LONG-TERM FOLLOW-UP OF RHEUMATIC PATIENTS UNDERGOING LEFT-SIDED VALVE-REPLACEMENT WITH TRICUSPID ANNULOPLASTY - VALIDITY OF PREOPERATIVE ECHOCARDIOGRAPHIC CRITERIA IN THE DECISION TO PERFORM TRICUSPID ANNULOPLASTY

Between September 1989 and December 1991, modified De Vega tricuspid a nnuloplasty was performed in 43 patients who survived surgery for mitr al or mitral plus aortic valve replacement. The preoperative indicatio ns for tricuspid annuloplasty were moderate to severe tricuspid regurg itation (TR) in 33 patients and mild or no TR but with a dilated tricu spid annulus (greater than or equal to 30 mm) as measured by 2-dimensi onal echocardiography at end-diastole in 10 patients. The mean age was 31 +/- 13 years. The mean duration of follow-vp was 57 +/- 18 months. Overall long-term mortality was 12%. On Doppler color flaw mapping, p ostoperative severe TR was present in 1 patient and moderate TR in 4 p atients at latest follow-up. The tricuspid annulus diameter decreased from 37 +/- 5 mm preoperatively to 24 +/- 6 mm at latest follow-up. Du ring the study period, an additional 77 patients underwent mitral valv e replacement or double valve replacement, but without tricuspid annul oplasty. Within this group, 38 patients had a preoperative tricuspid a nnulus diameter of greater than or equal to 30 mm, and 5 of these pati ents (13%) developed moderate or severe TR in the postoperative period , which may have been prevented had clinicians adhered to the preopera tive indications for tricuspid annuloplasty. Thus, preoperative echoca rdiographically documented moderate or severe TR or a tricuspid annulu s diameter of greater than or equal to 30 mm are valid indications for performing tricuspid annuloplasty; modified De Vega tricuspid annulop lasty is a durable procedure in rheumatic patients; it appears that re ducing the diastolic tricuspid annulus diameter to 24 mm is adequate t o prevent residual TR in the long term. (C) 1998 by Excerpta Medica, I nc.