Concomitant Tricuspid Annuloplasty for Patients with Tricuspid Valve Annulus Dilation and Mild Tricuspid Regurgitation Underwent Mitral Valve Replacement: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIYong-bo ¹ , TANGHong ² , LIANGChun-shui ¹ , HEFan ¹ ,  XIAOXi-jun ¹

1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Echocardio-graphy, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

XIAOXi-jun, Email: xijun.xiao@yahoo.com.cn

Keywords：

Heart valve disease; Mitral valve replacement; Tricuspid regurgitation; Tricuspid valve annulus dilation; Function of right ventricular

DOI：

10.7507/1007-4848.20150134

Video：

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Objective To investigate effect of cardiac function and tricuspid regurgitation (TR) degree of concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent mitral valve replacement (MVR), and provide an objective basis for clinical decision about concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent MVR. Methods A total of 36 patients who underwent MVR from April to October 2013 in Department of Cardiovascular Surgery, West China Hospital, Sichuan University were enrolled in this study. Preoperative echocardiography showed mild TR and tricuspid valve annular end-diastolic dimension (TVAEDD)/body surface area (BSA)>21 mm/m². All the 36 patients were randomly divided into a tricuspid annuloplasty group (TAPG group, n=18, including 7 males and 11 females) and a no tricuspid annuloplasty group (NTAPG group, n=18, including 6 males and 12 females). One week and 6 months postoperative echocardiography were recorded. Results There were no statistical differences in age, gender, heart rate, body surface area, preoperative cardiac function (NYHA), left atrium dimension (LAD), left ventricular dimension (LVD), maximal long-axis of RA (RA_mla), mid-RA minor distance (RA_mmd), right ventricle dimension (RVD2), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS) between the two groups (P>0.05). Six-months postoperative left atrial-ventricular diameter significantly reduced than that before surgery in the two groups (P<0.05). In the TAPG group, six-months postoperative right ventricle dimension (RVD1), right ventricular wall thickness (RVWT), tricuspid valve annular end-diastolic dimension (TVAEDD), tricuspid valve annular end-systolic dimension (TVAESD) significantly decreased, while percent shorting of tricuspid valve annulus (PSTVA) did not change significantly (P>0.05), TR degree improved significantly (P<0.05), right ventricular fractional area change (RVFAC) and right ventricular ejection fraction (RVEF) significantly increased (P<0.05). In the NTAPG group, compared with preoperative data, six-months postoperative RVD1, RVWT significantly increased, TVAEDD, TVAESD, PSTVA did not change significantly (P>0.05), RVEF reduced significantly (P<0.05), RVFAC increased significantly but less than that in the TAPG group at the same period, constituent ratio of TR changed significantly (P<0.05), but postoperative moderate or more TR were recorded in 6 patients. Conclusion Concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent mitral valve replacement (MVR) can help to decrease RVD1, RVWT, TVAEDD and TVAESD, improve the constituent ratio of TR, and increase RVFAC and RVEF.

Citation： LIYong-bo, TANGHong, LIANGChun-shui, HEFan, XIAOXi-jun. Concomitant Tricuspid Annuloplasty for Patients with Tricuspid Valve Annulus Dilation and Mild Tricuspid Regurgitation Underwent Mitral Valve Replacement: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(6): 518-525. doi: 10.7507/1007-4848.20150134 Copy

