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Open Access Highly Accessed Research article

Surgical treatment of tricuspid regurgitation after mitral valve surgery: a retrospective study in China

Zong-Xiao Li1, Zhi-Peng Guo1, Xiao-Cheng Liu1, Xiang-Rong Kong12, Wen-Bin Jing1, Tie-Nan Chen1, Wan-Li Lu1 and Guo-Wei He123*

Author Affiliations

1 Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Medical College, Nankai University, Tianjin, China

2 Department of Surgery, Oregon Health & Science University, Portland, OR 97225, USA

3 Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Medical College, Nankai University, No.61, the Third Avenue, TEDA, Tianjin, China 300457

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Journal of Cardiothoracic Surgery 2012, 7:30  doi:10.1186/1749-8090-7-30

Published: 10 April 2012

Abstract

Background

Functional tricuspid regurgitation (TR) occurs in patients with rheumatic mitral valve disease even after mitral valve surgery. The aim of this study was to analyze surgical results of TR after previous successful mitral valve surgery.

Methods

From September 1996 to September 2008, 45 patients with TR after previous mitral valve replacement underwent second operation for TR. In those, 43 patients (95.6%) had right heart failure symptoms (edema of lower extremities, ascites, hepatic congestion, etc.) and 40 patients (88.9%) had atrial fibrillation. Twenty-six patients (57.8%) were in New York Heart Association (NYHA) functional class III, and 19 (42.2%) in class IV. Previous operations included: 41 for mechanical mitral valve replacement (91.1%), 4 for bioprosthetic mitral valve replacement (8.9%), and 7 for tricuspid annuloplasty (15.6%).

Results

The tricuspid valves were repaired with Kay's (7 cases, 15.6%) or De Vega technique (4 cases, 8.9%). Tricuspid valve replacement was performed in 34 cases (75.6%). One patient (2.2%) died. Postoperative low cardiac output (LCO) occurred in 5 patients and treated successfully. Postoperative echocardiography showed obvious reduction of right atrium and ventricle. The anterioposterior diameter of the right ventricle decreased to 25.5 ± 7.1 mm from 33.7 ± 6.2 mm preoperatively (P < 0. 05).

Conclusion

TR after mitral valve replacement in rheumatic heart disease is a serious clinical problem. If it occurs or progresses late after mitral valve surgery, tricuspid valve annuloplasty or replacement may be performed with satisfactory results. Due to the serious consequence of untreated TR, aggressive treatment of existing TR during mitral valve surgery is recommended.

Keywords:
Tricuspid regurgitation; Annuloplasty; Tricuspid valve replacement; Mitral valve surgery; Rheumatic heart disease