BACKGROUND: Tricuspid regurgitation (TR) is a usual concomitant lesion in patients with severe mitral stenosis (MS) and its persistence after successful percutaneous mitral valvotomy (PMV) may contribute to patients' poor outcome. Objective: This study aims to investigate the outcome of cases with severe mitral stenosis and persistent moderate to severe TR after having undergone PMV.
METHODS: This is a retrospective cohort study done by reviewing records of patients with severe MS and significant TR who underwent PMV at the Philippine Heart Center form 1989 to 1998. Study participants were divided into those with trace to mild TR (group A) and those with persistently significant TR (group B) following PMV. Outcomes were observed in terms of the resolution or persistence of the TR and patients' clinical condition immediately and after 5 years after the procedure.
RESULTS: Seventy-nine patients were included in the study. Majority of the study population were female with mean age of 33 (SD 8) and 32 (SD 9.5) for groups A and B respectively. After successful PMV, the TR decreased to trace or mild (group A) in 42(53 percent) patients while 37(47 percent) had persistently significant TR (group B). On 5 year follow-up, 12(29 percent) patients with trace to mild TR developed significant TR. Of those with significant TR 5 years after PMV, there was a decrease in severity in 41 percent , while 59 percent continued to have significant TR. Elevated PAP, TVA size and RV diameter were associated with persistent TR and its development on long term follow-up. The event-free survival rates for trace to mild TR following successful PMV was 80 percent and 52 percent for those with significant TR.
CONCLUSION: There was significant improvement in severity of TR in majority of patients after successful PMV on both short-term and long-term follow-up, with improvement of clinical outcome and freedom from any cardiac events in 5 years. Increased PAP, TVA and RV diameter, together with TV leaflet thickening and non coaptation are factors associated with persistence of TR after PMV. (Author)