1.	?Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secon-dary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol, 2006, 47(10): 2130-2139.
2.	Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the manage-ment of valvular heart disease. Rev Esp Cardiol, 2007, 60(6):1e-50e.
3.	Sagie A, Freitas N, Chen MH, et al. Echocardiographic assessment of mitral stenosis and its associated valvular lesions in 205 patients and lack of association with mitral valve prolapse. J Am Soc Echocar-diogr, 1997, 10(2): 141-148.
4.	向波, 唐紅, 周文霞, 等. 二尖瓣置換加三尖瓣成形術前后右房室徑、房室環變化及臨床意義. 四川大學學報 (醫學版), 2009, 40(3):490-494.
5.	Kuwaki K, Morishita K, Tsukamoto M, et al. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease. Eur J Cardiothorac Surg, 2001, 20(3): 577-582.
6.	McCarthy PM, Sales VL. Evolving indications for tricuspid valve surgery. Current treatment options in cardiovascular medicine. Curr Treat Options Cardiovasc Med, 2010, 12(6): 587-597.
7.	肖錫俊, 蔣露, 李永波, 等. 聯合二瓣化和改良kay成形術處理左心瓣膜手術患者三尖瓣瓣環擴張的初步療效觀察. 中國胸心血管外科臨床雜志, 2012, 19(5): 516-519.
8.	Rudski LG, Lai WW, Afilalo J, Hua L, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography Endorsed By The European Association of Echocardiography, A Registered Branch of The European Society of Cardiology, and The Canadian Society of Echocardiography. J Am Soc Echocardiogr, 2010, 23(7): 685-713.
9.	Chopra HK, Nanda NC, Fan P, et al. Can two-dimensional echocar-diography and doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol, 1989, 14(5): 1266-1274.
10.	Colombo T, Russo C, Ciliberto GR, et al. Tricuspid regurgitation secondary to mitral valve disease-tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg, 2001, 9(4): 369-377.
11.	肖錫俊, 袁宏聲, 唐紅, 等. 二尖瓣置換術后三尖瓣反流的逆轉、殘留或加重. 中國胸心血管外科臨床雜志, 2006, 13(5): 307-310.
12.	Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation: annulus, commissure, or leaflet procedure? J Thorac Cardiovasc Surg, 2010, 139(6): 1473-1482.
13.	Henein MY, O'Sullivan CA, Li W, et al. Evidence for rheumatic valve disease in patients with severe tricuspid regurgitation long after mitral valve surgery: the role of 3d echo reconstruction. J Heart Valve Dis, 2003, 12(5): 566-572.
14.	Ghanta RK, Chen R, Narayanasamy N, et al. Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of func-tional tricuspid regurgitation: midterm results of 237 consecutive patients. J Thorac Cardiovasc Surg, 2007, 133(1): 117-126.
15.	Naqshband MS, Abid AR, Akhtar RP, et al. Functional tricuspid regurgitation in rheumatic heart disease: surgical options. Ann Thorac Cardiovasc Surg, 2010, 16(6): 417-425.
16.	Rankin JS, Hammill BG, Ferguson TB Jr, et al. Determinants of operative mortality in valvular heart surgery. J Thorac Cardiovasc Surg, 2006, 131(3): 547-557.
17.	?m D Michal, ?ech Jakub, Rokyta Richard, et al. Mild to moderate functional tricuspid regurgitation: retrospective comparison of surgical and conservative treatment. Cardiol Res Pract, 2010: 143878. doi: 10.4061/2010/143878.
18.	朱鵬, 肖錫俊, 唐紅, 等. 以三尖瓣瓣環徑作為三尖瓣成形手術指征的初步臨床觀察. 中國胸心血管外科臨床雜志, 2008, 15 (4):245-248.
19.	許莉, 樊朝美, 李一石, 等. 右心功能評價技術研究進展. 心血管病學進展, 2006, 27(4): 472-475.
20.	曾偉杰, 何建國. 右心功能評價技術研究進展. 醫學研究雜志, 2010, 10(9):15-18.
21.	van der Zwaan HB, Geleijnse ML, McGhie JS, et al. Right ventri-cular quantification in clinical practice: two-dimensional vs. three-dimensional echocardiography compared with cardiac magnetic resonance imaging. Eur J Echocardiogr, 2011, 12(9): 656-664.
22.	Tamborini G, Muratori M, Brusoni D, et al. Is right ventricular systolic function reduced after cardiac surgery? A two-and three-dimensional echocardiographic study. Eur J Echocardiogr, 2009, 10(5): 630-634.
23.	Larrazet F, Czitrom D, Laborde F, et al. Decreased right ventricular lateral wall velocities early after cardiac surgery. Echocardiography, 2011, 28(4): 438-441.
24.	López-Candales A, Rajagopalan N, Saxena N, et al. Right ventricular systolic function is not the sole determinant of tricuspid annular motion. Am J Cardiol, 2006, 98(7): 973-977.
25.	Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function—a study in normals and dilated cardiomyopathy. J Cardiol, 1995, 26(6): 357-366.
26.	Tei C, Dujardin KS, Hodge DO, et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr, 1996, 9(6): 838-847.
27.	Hui W, Abd El Rahman MY, Dsebissowa F, et al. Comparison of modified short axis view and apical four chamber view in evaluating right ventricular function after repair of tetralogy of fallot. Int J Cardiol, 2005, 105(3): 256-261.
28.	Dávila-Román VG, Waggoner AD, Hopkins WE, et al. Right ventri-cular dysfunction in low output syndrome after cardiac operations: assessment by transesophageal echocardiography. Ann Thorac Surg, 1995, 60(4): 1081-1086.
29.	Chen G, Sun K, Huang G. In vitro validation of right ventricular volume and mass measurement by real-time three-dimensional echocardiography. Echocardiography, 2006, 23(5): 395-399.
30.	van der Zwaan HB, Helbing WA, McGhie JS, et al. Clinical value of real-time three-dimensional echocardiography for right ventricular quantification in congenital heart disease: validation with cardiac magnetic resonance imaging. J Am Soc Echocardiogr, 2010, 23(2): 134-140.
31.	孫思娟, 陳國珍, 吳蘭平, 等. 超聲評估兒童右心室流出道重建圍手術期右心收縮功能變化及臨床價值探討. 中華臨床醫師雜志 (電子版), 2012, 6 (22): 7151-7154.
32.	Shiran A, Sagie A. Tricuspid regurgitation in mitral valve diseasein-cidence, prognostic implications, mechanism, and management. J Am Coll Cardiol, 2009, 53(5): 401-408.
33.	Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis, 1992, 1(1): 80-86.
34.	Braunwald NS, Ross J Jr, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation, 1967, 35(4 Suppl): Ⅰ63-Ⅰ69.
35.	Cohn Lawrence H, editor. Cardiac surgery in the adult. The third edition. New York: The McGraw-Hill Companies, 2008. 1109-1192.
36.	Hannoush H, Fawzy ME, Stefadouros M, et al. Regression of significant tricuspid regurgitation after mitral balloon valvotomy for severe mitral stenosis. Am Heart J, 2004, 148(5): 865-870.
37.	Matsuyama K, Matsumoto M, Sugita T, et al. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg, 2003, 75(6): 1826-1828.
38.	Kim HK, Kim YJ, Park JS, et al. Determinants of the severity of functional tricuspid regurgitation. Am J Cardiol, 2006, 98(2): 236-242.
39.	Dreyfus GD, Corbi PJ, Chan KM et al. Secondary tricuspid regurgi-tation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1): 127-132.

