There were 3 early deaths and 2 late deaths.(4) Hemodynamic studies on the follow-up state revealed that the pulmonary artery pressures were reduced in most cases, but on the contrary, the right atrial pressures were variable. In patients with right heart failure undergoing isolated mitral valve replacement, there was a higher incidence of the unsatisfactory results in the follow-up period.(5) From the results of this series, the authors propose that the functional tricuspid insufficiency should not be left alone but treated surgically according to its severity, that is, moderate tricuspid insufficiency in patients without right heart failure should be intervened by tricuspid annuloplasty and severe tricuspid insufficiency in patients with right heart failure needs tricuspid valve replacement.