Tricuspid Dysfunction During The Rheumatic Disease

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Published Oct 28, 2010
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Vol. 88 No. 11 (2010): Issue Nov 2010

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Youssef Ben Ameur
Ihsen Zairi
Kamel Kamoun
Mahdi Ben sassi
Salma Longo
Kais Battikh
Ml Slimane

Abstract

Background: Rheumatic tricuspid valve dysfunction is the rarest of all valvular disease and is often associated or secondary to left-sided valvular disease. She often realize tricuspid regurgitation. The surgical treatment is generally conservative but also it can be radical generally using bioprothèses.
Aim : to assess the epidemiology of the rheumatic tricuspid dysfunction, the average diagnoses and its therapeutic. To evaluate the results of the surgical
techniques, the factors of prognostis and to determine the therapeutic regarding an in front of important and symptomatic residual tricuspid regurgitation a long time after a valvular surgery first of the left heart.
Methods: A retrospective, single center of 84 consecutive patients having one significant tricuspid dysfunction regurgitation and/or significant stenosis of rheumatic origin. Hospitalized and followed between January 1992 and March 2008 in cardiology to the hospital Habib Thameur.
Results: The prevalence of the rheumatic tricuspid dysfunction was 8,42%. 70% of the patients had a tricuspid regurgitation. The average Age of our patients was 40 years. Our population consisted of 65,5% women. 21% of the patients had benefited at least from a percutaneous mitral dilation. 31% of the patients had antecedents of valvular cardiac surgery. 53% of the patients presented clinical signs of preoperative right cardiac failure and 58% of the patients were in permanent auricular fibrillation. The tricuspid regurgitation was major at 12% of the patients, severe at 88% of the patients, organics at 21% of the patients and functional at 31% of the patients. The average of the systolic pulmonary blood pressure was with 55 +-16,8 mm Hg. All the patients had an associated left valvulopathy. The average of the ejection fraction of the left ventricle was 56 + 12,6%. The dilation of the right cavities was noted at 70% of the patients. The patients of our series were subdivided in two distinct groups. The first group gathers 30 patients who were operated of tricuspid in same operational time as the surgery of the left valves. The surgical gesture on the tricuspid was always conservative. 70% of the patients profited from a tricuspid annuloplasty. Hospital mortality is 10%. 26% of the patients presented a significant residual tricuspid regurgitation after 60 months. 26% of the patients presented late cardiac failure. Late mortality was from 30% to 5 years and 43% to 10 years. The second group is represented by 54 patients not operated on the tricuspid. 30 patients (81%) presented one or more episodes of late cardiac failure. 50% of the patients died during the late follow-up. Among operated patients of the tricuspid, the predictive factors of the residual tricuspid regurgitation post operational are the age < 35 years and the mitral disease. The stage NYHA = 4 was the only predictive factor of hospital mortality. The
predictive factors of late right congestive heart failure postoperative are the clinical signs of preoperative right heart failure and the antecedents of mitral replacement . The predictive factors of late total congestive heart failure postoperative l are the functional tricuspid regurgitation and stage 4 of the NYHA.
Conclusion: The benefit of a systematic initial correction of a voluminous tricuspid regurgitation and even of average importance realized prematurely in same operation time that the left valvular gesture was largely shown. The late appearance of functional tricuspid regurgitation after mitral valve surgery is a pejorative marker in the evolution of these patients.

Keywords:

tricuspid valve, rheumatic disease, surgery, extracorporal circulation, evaluation of treatment result