1. ?Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secon-dary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol, 2006, 47(10): 2130-2139.
2. Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the manage-ment of valvular heart disease. Rev Esp Cardiol, 2007, 60(6):1e-50e.
3. Sagie A, Freitas N, Chen MH, et al. Echocardiographic assessment of mitral stenosis and its associated valvular lesions in 205 patients and lack of association with mitral valve prolapse. J Am Soc Echocar-diogr, 1997, 10(2): 141-148.
4. 向波, 唐紅, 周文霞, 等. 二尖瓣置換加三尖瓣成形術前后右房室徑、房室環變化及臨床意義. 四川大學學報 (醫學版), 2009, 40(3):490-494.
5. Kuwaki K, Morishita K, Tsukamoto M, et al. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease. Eur J Cardiothorac Surg, 2001, 20(3): 577-582.
6. McCarthy PM, Sales VL. Evolving indications for tricuspid valve surgery. Current treatment options in cardiovascular medicine. Curr Treat Options Cardiovasc Med, 2010, 12(6): 587-597.
7. 肖錫俊, 蔣露, 李永波, 等. 聯合二瓣化和改良kay成形術處理左心瓣膜手術患者三尖瓣瓣環擴張的初步療效觀察. 中國胸心血管外科臨床雜志, 2012, 19(5): 516-519.
8. Rudski LG, Lai WW, Afilalo J, Hua L, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography Endorsed By The European Association of Echocardiography, A Registered Branch of The European Society of Cardiology, and The Canadian Society of Echocardiography. J Am Soc Echocardiogr, 2010, 23(7): 685-713.
9. Chopra HK, Nanda NC, Fan P, et al. Can two-dimensional echocar-diography and doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol, 1989, 14(5): 1266-1274.
10. Colombo T, Russo C, Ciliberto GR, et al. Tricuspid regurgitation secondary to mitral valve disease-tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg, 2001, 9(4): 369-377.
11. 肖錫俊, 袁宏聲, 唐紅, 等. 二尖瓣置換術后三尖瓣反流的逆轉、殘留或加重. 中國胸心血管外科臨床雜志, 2006, 13(5): 307-310.
12. Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation: annulus, commissure, or leaflet procedure? J Thorac Cardiovasc Surg, 2010, 139(6): 1473-1482.
13. Henein MY, O'Sullivan CA, Li W, et al. Evidence for rheumatic valve disease in patients with severe tricuspid regurgitation long after mitral valve surgery: the role of 3d echo reconstruction. J Heart Valve Dis, 2003, 12(5): 566-572.
14. Ghanta RK, Chen R, Narayanasamy N, et al. Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of func-tional tricuspid regurgitation: midterm results of 237 consecutive patients. J Thorac Cardiovasc Surg, 2007, 133(1): 117-126.
15. Naqshband MS, Abid AR, Akhtar RP, et al. Functional tricuspid regurgitation in rheumatic heart disease: surgical options. Ann Thorac Cardiovasc Surg, 2010, 16(6): 417-425.
16. Rankin JS, Hammill BG, Ferguson TB Jr, et al. Determinants of operative mortality in valvular heart surgery. J Thorac Cardiovasc Surg, 2006, 131(3): 547-557.
17. ?m D Michal, ?ech Jakub, Rokyta Richard, et al. Mild to moderate functional tricuspid regurgitation: retrospective comparison of surgical and conservative treatment. Cardiol Res Pract, 2010: 143878. doi: 10.4061/2010/143878.
18. 朱鵬, 肖錫俊, 唐紅, 等. 以三尖瓣瓣環徑作為三尖瓣成形手術指征的初步臨床觀察. 中國胸心血管外科臨床雜志, 2008, 15 (4):245-248.
19. 許莉, 樊朝美, 李一石, 等. 右心功能評價技術研究進展. 心血管病學進展, 2006, 27(4): 472-475.
20. 曾偉杰, 何建國. 右心功能評價技術研究進展. 醫學研究雜志, 2010, 10(9):15-18.
21. van der Zwaan HB, Geleijnse ML, McGhie JS, et al. Right ventri-cular quantification in clinical practice: two-dimensional vs. three-dimensional echocardiography compared with cardiac magnetic resonance imaging. Eur J Echocardiogr, 2011, 12(9): 656-664.
