Article Sidebar

PDF
Date Published: 20/06/2022
Abstract Views: 122
Views PDF: 173
DOI: https://doi.org/10.51298/vmj.v514i1.2559
Issue
Vol. 514 No. 1 (2022)
Section
Các bài báo
How to Cite
Hải Yến, T. ., Ngọc Quang, N. ., & Đức Hùng, D. . (2022). TRICUSPID REGURGITATION AND RIGHT VENTRICULAR DYSFUNCTION AFTER MITRAL VALVE SURGERY CONCOMITANT TRICUSPID REPAIR. Vietnam Medical Journal, 514(1). https://doi.org/10.51298/vmj.v514i1.2559

TRICUSPID REGURGITATION AND RIGHT VENTRICULAR DYSFUNCTION AFTER MITRAL VALVE SURGERY CONCOMITANT TRICUSPID REPAIR

Trần Hải Yến1,, Nguyễn Ngọc Quang1, Dương Đức Hùng1
1 Vietnam National Heart Institute, Bach Mai Hospital

Main Article Content

Abstract

Objectives: To evaluate the frequency of tricuspid valve regurgitation (TR) and right ventricular dysfunction (RVD) after mitral valve surgery concomitant with tricuspid valve repaired and related factors. Subjects and methods: 109 consecutive subjects undergoing mitral valve surgery concomitant with tricuspid valve repaired at Vietnam National Heart Institute from August 2018 to May 2021. Timing ultrasound assessed the severity of TR and RV function (TAPSE, S', FAC) at 4 time points: before operation and 1-3 weeks, 1-3 months, 6-12 months after surgery. Results: 109 patients, mean age 52, female rate 68%, rheumatic valvular heart disease 94.5%, atrial fibrillation rate 87%. Before the operation, moderate TR was 49.5%, severe TR was 55.5% , RVD (FAC <35%) was 47.7%. The rate of moderate or higher postoperative TR at 1-3 weeks, 1-3 months and 6-12 months is 23.5%, 30% and 32.3% respectively (the rate of severe TR were 1%, 2.5%, and 4.6%, respectively). The decrease in TAPSE, S' parameters at all time points of postoperative follow-up compared to pre-operative time reflects a decrease in the longitudinal activity of the right ventricle rather than the global right ventricular (RV) function. The rate of RVD (FAC < 35%) before surgery was 47.7%, after surgery at 1 - 3 weeks, 1 - 3 months and 6 - 12 months, respectively, 52%, 30%, 23% . Pre-opreative severe TR was an independent echocardiographic predictor of post-operative moderate or higher TR at the 1-year follow-up. Organic TR, associated with aortic valve disease increases the risk of moderate to severe post-operative TR at the 1-year follow-up. The risk factors for early postoperative RV dysfunction (FAC < 35%) are  preoperative RV dysfunction (TAPSE, S', FAC parameters are under normal cut off, in which FAC < 35% is an independent predictor) and preoperative PAP > 50 mmHg. Postoperative progression TR has negative effect on RV function. Conclusions: Significant tricuspid regurgitation (TR) and RVD are frequently present in patients undergoing mitral valve surgery concomitant with tricuspid valve repair. Pre-opreative severe TR and RVD had adversely affect on TR and RVD after operation.

Article Details

Keywords

sửa van ba lá, hở van ba lá, rối loạn chức năng thất phải

References

1. Izumi C, Iga K, Konishi T. Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease. J Heart Valve Dis. 2002;11(3):353-356.
2. Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis. 1992;1(1):80-86.
3. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. doi:10.1016/j.echo.2014.10.003
4. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30(4):303-371. doi:10.1016/j.echo.2017.01.007
5. Del Rio JM, Grecu L, Nicoara A. Right Ventricular Function in Left Heart Disease. Semin Cardiothorac Vasc Anesth. 2019;23(1):88-107. doi:10.1177/1089253218799345
6. Maffessanti F, Gripari P, Tamborini G, et al. Evaluation of right ventricular systolic function after mitral valve repair: a two-dimensional Doppler, speckle-tracking, and three-dimensional echocardiographic study. J Am Soc Echocardiogr. 2012;25(7):701-708. doi:10.1016/j.echo.2012.03.017
7. Zanobini M, Saccocci M, Tamborini G, et al. Postoperative Echocardiographic Reduction of Right Ventricular Function: Is Pericardial Opening Modality the Main Culprit? Biomed Res Int. 2017;2017:4808757. doi:10.1155/2017/4808757
8. Kuwaki K, Morishita K, Tsukamoto M, Abe T. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease. Eur J Cardiothorac Surg. 2001;20(3):577-582. doi:10.1016/s1010-7940 (01) 00786-2