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References

  1. Acar J. Les cardiopathies valvulaires acquises. Paris : Flammarion Médecine Sciences, 1985:1-665.
  2. Recommandations de la Société Française de Cardiologie concernant la prise en charge des valvulopathies acquises et des dysfonctions de prothèse valvulaire. Arch Mal Coeur Vaiss 2005;98:2.
  3. Kuwaki K, Morishita K, Tsukamoto M et al. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with leftsided valvular disease. Eur J Cardiothorac Surg 2001;20:577-82.
  4. Steven J, Daniels MD, Gary S. Rheumatic tricuspid valve disease: twodimensional echocardiographic, himodynamic and angiographic correlations. Am J Cardiol 1983;51:492-6.
  5. Bernal JM, Ponton A, Diaz B et al. Surgery for rheumatic tricuspid valve disease : A 30-years experience. J Thorac Cardiovasc 2008;136:476-81.
  6. Han QQ, Xu ZY, Zhang BR, Zou LJ, Hao JH, Huang SD. Primary triple valve surgery for advanced rheumatic heart disease in Mainland China: a singlecenter experience with 871 clinical cases.Eur J Cardiothorac Surg 2007; 31:845-50.
  7. Djebbi M. La chirurgie dans les lésions acquises de la valve tricuspide. Thèse. Monastir 1997.
  8. Slimane ML, Bouakez A, Bouziri S, Zalila S, Ben Naceur M. Résultat de la correction des insuffisances tricuspides par valvuloplastie de Carpentier et annuloplastie de De Vega. Tunis Med 1989;67:409-14.
  9. Bernal JM, Gutinez-Morlatte J, Liorca J. Tricuspid valve repair: An old disease, a modern experience. Ann Thorac Surg 2004;78:2069-75.
  10. Mc Grath LB, Gonzalez-Lavin L, Bailey BM et al. Tricuspid valve operations in 530 patients. Twenty-five years assessment of early and late phase events. J Thorac Cardiovasc Surg 1990;99:124-33.
  11. Guenther T, Noebauer C, Mazzitelli D, Busch R, Tassani-Prell P, Lange R. Tricuspid valve surgery: a thirty-year assessment of early and late outcome. Eur J Cardiothorac Surg 2008; 34:402-9.
  12. Mc Carthy P, Bhudia SK, Rajeswaran J et al. Tricuspid repair:durability and risk factors for failure. J Thorac Cardiovasc Surg 2004;127:674-85.
  13. Al soufi B, Rao V, Borger M et al. Short-and long-term results of triple valve. Surgery in the modern era. Ann Thorac Surg 2006;81:2172-8.
  14. Tager R, Skudicky D, Mueller U et al. Long-term follow-up of rheumatic patients undergoing left-sided valve replacement with tricuspid annuloplasty-validity of preoperative echocardiographic criteria in the decision to perform tricuspid annuloplasty. Am J Cardiol 1998;81:1013-6.
  15. Carpentier A, Deloche A, Hanania G et al. Surgical management of acquired tricuspid valve disease. J Thorac Cardiovasc Surg 1974;1:53-65.
  16. Yousof AM, Shafei MZ, Endrys G, Khan N, Simo M. Tricuspid stenosis and regurgitation in rheumatic heart disease: a prospective cardiac catheterization study in 525 patients. Am Heart J 1985;110:60-4.
  17. Pellegrini A, Colombo T, Donatelli F et al. Evaluation and treatment of secondary tricuspid insufficiency. Eur J Cardiothorac Surg 1992;6:288-96.
  18. Revuelta JM, Garcia Rinaldi R. Segmental tricuspid annuloplasty: a new technique. J Thorac Cardiovasc Surg 1989;97:799-801.
  19. Cabrol C. Annuloplastie valvulaire : Un nouveau procédé. Nouv Presse Med. 1972; 1 : 1366.
  20. Shah PM, Raney AA. Tricuspid Valve Disease. Curr Probl Cardiol 2008;33:47-84.
  21. Bajzer CT, Stewart WJ, Cosgrove DM et al. Tricuspid valve surgery and intraoperative echocardiography: factors affecting survival, clinical outcome and echocardiographic success. J AM Coll Cardiol 1998;32:1023-31.
  22. Deloche A, Guerinon J, Fabiani JN et al. Etude anatomique des valvulopathies rhumatismales tricuspidiennes. Application à l'étude des différentes valvulopathies. Ann Chir Thorac Cardiovasc 1973;12:343-9.
  23. De Vega NG. Selective, adjustable and permanent annuloplasty. An original technic for the treatment of tricuspid insufficiency. Rev Esp Cardiol 1972;25:555-6.
  24. Abe T, Tukamoto M, Yanagiya M et al. De Vega's annuloplasty for acquired tricuspid disease: Early and late results in 110 patients. Ann Thorac Surg 1996;62:1876-7.
  25. Holper K, Haehnel JC, Augustin N et al. Surgery for tricuspid insufficiency: longterm follow-up after De Vega annuloplasty. Thorac Cardiovasc Surg 1993;41:1-8.
  26. Carpentier A, Deloche A, Dauptain J et al. A new reconstructive operation for correction of mitral and tricuspid insufficiency. J Thorac Cardiovasc Surg 1971;61:1-13.
