The Effects of Tricuspid De Vega Annuloplasty on Ventricular Functions in Patients with Mitral Valve Replacement and Concomitant Tricuspid Regurgitation

Öz

Introduction: The aim of this study is to evaluate the long term results of de Vega annuloplasty on ventricular functions in patients undergoing mitral valve replacement due to mitral valve pathology and functional tricuspid regurgiatiton. Patients and Methods: Eighty six patients who underwent mitral valve replacement in our clinic, during January 2008-June 2008 were involved in the study. The patients were grouped into two according to the presence of tricuspid pathology and annuloplasty. The demographic data and 6th and 24th month echocardiographic follow up were recorded. Results: First group consisted of 49 patients with pure mitral valve replacement patients and second group consisted of 37 patients that had tricuspid annuloplasty with mitral valve replacement. The demographic data and follow up echocardiographic results were compared. The statistical analysis showed that the patients with tricuspid regurgitation and recieved an annuloplasty had similiar ventricular functions with those who had pure mitral replacement. More significantly, in patients who recieved an annuloplasty with preoperative high pulmonary artery pressure and central venous pressure and bigger right atrial diameter, the ventricular findings in follow up were similiar with the pure mitral valve pathology. Conclusion: Tricuspid de vega annuloplasty is effective in functional tricuspid valve regurgitation. Long term follow up showed that ventricular findings were similiar with those who had only pure mitral pathology and mimimal regurgitation. Preoperative ejection fraction and grade of regurgiatiton is important in the decision making to perform annuloplasty

Anahtar Kelimeler

• Tricuspid valve regurgitation; cardiac valve annuloplasty; heart valve prosthesis implantation.

Triküspid Kapak Yetmezliğinin Eşlik Ettiği Mitral Kapak Replasmanı Yapılan Hastalarda, Triküspid De Vega Annuloplastinin Ventrikül Fonksiyonlarına Etkisi

Öz

Giriş: Bu çalışmada amaç, izole mitral kapak hastalığı nedeniyle mitral kapak replasmanı yapılan olgularda eşlik eden hafif, orta, ileri fonksiyonel triküspid yetmezliği nedeniyle yapılan triküspid De Vega annuloplastinin uzun dönem takipte ventrikül fonksiyonu ve yaşam kalitesine etkisini ortaya koymaktır. Hastalar ve Yöntem: Kliniğimizde Ocak 2008-Temmuz 2008 tarihleri arasında mitral kapak replasmanı uygulanmış 86 hasta çalışmaya dahil edildi. Hastalar triküspid kapak patolojisi ve triküspid kapak tamiri yapılmasına göre gruplara ayrıldı. Hastaların preoperatif demografik verileriyle altı aylık ve 24 aylık ekokardiyografik özellikleri kaydedildi. Bulgular: Birinci grup izole mitral kapak replasmanı yapılan 49 hasta, ikinci grup mitral kapak replasmanı ve beraberinde triküspid De Vega yapılan 37 hastadan oluştu. İki grup arasında preoperatif demografik veriler ve ekokardiyografik 6. ve 24. aydaki veriler incelendi. Yapılan istatistiksel analizler; triküspid De Vega yapılan hastaların ejeksiyon fraksiyonu ve diğer ekokardiyografik parametrelerdeki değişimlerinin daha iyi olduğunu ve özellikle pulmoner arter basıncı, sağ atriyum çapı ve santral venöz basınç değeri yüksek hastalarda yapılan triküspid tamirinin orta ve uzun dönem parametrelerinin, triküspid yetmezliği olmayan hastalarla aynı düzeyde olduğunu göstermiştir. Sonuç: Fonksiyonel triküspid kapak yetmezliğinde triküspid De Vega annuloplasti etkili bir tedavi yöntemidir. Yirmi dört aylık takiplerde triküspid yetmezliği olmayan veya hafif derecede olanlarla aynı progresyonu göstermektedir. Fonksiyonel triküspid yetmezliği müdahaleye karar vermek için triküspid kapak yetmezlik derecesi ve düşük ejeksiyon fraksiyonu önemli kriterlerdir.

Anahtar Kelimeler

• Triküspid yetmezliği; annuloplasti; mitral kapak replasmanı.