22. Tamborini G, Muratori M, Brusoni D, et al. Is right ventricular systolic function reduced after cardiac surgery? A two-and three-dimensional echocardiographic study. Eur J Echocardiogr, 2009, 10(5): 630-634.
23. Larrazet F, Czitrom D, Laborde F, et al. Decreased right ventricular lateral wall velocities early after cardiac surgery. Echocardiography, 2011, 28(4): 438-441.
24. López-Candales A, Rajagopalan N, Saxena N, et al. Right ventricular systolic function is not the sole determinant of tricuspid annular motion. Am J Cardiol, 2006, 98(7): 973-977.
25. Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function—a study in normals and dilated cardiomyopathy. J Cardiol, 1995, 26(6): 357-366.
26. Tei C, Dujardin KS, Hodge DO, et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr, 1996, 9(6): 838-847.
27. Hui W, Abd El Rahman MY, Dsebissowa F, et al. Comparison of modified short axis view and apical four chamber view in evaluating right ventricular function after repair of tetralogy of fallot. Int J Cardiol, 2005, 105(3): 256-261.
28. Dávila-Román VG, Waggoner AD, Hopkins WE, et al. Right ventri-cular dysfunction in low output syndrome after cardiac operations: assessment by transesophageal echocardiography. Ann Thorac Surg, 1995, 60(4): 1081-1086.
29. Chen G, Sun K, Huang G. In vitro validation of right ventricular volume and mass measurement by real-time three-dimensional echocardiography. Echocardiography, 2006, 23(5): 395-399.
30. van der Zwaan HB, Helbing WA, McGhie JS, et al. Clinical value of real-time three-dimensional echocardiography for right ventricular quantification in congenital heart disease: validation with cardiac magnetic resonance imaging. J Am Soc Echocardiogr, 2010, 23(2): 134-140.
31. 孫思娟, 陳國珍, 吳蘭平, 等. 超聲評估兒童右心室流出道重建圍手術期右心收縮功能變化及臨床價值探討. 中華臨床醫師雜志 (電子版), 2012, 6 (22): 7151-7154.
32. Shiran A, Sagie A. Tricuspid regurgitation in mitral valve diseasein-cidence, prognostic implications, mechanism, and management. J Am Coll Cardiol, 2009, 53(5): 401-408.
33. Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis, 1992, 1(1): 80-86.
34. Braunwald NS, Ross J Jr, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation, 1967, 35(4 Suppl): Ⅰ63-Ⅰ69.
35. Cohn Lawrence H, editor. Cardiac surgery in the adult. The third edition. New York: The McGraw-Hill Companies, 2008. 1109-1192.
36. Hannoush H, Fawzy ME, Stefadouros M, et al. Regression of significant tricuspid regurgitation after mitral balloon valvotomy for severe mitral stenosis. Am Heart J, 2004, 148(5): 865-870.
37. Matsuyama K, Matsumoto M, Sugita T, et al. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg, 2003, 75(6): 1826-1828.
38. Kim HK, Kim YJ, Park JS, et al. Determinants of the severity of functional tricuspid regurgitation. Am J Cardiol, 2006, 98(2): 236-242.
39. Dreyfus GD, Corbi PJ, Chan KM et al. Secondary tricuspid regurgi-tation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1): 127-132.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Concomitant Tricuspid Annuloplasty for Patients with Tricuspid Valve Annulus Dilation and Mild Tricuspid Regurgitation Underwent Mitral Valve Replacement: A Randomized Controlled Trial

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