TRICUSPID REGURGITATION AND RIGHT HEART DIMENSIONS AT EARLY AND LATE FOLLOW-UP AFTER ORTHOTOPIC CARDIAC TRANSPLANTATION

Tricuspid regurgitation is common immediately after cardiac transplant ation, but its course over long-term follow-up is not known. This stud y was performed to determine the prevalence of valvular regurgitation and to evaluate if pulmonary hypertension or right ventricular enlarge ment were associated with the severity of tricuspid regurgitation at e arly and Late follow-up after cardiac transplantation. Fifty-five pati ents had hemodynamic and echocardiographic studies performed at 1 week and 2.4 +/- 1.3 years after cardiac transplantation. Right ventricula r dimensions were measured and related to the severity of tricuspid re gurgitation as assessed by Doppler color flow. There was a fall in rig ht heart filling pressures with decreases in. the systolic pulmonary a rtery pressure (31 mmHg +/- 7 mmHg vs 27 mmHg +/- 7 mmHg, P = 0.0001) and right atrial pressure (8 +/- 5 mmHg vs 6 +/- 4 mmHg, P < 0.01). Si xty-three percent of patients had mild or higher grade tricuspid regur gitation initially and 71% at follow-up (P = NS). The major determinan t of tricuspid regurgitation severity at late follow-up was the presen ce of flail tricuspid leaflets (P < 0.0001). There was an association between the change in grade of tricuspid regurgitation. and the change in, right ventricular diastolic area (P = 0.002) and the change in, t ricuspid annulus diameter (P < 0.0001). The prevalence of tricuspid re gurgitation remains high at lute follow-up after cardiac transplantati on and neither pulmonary hypertension nor right ventricular dilatation are prerequisites for tricuspid regurgitation, which can persist in, their absence. Flail tricuspid leaflets are the most important predict ors of the severity of tricuspid regurgitation following cardiac trans plantation.