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[Tricuspid annuloplasty and right ventricular function in mitral valve disease]
Abstract:
From 1985 to 1987, we examined relationship between the lesion of tricuspid valve and right ventricular function in 31 patients (male: 9, female: 22) with mitral valve disease. The median age at operation was 52 years (range 37-69 years). Group I consisted of 17 patients (MS: 10, MSR: 5, MR: 2) accompanied with tricuspid regurgitation (TR) and Group II 14 patients (MS: 12, MSR: 2) without TR. In all cases of Group I tricuspid annuloplasty (TAP) were performed correctly. De Vega methods were done in 12 cases and Carpentier rings were used in 5 cases. Cardiac catheterization was done before and after operation. And right ventricular volume was measured by right ventricular angiography. In both groups pulmonary capillary wedge pressure, pulmonary artery pressure and cardiac index were improved postoperatively. Pulmonary artery resistance (PAR) and total pulmonary resistance (TPR) in Group I were significantly higher before operation but there were no difference between two groups postoperatively. Right ventricular end-diastolic volume index (RVEDVI) and right ventricular end-systolic volume index (RVESVI) in Group I were significantly improved postoperatively, but in Group II these were within normal range both pre- and postoperatively. Preoperative PAR was correlated inversely with postoperative right ventricular ejection fraction (RVEF). It means that patients with severe pulmonary vascular lesion had postoperative lower right ventricular function. In both groups, RVESVI was in inverse correlation with RVEF pre- and postoperatively. In both groups, there was an inverse correlation between the per cent change of RVESVI and that of RVEF. This means that RVESVI influenced right ventricular pump function.
Insights
Tricuspid regurgitation (TR) significantly impacts right ventricular function in mitral valve disease patients undergoing tricuspid annuloplasty (TAP). Postoperative improvements in right ventricular volume and ejection fraction were observed, particularly in patients with TR.
Area of Science:
- Cardiovascular Surgery
- Cardiac Physiology
- Valvular Heart Disease
Context:
- Mitral valve disease often coexists with tricuspid valve pathology.
- Tricuspid regurgitation (TR) can significantly affect right ventricular (RV) function.
- Understanding the impact of TR on RV function is crucial for surgical outcomes.
Purpose:
- To investigate the relationship between tricuspid valve lesions and right ventricular function in patients with mitral valve disease.
- To evaluate the impact of tricuspid annuloplasty (TAP) on RV function in patients with and without TR.
- To assess the correlation between pulmonary vascular resistance and RV function postoperatively.
Summary:
- This study analyzed 31 patients with mitral valve disease, comparing 17 with TR (Group I) and 14 without TR (Group II) undergoing TAP.
- Both groups showed improvements in pulmonary hemodynamics and cardiac index postoperatively.
- Group I (with TR) demonstrated significant postoperative improvement in RV end-diastolic and end-systolic volumes, while Group II maintained normal RV volumes.
- Preoperative pulmonary artery resistance (PAR) inversely correlated with postoperative RV ejection fraction (RVEF), indicating poorer RV function with severe pulmonary vascular lesions.
- Right ventricular end-systolic volume index (RVESVI) was inversely correlated with RVEF both pre- and postoperatively, highlighting its influence on RV pump function.
Impact:
- Tricuspid annuloplasty effectively improves RV function in patients with mitral valve disease and coexisting tricuspid regurgitation.
- Pulmonary vascular resistance is a key factor influencing postoperative RV function.
- RVESVI is a significant determinant of RV pump performance in this patient population.