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J Thorac Cardiovasc Surg 1999;117:463-471
© 1999 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

LONG-TERM EVALUATION OF TREATMENT FOR FUNCTIONAL TRICUSPID REGURGITATION WITH REGURGITANT VOLUME: CHARACTERISTIC DIFFERENCES BASED ON PRIMARY CARDIAC LESION

From the Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan.

Received for publication Sept 12, 1997. Revisions requested Nov 12, 1997. Revisions received Oct 5, 1998. Accepted for publication Oct 5, 1998. Address for reprints: Takaki Sugimoto, MD, Department of Surgery, Division II, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.

Objectives: The aim of this study was to characterize differences in the long-term effects of treatment for functional tricuspid regurgitation based on the primary cardiac lesion.
Methods: Ninety-six patients with valvular heart disease and 32 patients with atrial septal defects associated with tricuspid regurgitation were studied. The tricuspid annular diameter was associated with evidence of right heart failure. In valvular heart disease, a Kay annuloplasty was performed in 33 patients with a tricuspid annular diameter of 40 mm to 44 mm, a modified De Vega annuloplasty in 12 patients with a tricuspid annular diameter of 45 mm to 49 mm, and a modified De Vega annuloplasty, annuloplasty using a Carpentier ring, or tricuspid valve replacement in each of 4 patients with a tricuspid annular diameter of 50 mm. In atrial septal defects, a Kay annuloplasty was performed in 11 patients with a tricuspid annular diameter of 45 mm to 49 mm, and a modified De Vega annuloplasty was performed in 5 patients with a tricuspid annular diameter of 50 mm. A mean follow-up period was 79 months after operation.
Results: In the patients with a tricuspid annular diameter of <50 mm, the hemodynamic and clinical findings and tricuspid regurgitation remarkably improved. In the patients with valvular heart disease with a tricuspid annular diameter of 50 mm, however, the right heart parameters also showed improvement but less so when compared with those patients with a tricuspid annular diameter of <50 mm. In addition, 4 patients undergoing a modified De Vega annuloplasty have had a gradual increase in tricuspid regurgitation and clinical manifestations late after the operation. In contrast, all 5 patients with atrial septal defects with a tricuspid annular diameter of 50 mm have shown remarkable improvement, similar to those with a tricuspid annular diameter of <50 mm. Preoperative analyses revealed that the right heart function in atrial septal defects had not deteriorated to the same extent as in valvular heart disease.
Conclusion: In the patients with a severely dilated tricuspid anulus (50 mm), the postoperative change of tricuspid regurgitation differed between those patients with valvular heart disease and atrial septal defects.

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