Abstract 3403: Progression of Isolated Tricuspid Regurgitation Late After Left-Sided Valve Surgery
Objectives: Severe tricuspid regurgitation (TR) sometimes develops late after left-sided valve surgery without significant left heart failure, pulmonary hypertension or rheumatic tricuspid valve. The degree of TR influences functional status and prognosis in patients after surgery. The purpose of this study is to clarify the clinical characteristics and mechanism of severe isolated TR late after left-sided valve surgery.
Methods: Among 520 consecutive patients who underwent left-sided valve surgery between 1990 and 2003, we studied 372 patients (mitral only; 179, aortic only; 133, both; 60patients), who showed no or mild TR early after operation and were followed up with echocardiography for at least 5 years. Concominant tricuspid annuloplasty was performed in 54 patients and 199 patients were afflicted with atrial fibrillation. Mean follow-up period was 9.4 years. The degree of TR, tricuspid annular diameter, right atrial area and tenting area were measured at follow-up echocardiographic examinations and chronological changes of these factors were evaluated.
Results: Among the 372 patients, severe isolated TR was detected in 23 patients (6%). Atrial fibrillation and mitral valve surgery were significant clinical risk factors for progression of severe isolated TR. 9.2% of the patients after mitral valve surgery, in particular, 18% of the patients after mitral valve replacement showed severe isolated TR. In the 23 patients with severe isolated TR, the tricuspid annular diameter and the right atrial area were already enlarged early after left-sided valve surgery and both of these increased prior to TR progression. Tenting area wasn’t related to the progression of severe isolated TR. Severe TR devloped at a mean of 8.6 years (2–18 years) after surgery.
Conclusions: Severe isolated TR developing late after mitral valve surgery wasn’t uncommon, thus it is important to recognize this disease entity. Annular dilatation was the main cause of isolated TR and serial echocardiographic data is important to detect late progression of isolated TR and to assess its mechanisms.