SIGNIFICANT TRICUSPID REGURGITATION DOES NOT RESOLVE AFTER PERCUTANEOUS BALLOON MITRAL VALVOTOMY

A total of 318 consecutive patients with mitral stenosis underwent per cutaneous mitral valvotomy at our institution from 1987 to 1993. Of th ose, 98 patients had color Doppler echocardiographic studies performed before, 24 hours after, and late after the intervention. On the basis of color Doppler echocardiographic grading of tricuspid regurgitation , 32 patients (32%; mean age 57 +/- 15 years) had significant (moderat e or severe) tricuspid regurgitation before the intervention and were the subject of this study. The follow-up study was performed 18.4 +/- 13 months after the procedure, Successful percutaneous mitral valvotom y (greater than or equal to 1.5 cm(2) valve area or greater than or eq ual to 50% increase after valvotomy) with no restenosis at follow-up w as achieved in 20 patients. Tricuspid regurgitation decreased by one g rade (from severe to moderate) in only four subjects in this group and in none of the 12 patients who did not meet the criteria for successf ul percutaneous mitral valvotomy or who had restenosis. Thus tricuspid regurgitation did not improve in 88% of all patients studied. On aver age, no significant change was observed in the ratio of maximal tricus pid;regurgitant jet area to right atrial area 24 hours after percutane ous mitral valvotomy and at late follow-up (37% vs 33% vs 34%, respect ively) or in any of the right heart dimensions, even in patients who u nderwent successful percutaneous mitral valvotomy. Right ventricular s ystolic pressure also did not change significantly on average in those patients (46 +/- 15 versus 42 +/- 14 versus 48 +/- 18 mm Hg, respecti vely). However, right ventricular dimensions did not decrease and tric uspid regurgitation did not resolve even in a subgroup of patients in whom right ventricular systolic pressure fell by more than 10 mm Hg (u p to 41 mm Hg).