Outcome of significant functional tricuspid regurgitation after percutaneous mitral valvuloplasty

Background: The outcome of significant functional tricuspid regurgitation (TR) associated with mitral stenosis (MS) after percutaneous mitral valvuloplasty (PMV) remains to be clarified. Methods: From 265 patients who underwent PMV at our institution from 1995 to 2000 and who were regularly observed, we selected 71 patients (55 women, mean age 43 ± 11 years) who showed significant moderate to severe functional TR before PMV. We analyzed data from the echocardiograms performed before, 24 hours after, and long after the intervention (29 ± 12 months) and analyzed clinical outcomes. Resolution of TR was defined as trace or mild TR on the follow-up color Doppler study. Results: Patients with moderate to severe TR showed more severe MS and pulmonary hypertension and more atrial fibrillation than patients with less than moderate TR. TR was resolved on the follow-up echocardiography in 23 of the 71 patients with significant TR before PMV (32%). The TR jet area before PMV (P < .05) and the late decrement of peak transmittal pressure gradient (P < .01) were independent determinants of resolution. TR was resolved in only 6.7% of patients (1/15) with an unsuccessful long-term PMV result, but was resolved in 39% of patients (22/56) with a successful long-term result (P < .05). During the clinical follow-up period (mean length 38 ± 20 months), 4 patients underwent open heart surgery 24 to 39 months after PMV, and there was no overall mortality. Conclusions: Significant functional TR was associated with more severe MS, and it could be diminished when the transmittal pressure gradient was sufficiently relieved with PMV.