Publication: Tricuspid Valve Repair: Devega’s Tricuspid Annuloplasty in Moderate Secondary Tricuspid Regurgitation
Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Moderate secondary tricuspid incompetence has variable natural history if left
unattended during mitral valve surgery. Recent data suggest progression of the
secondary tricuspid incompetence over time. Secondary moderate tricuspid
regurgitation in rheumatic mitral valve disease may regress after mitral valve
surgery without direct intervention.
Objectives:
The present retrospective comparative hospital based tudy was done to assess
early result of DeVega tricuspid valve annuloplasty amongst those with moderate
tricuspid regurgitation due to rheumatic mitral valve disease.
Methods:
Group I (mitral valve replacement with tricuspid repair) and Group II (mitral valve
replacement only) were compared regarding functional class, heart rate, rhythm,
cardiac dimensions, function and valve pathology. The two groups were followed
up at three months post-operatively and evaluated for their functional class and
echocardiography variables. The data was analyzed with SPSS 16.0
Results:
There were 43 patients who underwent mitral valve replacement with moderate
tricuspid regurgitation. Twenty three underwent mitral valve replacement with
tricuspid repair group (Group 1). Most of the patients were women (28/43). The
mean age was 31.4 + 14.8 and 25.13 + 9.4 years. Group I had 21(91.3%) and Group
II had 17 (85%) in NYHA class III & IV. The pre-operative echocardiographic cardiac
left ventricular and left atrial dimensions, left ventricular function and valve lesions
were statistically similar for both groups, except PASP was higher amongst tricuspid
repair (Group 1: 38.60 + 12.75mHg, Group 2: 61.52 + 19.76mmHg; p= <0.05). At
three month’s review after surgery, four patients were in NYHA II amongst those
without tricuspid repair (Group II), whilst the rest were in NYHA I. Left ventricular
dimensions, Left Ventricular function and valve prosthetic valve function were
similar between groups. Eleven (47.8%) patients in Group I and only five (25%) of
Group II had trace or less TR at the follow-up (p < 0.05). There were 7 (16.2%)
patients who had persistent moderate TR. Higher PASP and larger LV dimensions at
three months were predictive of persistent moderate TR.
Conclusion
Mitral valve replacement does decrease the severity of tricuspid regurgitation
amongst those with secondary moderate tricuspid regurgitation by at least one
grade, but DeVega’s annuloplasty confers a better repair result.
Key Words
tricuspid valve, tricuspid annuloplasty; DeVega’s annuloplasty; secondary tricuspid
regurgitation
Description
Pradhan S,1 Gautam NC,1 Singh YM,1 Shakya S,1 Timala RB,1 Sharma J,1 Koirala B2
Department of Cardiac Surgery Shahid Gangalal National Heart Center Bansbari. Kathmandu
2Department of Cardio-Thoracic and Vascular Surgery, Man Mohan Center for Cardio-Thoracic, Vascular & Transplant Surgery, Institute of Medicine
Maharajgunj. Kathmandu