TRICUSPID INFLOW AND REGURGITANT FLOW DYNAMICS AFTER MITRAL-VALVE REPLACEMENT - DIFFERENCES RELATING TO SURGICAL REPAIR OF THE TRICUSPID-VALVE

Background and aims of the study: Changes in tricuspid inflow and regu rgitant flow dynamics were evaluated in patients with functional tricu spid regurgitation (TR) who underwent mitral valve replacement (MVR) w ith and without tricuspid annuloplasty (TAP). Methods: In a group of 3 0 patients, all with atrial fibrillation, 15 underwent TAP performed a ccording to the modified De Vega technique; the remaining 15 did not u ndergo TAP. Patients were studied before and serially after surgery, u sing pulsed and color Doppler echocardiography. The mean follow up was 4.7 years in the TAP group and 5.1 years in the nonTAP group. Results : In the TAP group, immediately after surgery, the area of the TR jet decreased markedly, and the deceleration time of the tricuspid inflow velocity wave was significantly prolonged compared with that before su rgery. By contrast, in the non-TAP group, both the area of the TR jet and deceleration time of tricuspid inflow velocity were virtually unch anged. The area of the TR jet remained small for a long period in the TAP group, but in non-TAP patients was increased in four cases over se ven years, with two patients developing right-sided heart failure. Rec ent data showed the area of the TR jet to be significantly smaller, wi th maximum tricuspid inflow velocity significantly increased, and dece leration time of the tricuspid inflow velocity wave significantly prol onged in the TAP group compared with the non-TAP group. Conclusions: I n patients with functional tricuspid regurgitation undergoing MVR, con comitant TAP may cause mild tricuspid stenosis, but produces sustained preventive effects against TR. Careful follow up is needed in patient s who have not undergone TAP, as TR is not markedly decreased and may even be exacerbated. Aggressive TAP is recommended in patients showing dilatation of the tricuspid annulus, even if TR is mild.