Management of Severe Pulmonary Regurgitation and Severe Secondary Tricuspid Regurgitation

Document Type : Original Article

Authors

1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Management of severe functional tricuspid regurgitation (TR) at the time of pulmonary valve replacement in the setting of severe pulmonary regurgitation in adult congenital heart diseases has not been examined clearly.
Methods: Thirty-five patients with severe functional TR who were candidates for pulmonary valve replacement with congenital heart diseases were chosen. Baseline features and echocardiographic and clinical findings were compared between isolated pulmonary valve replacement, tricuspid valve repair, and pulmonary valve replacement groups.
Results: In the tricuspid valve repair group, TR was significantly improved compared with the isolated pulmonary valve replacement group in the early postoperative (P<0.001), short-term (P=0.009), and mid-term (P=0.035) follow-up periods. Functional capacity was improved in the tricuspid valve repair group (P=0.009) compared with the isolated pulmonary valve replacement group.
Conclusions: Our study has introduced the concomitant tricuspid valve repair as a safe approach in patients with severe functional TR at the time of pulmonary valve replacement. It can efficiently reduce TR severity in mid-term follow-up and improve the long-term functional capacity. However, there were no significant effects on mortality during the follow-up period. (Iranian Heart Journal 2022; 23(2): 34-41)

Keywords


  1. Lueck S, Bormann E, Rellensmann K, Martens S, Rukosujew A. Impact of additional tricuspid valve annuloplasty in tof patients undergoing pulmonary valve replacement. The Journal of cardiovascular surgery. 2019; 60:268-273
  2. Kogon B, Mori M, Alsoufi B, Kanter K, Oster M. Leaving moderate tricuspid valve regurgitation alone at the time of pulmonary valve replacement: A worthwhile approach. The Annals of thoracic surgery. 2015; 99:2117-2122; discussion 2122-2113
  3. Mahle WT, Parks WJ, Fyfe DA, Sallee D. Tricuspid regurgitation in patients with repaired tetralogy of fallot and its relation to right ventricular dilatation. The American journal of cardiology. 2003; 92:643-645
  4. Giamberti A, Chessa M, Ballotta A, Varrica A, Agnetti A, Frigiola A, Ranucci M. Functional tricuspid valve regurgitation in adults with congenital heart disease: an emerging problem. J Heart Valve Dis. 2011 Sep 1;20(5):565-70.
  5. Woudstra OI, Bokma JP, Winter MM, Kiès P, Jongbloed MRM, Vliegen HW, Groenink M, Meijboom FJ, Mulder BJM, Bouma BJ. Clinical course of tricuspid regurgitation in repaired tetralogy of fallot. International journal of cardiology. 2017; 243:191-193
  6. Bokma JP, Winter MM, Oosterhof T, Vliegen HW, van Dijk AP, Hazekamp MG, Koolbergen DR, Groenink M, Mulder BJ, Bouma BJ. Severe tricuspid regurgitation is predictive for adverse events in tetralogy of fallot. Heart (British Cardiac Society). 2015; 101:794-799
  7. Geva T. Indications for pulmonary valve replacement in repaired tetralogy of fallot: The quest continues. Circulation. 2013; 128:1855-1857
  8. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL. 2017 esc/eacts guidelines for the management of valvular heart disease. European heart journal. 2017; 38:2739-2791
  9. Cherry SV, Jain P, Rodriguez-Blanco YF, Fabbro M. Noninvasive evaluation of native valvular regurgitation: A review of the 2017 American Society of Echocardiography guidelines for the perioperative echocardiographer. Journal of Cardiothoracic and Vascular Anesthesia. 2018 Apr 1;32(2):811-22.
  10. Kurkluoglu M, John AS, Cross R, Chung D, Yerebakan C, Zurakowski D, Jonas RA, Sinha P. Should tricuspid annuloplasty be performed with pulmonary valve replacement for pulmonary regurgitation in repaired tetralogy of fallot? Seminars in thoracic and cardiovascular surgery. 2015; 27:159-165
  11. Antunes MJ, Rodríguez-Palomares J, Prendergast B, De Bonis M, Rosenhek R, Al-Attar N, Barili F, Casselman F, Folliguet T, Iung B, Lancellotti P, Muneretto C, Obadia JF, Pierard L, Suwalski P, Zamorano P. Management of tricuspid valve regurgitation: Position statement of the european society of cardiology working groups of cardiovascular surgery and valvular heart disease. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery. 2017; 52:1022-1030
  12. Deshaies C, Trottier H, Khairy P, Al-Aklabi M, Beauchesne L, Bernier PL, Dhillon S, Gandhi SK, Haller C, Friesen CL, Hickey EJ. Tricuspid intervention following pulmonary valve replacement in adults with congenital heart disease. Journal of the American College of Cardiology. 2020 Mar 10;75(9):1033-43.
  13. Roubertie F, Séguéla PE, Jalal Z, Iriart X, Roques X, Kreitmann B, Al-Yamani M, Pillois X, Thambo JB. Tricuspid valve repair and pulmonary valve replacement in adults with repaired tetralogy of fallot. The Journal of thoracic and cardiovascular surgery. 2017; 154:214-223