Moderate and severe tricuspid regurgitation (TR) in patients with severe mitral stenosis may persist after succesful percutaneous mitral balloon valvotomy (PMV). Its clinical importance has been well established because ts persistence may contribute to a poor outcome after the procedure.
This is a cohort study over a five-year period of cases seen at the Philippine Heart Center. The records of patients with significant TR before successful PMV were reviewed in term of the resolution and its persistence immediately and long after the procedure. Clinical outcome were also analyzed in relation to significant TR in terms of functional impairment, repeated PMV, mitral surgery and death. Factors associated with persistence of TR were also noted. Survival analysis was performed to estimate the event free survival rates while Chi-square, Fisher exact and Mann-Whitney U-Test was used to determine association of different variables with outcome.
Seventy-nine patients were included in the study. They were divided into two groups, those with insignificant TR and those with significant TR immediately after successful PMV. Majority of the population were female with mean age of 33±8 and 32±9.5 respectively. Tricuspid regurgitation was resolved to trace or mild in 42 (53%) patients and persisted in 37(47%). On 5 year follow-up TR became insignificant i 15 (41%) patients who initially had moderate to severe TR after PMV, while 22 (59%) continued to have significant TR. Twelve (29%) patients wih intially had trace to mild TR after PMV developed significant TR. Patients with moderate severe TR immediately and after PMV and those who developed significant TR on fololow-up had elevated PAP, TVA and RV diameter on the last follow-up. Presence organic TR was also significantly associated with patients having persistent significant TR. There was a marked reduction of symptoms in almost all of the patients after the procedure, and majority remained remarkably stable on follow-up. However patients with significant TR on follow-up had higher rates of functional impairment compared to those in whom TR resolved to trace or mild. The event free survival rates for trace to mild TR was 80% and 52% for those with moderate to severe TR.
Over all, there was significant improvement in severity of TR in a good number of patients on both short-term and long-term follow-up after successful PMV. More than two thirds of patients were also found to improve clinically with no cardiac events on 5 year of follow-up.