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(Circulation. 2005;112:I-453 – I-457.)
© 2005 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Progression of Tricuspid Regurgitation After Repaired Functional Ischemic Mitral Regurgitation

Akira Matsunaga, MD; Carlos M. G. Duran, MD, PhD

From The International Heart Institute of Montana Foundation at Saint Patrick Hospital and Health Sciences Center and The University of Montana (C.M.G.D.), Missoula, Mont; and the Department of Anesthesiology and Clinical Care Medicine (A.M.), Kasoshima University, Japan.

Correspondence to Carlos M.G. Duran, MD, PhD, The International Heart Institute of Montana, 554 W Broadway, Missoula, MT 59802. E-mail duran{at}saintpatrick.org

Background— Despite correction of left-sided cardiac lesions, associated functional tricuspid regurgitation (TR) that was surgically ignored can persist. It can also appear de novo. The aim of this study was to analyze TR in a group of patients who underwent successful revascularization and mitral valve repair (MVRep) for functional ischemic mitral regurgitation (MR).

Methods and Results— Among 124 consecutive patients with MVRep, 70 left the operating room with MR 1+ and had a preoperative and follow-up transthoracic echocardiogra. Moderate or greater MR or TR was considered significant. Twenty-one patients (30%) had TR before surgery, and only 9 had TR repaired. The postoperative incidence of residual TR was not significantly different whether the tricuspid valve had been repaired (4 of 9 [44%]) or surgically ignored (8 of 12 [67%]). At last follow-up, 34 patients (49%) had significant TR. The incidence of TR increased from 25% at <1 year to 53% between 1 and 3 years and 74% at >3 years. Absence or presence of recurrent MR did not significantly affect TR (14 of 22 [64%] with MR versus 20 of 48 [42%] with no MR). Preoperative and postoperative tricuspid annulus size in patients with late TR was significantly larger than in patients without TR.

Conclusions— Functional TR is frequently associated with functional ischemic MR. After MVRep, close to 50% of patients have TR. The incidence of postoperative TR increases with time. Preoperative tricuspid annulus dilation might be a predictor of late TR.

Key Words: valves • regurgitation • ischemia • mitral valve • tricuspid valve

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