[Echocardiographic evaluation of the tricuspid valve in rheumatic mitral valvulopathy]

The recognition of tricuspid valve involvement in presence of rheumatic mitral valve disease is important when surgery is contemplated. At the National Institute of Cardiology in Mexico City, we studied 57 patients with preoperative echocardiogram and catheterisation on whom the tricuspid valve (TV) was explored during surgical repair of mitral valve disease. TV was normal in 17 patients (group I), 28 had functional tricuspid insufficiency (group II) and 12 had rheumatic involvement (group III). Surgical treatment over TV was required in 22 (20 annuloplasty, 1 comissurotomy and 1 homograft valve replacement). We found pure mitral stenosis in 15, mitral stenosis and regurgitation in 36 and 6 with pure mitral insufficiency; the surgical repair over the mitral valve consisted in: 4 comissurotomies and 53 prosthetic valve replacement. At catheterisation, no significant pressure differences were found among the groups (right atrium, end diastolic of right ventricle, systolic pulmonary artery and capillary wedge). Echocardiogram showed E-F slope velocity diminished in group III (P less than 0.01), a diastolic anterior motion of septal leaflet of TV was found in 22 patients. No significant differences in the right ventricle measurements were found. In 7 patients a systolic anterior motion of interventricular septum was observed, all had mitral stenosis, 6 from group II and 1 from group III. We conclude that: echocardiogram study is a useful tool for the evaluation of TV involvement in patients with rheumatic mitral valve disease.