MILD FUNCTIONAL TRICUSPID REGURGITATION: AN ITS COURSE AFTER MITRAL VALVE REPLACEMENT AND PREOPERATIVE ECHOCARDIOGRAPHIC PREDICTIVE CRITERION SHOWING POSTOPERATIVE RESIDUAL TRICUSPID REGURGITATION

İbrahim Gökşin^*, Arif Yılmaz^{Gökhan Önem}, Ufuk Ali Türk^*, Engin Tulukoğlu^{Mustafa Saçar}, Mansur Şağban

Pamukkale Üniversitesi Tıp Fakültesi, Göğüs Kalp Damar Cerrahisi Ana Bilim Dalı, Denizli
^*İzmir Atatürk Eğitim ve Araştırma Hastanesi, Göğüs Kalp Damar Cerrahisi Kliniği, İzmir
^**İzmir Atatürk Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, İzmir

Background: Mild functional tricuspid regurgitation (TR) generally regresses or completely disappears after mitral valve replacement, but there is a chance of progression in 13% of patients. Residual TR increases patients morbidity and mortality postoperatively. The aim of the study was to determine the postoperative course of mild functional TR after mitral valve replacement and whether or not there was any significant differences in preoperative echocardiographic parameters between the patients with or without residual TR.

Methods: Twentyfive patients with mild functional TR was included to this study. Preoperative and postoperative functional TR was evaluated with color flow doppler echocardiography in apical 4-chamber view with the measurment of mosaic formation area in the right atrium during systole. For every patient, right atrial inferior-superior (RA inf/sup), mediolateral (RA med/lat) diameters, right ventricular outflow tract (RVOT) and inflow tract (RVIT) diameters, left ventricular ejection fraction (LVEF) and pulmonary arterial sistolic pressure (PAPs) were measured. Wilcoxon macthed pairs signed rank test was used for analysis of data.

Results: After mitral valve replacement, mild functional TR completely dissapeared in 48% (12), regressed in 56% (14), remained the same in 32% (8) and progressed in 12% (3) of the patients. Preoperative echocardiographic parameters in patients with or without postoperative residual TR were as following: RA inf/sup 56.53 ± 8.78 / 50.25 ± 3.33 mm, RA med/lat 44.46 ± 4.71 / 38.16 ± 4.04 mm, RVOT 24.84 ± 2.6 / 24.25 ± 2.49 mm, RVIT 40.69 ± 2.28 / 39 ± 3.71 mm, LVEF %57.69 ± 8.15 / %61.75 ± 5.81, PAPs 58.92 ± 8.97 / 55,.33 ± 6.89 respectively. There was a significant difference in preoperative right atrial dimension between the patients with or without residual TR (p < 0.05).

Conclusion: In conclusion, preoperative right atrial diameters are predictive criterion for postoperative residual TR.

Keywords : Mild functional tricuspid regurgitation, residual tricuspid regurgitation

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