The necessity for tricuspid valve repair can be determined intraoperatively by two-dimensional echocardiography

Abstract

Residual significant tricuspid regurgitation after mitral valve operations may significantly increase postoperative morbidity and mortality. However, routine techniques to detect tricuspid regurgitation preoperatively and intraoperatively are inaccurate. Two-dimensional echocardiography was performed intraoperatively to assess its ability to evaluate and quantify the severity of tricuspid regurgitation. In 50 patients who underwent cardiac operations, 5 ml of dextrose or saline was injected into the right ventricle to generate echogenic "contrast." In patients with tricuspid regurgitation, there was systolic reflux of contrast into the right atrium, which could be semiquantified on a scale of 0 to 4+. Besides correlating well with preoperative Doppler studies for the presence or absence of tricuspid regurgitation in 18 patients (sensitivity = 0.90, specificity = 1.00), the intraoperative contrast method could quantify the severity of reflux. The 50 patients were divided into two groups on the basis of severity of tricuspid regurgitation as assessed by intraoperative two-dimensional contrast echocardiography. Group I (36 patients) had no or mild (0-2+) regurgitation, and Group II (14 patients) had moderate to severe (3-4+) tricuspid regurgitation. Patients with significant tricuspid regurgitation (Group II) had greater intraoperative preprocedure and postprocedure systolic and diastolic pulmonary pressures. Additionally, the systolic tricuspid anulus length, as measured in the intraoperative right ventricular inflow view, correlated better with severity of tricuspid regurgitation (r = 0.76, p = 0.005) than mean pulmonary pressure (r = 0.52, p less than 0.01). Therefore, intraoperative contrast two-dimensional echocardiography can accurately assess the relative severity of tricuspid regurgitation. Importantly, intraoperative measurement of tricuspid anulus diameter could predict the presence of significant echocardiographic tricuspid regurgitation before as well as immediately after the operation. Two-dimensional echocardiography may be an important intraoperative method both for evaluating the presence and severity of residual tricuspid regurgitation immediately after left heart operations as well as for determining which patients should undergo tricuspid valve repair.