Outcome of significant functional tricuspid regurgitation after percutaneous mitral valvuloplasty.

BACKGROUND The outcome of significant functional tricuspid regurgitation (TR) associated with mitral stenosis (MS) after percutaneous mitral valvuloplasty (PMV) remains to be clarified. METHODS From 265 patients who underwent PMV at our institution from 1995 to 2000 and who were regularly observed, we selected 71 patients (55 women, mean age 43 +/- 11 years) who showed significant moderate to severe functional TR before PMV. We analyzed data from the echocardiograms performed before, 24 hours after, and long after the intervention (29 +/- 12 months) and analyzed clinical outcomes. Resolution of TR was defined as trace or mild TR on the follow-up color Doppler study. RESULTS Patients with moderate to severe TR showed more severe MS and pulmonary hypertension and more atrial fibrillation than patients with less than moderate TR. TR was resolved on the follow-up echocardiography in 23 of the 71 patients with significant TR before PMV (32%). The TR jet area before PMV (P <.05) and the late decrement of peak transmitral pressure gradient (P <.01) were independent determinants of resolution. TR was resolved in only 6.7% of patients (1/15) with an unsuccessful long-term PMV result, but was resolved in 39% of patients (22/56) with a successful long-term result (P <.05). During the clinical follow-up period (mean length 38 +/- 20 months), 4 patients underwent open heart surgery 24 to 39 months after PMV, and there was no overall mortality. CONCLUSIONS Significant functional TR was associated with more severe MS, and it could be diminished when the transmitral pressure gradient was sufficiently relieved with PMV.