Progression of tricuspid regurgitation after repaired functional ischemic mitral regurgitation

Circulation. 2005 Aug 30;112(9 Suppl):I453-7. doi: 10.1161/CIRCULATIONAHA.104.524421.


Background: Despite correction of left-sided cardiac lesions, associated functional tricuspid regurgitation (TR) that was surgically ignored can persist. It can also appear de novo. The aim of this study was to analyze TR in a group of patients who underwent successful revascularization and mitral valve repair (MVRep) for functional ischemic mitral regurgitation (MR).

Methods and results: Among 124 consecutive patients with MVRep, 70 left the operating room with MR < or =1+ and had a preoperative and follow-up transthoracic echocardiograph. Moderate or greater MR or TR was considered significant. Twenty-one patients (30%) had TR before surgery, and only 9 had TR repaired. The postoperative incidence of residual TR was not significantly different whether the tricuspid valve had been repaired (4 of 9 [44%]) or surgically ignored (8 of 12 [67%]). At last follow-up, 34 patients (49%) had significant TR. The incidence of TR increased from 25% at <1 year to 53% between 1 and 3 years and 74% at >3 years. Absence or presence of recurrent MR did not significantly affect TR (14 of 22 [64%] with MR versus 20 of 48 [42%] with no MR). Preoperative and postoperative tricuspid annulus size in patients with late TR was significantly larger than in patients without TR.

Conclusions: Functional TR is frequently associated with functional ischemic MR. After MVRep, close to 50% of patients have TR. The incidence of postoperative TR increases with time. Preoperative tricuspid annulus dilation might be a predictor of late TR.

MeSH terms

  • Aged
  • Disease Progression
  • Echocardiography, Doppler
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency / etiology
  • Mitral Valve Insufficiency / surgery*
  • Myocardial Infarction / complications*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Period
  • Retrospective Studies
  • Tricuspid Valve / diagnostic imaging
  • Tricuspid Valve Insufficiency / diagnostic imaging
  • Tricuspid Valve Insufficiency / epidemiology
  • Tricuspid Valve Insufficiency / etiology*
  • Tricuspid Valve Insufficiency / surgery