ABSTRACT
Objective To review the patients with rheumatic tricuspid valve disease ( RTVD) who were confirmed in cardiac operation and underwent tricuspid valve repair ,and summarize two and three-dimensional echocardiography ( 2D-STE ,3D-STE) characteristics of RTVD ,and evaluate the surgical procedures and outcomes of RTVD . Methods Between December 2009 and December 2017 ,359 patients with rheumatic heart disease ( RHD) underwent left-sided valvular replacement were enrolled . During the operation , 56 patients with RTVD were confirmed . All patients underwent 2D-STE and 3D-STE preoperatively . The preoperative echo characteristics of RTVD and the procedure of tricuspid valvular repair were reviewed . The morphology and function of tricuspid valve were followed after operation . Results Fifteen patients with RTVD were diagnosed by transthoracic echocardiography( TTE) preoperatively .Eight patients were presented tricuspid stenosis . Tricuspid annulus diameter [ ( 40 .3 ± 5 .6 ) mm ] , tethering distance[(5.9±2.2)mm] ,andpulmonaryarterysystolicpressure[(46.3±15.9)mmHg(1mmHg=0.133 kPa) ] were measured by echocardiography ,preoperatively . Moderate and severe tricuspid regurgitation were presented in 32 patients( 57 .1％ ) . All patients underwent tricuspid valvular repair . During the mean follow-up (78 .9 months) ,tricuspid annulus diameter was reduced and tricuspid regurgitation was relieved . Recurrent tricuspid regurgitation occurred in 8 patients(14 .3％ ) . Conclusions Preoperatively 2D-STE and 3D-STE need to evaluate tricuspid valve very carefully . Compared with functional tricuspid regurgitation , RTVD has some characteristics ,including more serious tricuspid reflux grade ,higher tethering distance ,the mismatch between tricuspid reflux degree and tricuspid anmular diameter or pulmonary artery pressure . Tricuspid valve repair shows better early and mid-term outcomes .
ABSTRACT
Objective The aim of this study was to summarize the characteristics of rheumatic tricuspid valve disease ( RTVD) and to evaluate the mid-term outcomes in patients undergoing tricuspid valve repair with RTVD. Methods Between January 2009 and June 2016, 251 consecutive patients with rheumatic heart disease( RHD) underwent left-sided valvular re-placement by a single surgeon. We analyzed 39 patients with RTVD which was diagnosed during the operation. Among them, 32 patients, with moderate or higher tricuspid regurgitation( TR) , were compared with other 59 patients of functional tricuspid regurgitation( FTR) for a better understanding of the features of the RTVD. A total of 39 patients were categorized into 2 groups:Ring annuloplasty group(n=33) and non-Ring annuloplasty group(n=6) which consisted of modified De Vega annu-loplasty for 4 patients and edge-to-edge repair for 2. Meanwhile, 13 of them underwent concomitant tricuspid commissurotomy and 1 patient had a tricuspid leaflet augmentation procedure. We analyzed the mid-term outcomes of 22 patients( follow-up du-ration>1 year)with a mean follow-up duration of(45.5 ±25.1) months. Results Compared with FTR, patients with RTVD had higher preoperative TR grade(3.1 ±0.8 vs. 2.6 ±0.7, P=0.004) but with lower preoperative PASP[(53.8 ±19.4) mmHgvs.(63.6±21.5)mmHg,P=0.037)](1mmHg=0.133kPa) andtricuspidannulusdiameter(TAD) thatobserved bothinpreoperativeechocardiogramtests[(37.0±5.7)mmvs.(41.9±6.7)mm,P=0.018)]andintraoperativedetection [(35.6±4.1)mmvs.(39.9±6.5)mm,P=0.000)] . TherewasnoearlymortalityandresidualmoderateorhigherTR grades in either group. Compared with patients in non-ring annuloplasty group, patients in ring annuloplasty group showed low-er postoperative TR grade(0. 2 ± 0. 4 vs. 0. 7 ± 0. 5, P=0. 039) and acceptable TR grade(0. 8 ± 0. 5 vs. 1. 3 ± 1. 9, P>0. 050) during the mid-term follow-up. PASP, the peak diastolic velocity and pressure gradient across tricuspid valve were not different between groups in preoperative, postoperative and follow-up. Conclusion Compared with FTR, Patients with RTVD had lower preoperative PASP and TAD, but with a higher preoperative TR grade. In our study, ring annuloplasty showed simi-lar mid-term outcomes compared with other procedures.