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Long-term follow-up after Carpentier tricuspid valvuloplasty
H Lambertz1, C Minale, F A Flachskampf
1Department of Internal Medicine I, Klinikum of the Rheinisch-Westfälische Technische Hochschule, Aachen, Federal Republic of Germany.
Insights
Long-term tricuspid valve repair using Carpentier rings yielded encouraging results, with most patients showing clinical improvement. Echocardiography effectively monitored outcomes, detecting tricuspid regurgitation and stenosis post-surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
- Echocardiography
Background:
- Tricuspid valve disease often coexists with mitral valve disease, necessitating combined surgical approaches.
- Long-term outcomes of tricuspid valve annuloplasty, particularly with Carpentier rings, require thorough evaluation.
Purpose of the Study:
- To assess the long-term clinical and hemodynamic results of tricuspid valve annuloplasty using Carpentier rings.
- To evaluate the efficacy of echocardiography in monitoring postoperative tricuspid valve function.
Main Methods:
- Retrospective analysis of echocardiographic and catheterization data from 51 patients undergoing tricuspid valve annuloplasty.
- Patients were categorized into groups based on postoperative clinical improvement and tricuspid regurgitation/stenosis severity.
Main Results:
- 37 patients (Group A) showed significant clinical improvement; 11 had mild tricuspid stenosis.
- 8 patients (Group B) had no improvement, with persistent moderate tricuspid regurgitation or stenosis.
- 6 patients (Group C) deteriorated, with severe tricuspid regurgitation or significant tricuspid stenosis.
Conclusions:
- Tricuspid valve annuloplasty with Carpentier rings offers encouraging long-term results for selected patients.
- Tricuspid stenosis can develop postoperatively, especially in patients with specific leaflet characteristics.
- Doppler echocardiography is a reliable method for assessing postoperative tricuspid regurgitation and pressure gradients.
Abstract:
To study the long-term results of tricuspid valvuloplasty, pre- and postoperative (51 +/- 17 months) echocardiographic and catheterization data were collected from 51 patients (aged 59 +/- 9 years). Because of severe mitral stenosis all patients received a heterograft in the mitral position and underwent reconstructive tricuspid surgery with Carpentier rings. With regard to postoperative clinical outcome three patient groups were distinguished: 37 patients (group A) showed clear clinical improvement; in seven patients mild, and in three patients moderate tricuspid regurgitation persisted. A mild tricuspid stenosis of less than 4 mm Hg mean diastolic gradient was found in 11 patients. Patients in group B (n = 8) showed no clinical improvement, but there was persistence of moderate tricuspid regurgitation associated with nearly unchanged pulmonary hypertension in five patients and moderate tricuspid stenosis in two. Six patients (group C) showed deterioration of their clinical status; in two patients a severe degree of tricuspid regurgitation persisted, and four patients were first seen with a tricuspid stenosis with a mean diastolic gradient greater than 7 mm Hg. Analysis of postoperative data showed that tricuspid stenosis may develop during surgery in patients with slightly shrunken valve leaflets. Although the area of the anterior tricuspid leaflet was slightly underestimated, we found that long-term results of tricuspid valve annuloplasty with a Carpentier ring were encouraging. Doppler echocardiography for detection of tricuspid regurgitation and transvalvular pressure gradient showed results identical to hemodynamic data and is a suitable and sensitive method for evaluating postoperative results after tricuspid valve annuloplasty.