Objective-To determine the changes of flow in the hepatic artery and p
ortal vein of patients undergoing tricuspid valve repair together with
mitral valve replacement. Design-Non-randomised parallel group study.
Setting-Tertiary referral centre. Patients-18 patients with mitral va
lve disease with or without tricuspid regurgitation (age range 46-73;
six men) and six patients with coronary artery disease and normal left
ventricular function (women age range 39-78; four men). Interventions
-Mitral valve replacement with or without modified De Vega repair of t
he tricuspid valve or coronary artery bypass surgery. Main outcome mea
sures-Flow in the hepatic artery and portal vein as measured by duplex
Doppler flowmetry before and two to four weeks after operation. Resul
ts-Preoperative hepatic artery flow was less in patients with mitral v
alve disease than in patients with coronary artery disease (162.7(13.1
) ml.min(-1) upsilon 242.5(6.6) ml.min(-1), p < 0.05). Portal vein per
fusion was significantly reduced only in patients with associated tric
uspid regurgitation compared with (844(83) ml.min(-1) upsilon ml.min(-
1) p < 0.05). Hepatic perfusion was unaltered after operation in patie
nts undergoing coronary artery bypass surgery (p > 0.05). Flow in the
hepatic artery and portal vein was improved only in patients undergoin
g mitral valve replacement with associated tricuspid valve repair (p <
0.05). Conclusion-Abnormalities of hepatic perfusion can be measured
non-invasively in all patients with mitral valve disease but especiall
y in those with associated tricuspid regurgitation needing valve repai
r. These abnormalities improved two to four weeks after mitral valve s
urgery and tricuspid valve repair, suggesting that measurement of port
al flow might be a useful means of assessing the severity of tricuspid
regurgitation.