HEPATIC PORTAL VENOUS FLOW IN PATIENTS UNDERGOING TRICUSPID-VALVE SURGERY

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.