DISAPPEARANCE OF MITRAL AND TRICUSPID REGURGITATION IN HEMODIALYSIS-PATIENTS AFTER ULTRAFILTRATION

Background. Doppler echocardiography has recently revealed frequent oc currence of valvular (in particular mitral) regurgitation in dialysis (HD) patients. We hypothesized that this may be in part 'functional' a nd related to the cardiac dilatation which is also frequently present. Thus it would be possible to improve it by ultrafiltration. Methods. Mitral and tricuspid regurgitation was detected in 21 haemodialysis pa tients who had cardiomegaly but no manifest cardiac failure. They were treated by intensified ultrafiltration sessions, as much as they coul d tolerate, while all antihypertensive drugs were stopped. Doppler ech ocardiograms were then repeated. Results. Mitral regurgitation disappe ared in 13 and tricuspid regurgitation in 14 patients, while lesser de grees of either of them persisted in seven. This was accompanied by de creases of body weight (5.4 +/- 2.7 kg) mean arterial pressure(l25 +/- 15 to 95 +/- 11 mmHg), cardiothoracic index (from 0.57 to 0.47), and left atrial (28 +/- 4 to 22 +/- 3 mm/m(2)), left ventricular systolic (25 +/- 5 to 21 +/- 55 mm/m(2)) and left ventricular diastolic (31 +/- 5 to 27 +/- 5 mm/m(2)), and mitral annular diameters (19.4 +/- 2 to 1 6.6 +/- 2 mm/m(2)). Ejection fraction increased but remained below 50% in 11 patients. Conclusion. Most of the mitral and tricuspid regurgit ations seen in HD patients are partly or completely functional, due to dilatation of the mitral annulus which is related to volume overload. A more aggressive approach, while discontinuing antihypertensive drug s can correct or improve many of them and also ameliorate cardiac func tion.