Echocardiographic study of functional tricuspid regurgitation and results of tricuspid valve repair

Background

Functional tricuspid regurgitation (FTR) is often neglected. No clear consensus has been reached on superiority of preoperative transthoracic (TTE) or intraoperative transesophageal echocardiography (TEE) in assessment of tricuspid regurgitation (TR) in rheumatic heart disease. There is still debate when to consider for surgical repair of FTR and its benefits.

Methods

A total of 50 patients with rheumatic heart disease involving mitral, aortic or both valves with moderate and severe TR were included in the study. TR was assessed using preoperative TTE and intraoperative TEE. 36 out of 50 patients underwent tricuspid valve repair. Two patients died in postoperative period. Results of tricuspid valve repair were studied in 34 patients after six months of surgery.

Results

TTE was superior in assessing tricuspid annulus size, central jet area, vena contracta, right atrium size and right ventricle systolic pressure. Patients undergoing tricuspid valve repair had better quality of life with significant improvement in grade of dyspnea, angina, pedal edema and hepatomegaly. The annulus size, jet velocity and right ventricle systolic pressure were significantly lower in patients who underwent tricuspid valve repair. Tricuspid valve should be repaired in all cases of moderate to severe TR with significant annular dilation (>38 mm).

Conclusions

FTR is better assessed by TTE compared to intraoperative TEE. Concomitant TR correction (even in moderate degree of TR with tricuspid annulus ≥ 38 mm) should be strongly considered at the time of left side valve surgery resulting in better quality of life.