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CLINICAL RESEARCH: VALVULAR HEART DISEASE

Does lowering pulmonary arterial pressure eliminate severe functional tricuspid regurgitation?

Insights from pulmonary thromboendarterectomy

H. Mehrdad Sadeghi, MD^*,*, Bruce J. Kimura, MD, FACC, Ajit Raisinghani, MD, FACC^*, Daniel G. Blanchard, MD, FACC^*, Ehtisham Mahmud, MD, FACC^*, Peter F. Fedullo, MD, Stuart W. Jamieson, MB and Anthony N. DeMaria, MD, MACC^*

^* Cardiology, University of California-San Diego Medical Center, San Diego, California, USA
Pulmonary Medicine, University of California-San Diego Medical Center, San Diego, California, USA
Cardiothoracic Surgery, University of California-San Diego Medical Center, San Diego, California, USA
Division of Cardiology, Scripps-Mercy Hospital, San Diego, California, USA

Manuscript received March 5, 2003; revised manuscript received November 19, 2003, accepted December 19, 2003.

^* Reprint requests and correspondence: Dr. H. Mehrdad Sadeghi, 765 Medical Center Court, Suite 211, Chula Vista, California 91911, USA.
hmsmd1{at}hotmail.com

Presented in part at the 11th Annual Scientific Sessions of the American Society of Echocardiography, Chicago, Illinois, June 2000.

OBJECTIVES: Because pulmonary thromboendarterectomy (PTE) can result in an immediate reduction in pulmonary artery (PA) pressure, we sought to evaluate the effect of PTE on severe tricuspid regurgitation (TR) without tricuspid annuloplasty.

BACKGROUND: Few data exist regarding the frequency and magnitude of functional TR improvement after reduction in PA pressure.

METHODS: We identified 27 patients with severe TR, defined by a regurgitant index (RI) >33%, who underwent PTE. The RI, tricuspid annular diameter (TAD), apical displacement of leaflet coaptation, and estimated PA systolic pressure were determined on pre- and post-PTE echocardiograms. Patients were stratified based on resolution (RI 33%) or persistence (RI >33%) of severe TR.

RESULTS: Comparing pre- and post-PTE echocardiography results, severe TR resolved in 19 of 27 (70%) patients. This group had a more effective PA systolic pressure reduction after PTE (49 ± 20 mm Hg vs. 32 ± 16 mm Hg by echocardiography, p = 0.075, and 37 ± 16 mm Hg vs. 16 ± 13 mm Hg by catheter measurement, p = 0.004). No difference was observed in TAD, apical displacement of the tricuspid valve, or other features compared with the group with persistent severe TR. There was a trend toward longer hospital stays in the group with persistent severe TR (19 ± 15 days vs. 14 ± 9 days; p = 0.55).

CONCLUSIONS: After significant PA pressure reduction by PTE, severe functional TR with a dilated annulus may improve without annuloplasty despite dilated tricuspid annulus diameters.

Abbreviations and Acronyms   AF = atrial fibrillation   CTEPH = chronic thromboembolic pulmonary hypertension   JA = jet area   PA = pulmonary artery   PTE = pulmonary thromboendarterectomy   PVR = pulmonary vascular resistance   RA = right atrial   RI = regurgitant index   RV = right ventricle/ventricular   TAD = tricuspid annular diameter   TR = tricuspid regurgitation

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