  27. Okada Y, Shomura T, Yamaura Y et al. Comparison of the Carpentier and Duran prosthetic rings used in mitral reconstruction. Ann Thorac Surg 1995;59:658-62.
  28. Duran CM, Pomar JL, Colman T et al. Is tricuspid valve repair necessary? J Thorac Cardiovasc Surg 1980;80:849-60.
  29. Gatti G, Maffei G, Lusa AM et al. Tricuspid valve repair with the Cosgrove- Edwards annuloplasty system: early clinical and echocardiographic results. Ann Thorac Surg 2001;72:764-7.
  30. Gillinov AM, Cosgrove DM, Shiota T et al. Cosgrove-Edwards annuloplastie system: midterm results. Ann Thorac Surg 2000;69:717-21.
  31. Mc Carthy J, Cosgrove III D. Tricuspid valve repair with the Cosgrove-Edwards annular system. Ann Thorac Surg 1997;64:267-8.
  32. Delahaye JP, Rondepierre D, Gaspard P. Le remplacement valvulaire tricuspidien par la prothèse de Hancock. Arch Mal Coeur 1981;74:281-8.
  33. Scully HE, Armstrong CS. Tricuspid valve replacement. Fifteen years of experience with mechanical prostheses and bioprotheses. J Thorac Cardiovasc Surg 1995;109:1035-41.
  34. Tang L, Gilbert H, Tirone ED et al. Tricuspid Valve repair with an annuloplastie ring results in improved long-term outcomes. Circulation 2006;114:577-81.
  35. Van Nooten GJ, Caes F, Taeymans Y et al. Tricuspid valve replacement: post operative and long-term results. J Thorac Cardiovasc Surg 1995;672-9.
  36. Kawachi Y, Tominaga R, Hisahara M et al. Excellent durability of the Hancock porcine bioprosthesis in the tricuspid position. A sixteen-year follow-up study. J Thorac Cardiovasc Surg 1992;104:1561-6.
  37. Nakano K, Eishi K, Kosakai Y et al. Ten-year experience with the Carpentier-Edwards pericardial xenograft in the tricuspid position. J Thorac Cardiovasc Surg 1996;111:605-12.
  38. Nakano K, Ishibashi-Ueda H, Kobayashi J et al. Tricuspid valve replacement with bio prostheses: long-term results and causes of valve dysfunction. Ann Thorac Surg 2001;71:105-9.
  39. Ohata T, Kigawa I, Tohda E et al. Comparison of durability of bioprotheses in tricuspid and mitral positions. Ann Thorac Surg 2001;71:240-3.
  40. Couetil JP, Argyriadis PG, Shafy A et al. Partial replacement of the tricuspid valve by mitral homografts in acute endocarditis. Ann Thorac Surg 2002;73:1808-12.
  41. Ramsheyi A, D'Attellis N, Le Lostec Z et al. Partial mitral homograft for tricuspid valve repair. Ann Thorac Surg 1997;64:1486-8.
  42. Matsuyama K, Matsumoto M, Sugita T et al. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg 2003;75:1826-8.
  43. Mueller XM, Tevaearai HT, Stumpe F et al. Tricuspid valve involvement in combined mitral and aortic valve surgery. J Cardiovasc Surg 2001;42:443-9.
  44. Onoda K, Yasuda F, Takao M. et al. Long-term follow-up after Carpentier-Edwards ring annuloplasty for tricuspid regurgitation. Ann Thorac Surg 2000;70:796-9.
  45. Rivera R, Duran E, Ajuria M. Carpentier's flexible ring versus De Vega's annuloplasty. A prospective randomized study. J Thorac Cardiovasc Surg 1985;89:196-203.
  46. Dalrymple-Hay MJ, Leung Y, Ohri SK et al. Tricuspid valve replacement: bioprotheses are preferable. J Heart Valve Dis 1999;8:644-8.
  47. Poveda JJ, Bernal JM, Matorras P et al. Tricuspid valve replacement in rheumatic disease: preoperative predictors of hospital mortality. J Heart Valve Dis 1996;5:26-30.
  48. Staab ME, Nishimura RA, Dearani JA. Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients. J Heart Valve Dis 1999;8:567-74.
  49. Farinas JM, Leclerc Y, Antchouey AM et al. Tricuspid valve replacement: longterm clinical and echocardiographic follow-up. Ann Chir 1996;50:707-12.
  50. Veyrat C, Kalmanson D, Farjon M. et al. Non invasive diagnosis and assessment of tricuspid regurgitation and stenosis using one and two dimensional echo pulsed Doppler. Be Heart J 1982;47:596-605.
  51. Hornick P, Harris PA, Taylor KM. Tricuspid valve replacement subsequent to previous open heart surgery. J Heart Valve Dis 1996;5:20-5.
  52. Guidelines on the management of valvular heart disease. The Task Force on the Management of valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007;28:230-68.
  53. Iscan ZH, Vural KM, Bahar I, Mavioglu L, Saritas A. What to expect after tricuspid valve replacement? Long-term results. Eur J Cardiothorac Surg 2007;32:296-300.