Kaynakça

1. Paç M, Akçevin a, Aykut Aka S, Büket S, Sarıoğlu S. Kalp ve Da- mar Cerrahisi. 1. Baskı. Ankara: Nobel Tıp Kitabevi, 2004:543-7.
2. Duran E. Kalp ve Damar Cerrahisi.1. Baskı. İstanbul: Çapa Tıp Kitabevi, 2004:1319-23.
3. Waller BF, Howard J, Fess S. Pathology of tricuspid valve stenosis and pure tricuspid regurgitation-Part 3. Clin Cardiol 1995;18:225- 30.
4. Antunes J, Barlow JB. Management of tricuspid valve regurgitati- on. Manuel Heart 2007;93:271-6.
5. Mccarthy PM, Bhudia SK, Rajeswaran J, Hoercher KJ, Lytle BW. Tricuspid valve repair: durability and risk factors for failure. J Tho- rac Cardiovasc Surg 2004;127:674-85.
6. Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg 2003;75:1826-8.
7. Braunwald N, Cooper T, Morrow A. Complete replacement of the mitral valve. J Thorac Surg 1960;40:1.
8. Pluth JR, Ellis FH. Tricuspid insufficiency in patients undergoing mitral valve replacement. Conservative management, annulop- lasty or replacement. J Thorac Cardiovasc Surg 1969;58:484-91.

9. Duran CMG, Pomar JL, Colman T, Figueroa A, Revuelta JM, Uba- go JL. Is tricuspid valve repair necessary? J Thorac Cardiovasc Surg 1980;80:849-54.
10. Sagie A, Schwammenthal E, Palacious IF. Significant tricuspid regurgitation does not resolve after percutaneous ballon mitral valvotomy. J Thorac Cardiovasc Surg 1994;108:727-35.
11. Waggoner AD, Quinones MA, Young JB, Brandon TA, Shah AA, Verani MS, et al. Pulsed doppler echocardiographic detection of right-sided valve regurgitation. Am J Cardiol 1981;47:279-86.
12. Curtis JM, Thyssen M, Breuer HWM, Loogen F. Doppler versus contrast echocardiography for diagnosis of tricuspid regurgitation. Am J Cardiol 1985;56:333-6.
13. Turina J, Stark T, Seifert B, Turina M. Predictors of the long -term outcome after combined aortic and mitral valve surgery. Circulati- on 1999;100:1148-53.
14. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long- term survival. J Am Coll Cardiol 2004;43:405-9.
15. Porter A, Hapira Y, Wurzel M, Sulkes J, Vaturi M, Adler Y, et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J Heart Valve Dis 1999;8:57- 62.
16. Matsuyama K, Matsumoto M , Sugita T, Nishizawa J, Tokuda Y, Matsuo T. Predictors of tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg 2003;75:1826-8.
17. Matsunage A, Duran CM. Progression of tricuspid regurgitation after repaired functinal ischemic mitral regurgitation. Circulation 2005;112:1453-7.
18. Califiore AM, Gallina S, Laco AL, Contini M, Bivona A, Gogliardi et al. Mitral valve surgery for functional mitral regurgitation; should moderate-or-more tricuspid regurgitation be treated? Apropensity score analysis. Ann Thorac Surg 2009;3:698-703.
19. Boyacı A, Gokce V, Topaloglu S, Korkmaz S, Göksel S. Outcome of significant functional tricuspid regurgitation late after mitral val- ve replacement for predominant rheumatic mitral stenosis. Angio- logy 2007;58:336-42.
20. Duran CMG, Kumar N, Prabhakar G, Ge Z, Biachi S, Gometza B. Vanishing De Vega annuloplasty for functional tricuspid regurgita- tion. J Thorac Cardiovasc Surg 1993;106:609-13.
21. Gökşin İ, Yılmaz A, Önem G, Baltalarlı A, Türk UF, Tulukoğlu E ve ark. Hafif fonksiyonel triküspid regürjitasyonu: Mitral kapak replas- manı sonrası seyri ve postoperatif rezidüel triküspid regürjitasyo- nunu gösteren preoperatif ekokardiyografik prediktif kriterler. Turk Gogus Kalp Dama 2002;10:139-43.
22. Yamasaki N, Kondo F, Kubo T, Okawa M, Matsumura Y, Kitaoka H, et al. Severe tricuspid regurgitation in the aged: atrial remode- ling associated with long-standing atrial fibrillation. J Cardiol 2006; 48:315-23.