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Abstract
The tricuspid valve complex consists of three leaflets (anterior, posterior, and septal), the chordae tendinae, the papillary muscles, the tricuspid annulus, and the right atrial and right ventricular myocardium. Successful valve function depends on the integrity and coordination of these components.
There are two types of tricuspid regurgitation, primary and secondary. Secondary (functional) tricuspid regurgitation is more common than the primary type and is attributed to dilatation of the right ventricle and tricuspid annulus due to volume or pressure overload of the right ventricle.
Significant tricuspid regurgitation is associated with increased morbidity and mortality. The concept that secondary tricuspid regurgitation decreases after left-sided surgery alone has led to functional tricuspid regurgitation being often ignored or undertreated. However, surgically untreated functional tricuspid regurgitation can persist or even worsen despite correction of the associated left-sided lesion suggesting that a more aggressive approach towards this disease should be advocated. Whether preoperative tricuspid regurgitation will regress or progress late after surgery is unknown.
This study was conducted over 30 patients with functional tricuspid regurgitation associated with left-sided valvular heart lesions. They were divided into two groups depending on whether the tricuspid valve was repaired or not:
Group 1: Included 14 patients without any surgical intervention to the tricuspid valve.
Group 2: Included 16 patients with De Vega repair of the tricuspid valve.
Both groups were assessed preoperatively using TTE, intraoperatively before the beginning of surgery and after the completion of surgery using TEE, and three months later using TTE as regard the degree of tricuspid regurgitation.
The results showed that the surgical decision to repair or not to repair the tricuspid valve was based on the degree of preoperative tricuspid regurgitation, the more severe the degree of tricuspid regurgitation, the more likely the repair would be done.
The results also showed that TEE is a reliable method to assess the degree of tricuspid regurgitation intraoperatively before the beginning and after the completion of surgery, as there was no significant difference between the measurement of the degree of tricuspid regurgitation preoperatively using TTE and intraoperatively before the beginning of surgery using TEE, and postoperatively using TTE and intraoperatively after the completion of surgery using TEE.
The results also showed that the tricuspid regurgitation is improved postoperatively whether the repair was done or not, being statistically significant in case the De Vega repair to the tricuspid valve was done and statistically insignificant in case the repair was not done.