Characteristic difference of functional tricuspid regurgitation between acquired valvular heart disease and atrial septal defect

Sugimoto, T.; Ota, T.; Sato, H.; Iwahashi, K.; Okada, M.; Nakamura, K.

Nihon Kyobu Geka Gakkai 38(10): 2056-2062

1990


ISSN/ISBN: 0369-4739
PMID: 2266280
Document Number: 366261
The characteristic difference in functional tricuspid regurgitation(TR) was studied between acquired valvular heart disease (VHD) and adult atrial septal defect (ADS). Fifty patients of VHD and 20 patients of ASD were subjected to this study. In all patients, the TR volume per beat (VTR) was calculated with out original method using 2-dimensional color Doppler (2-DD) and continuous-wave Doppler (CW) echocardiograpies. VTR is obtained by the product of the cross-sectional areas (S) of the base of regurgitant jet in 2-DD and the regurgitant volume of one unit area (Vu) in CW (VTR = 1/3 .cntdot. S .cntdot. Vu). The preoperative evaluation of TR according to VTR showed a good relationship with the operative findings, and the patients with preoperative VTR .gtoreq. 10 cc were candidates for tricuspid valve repair. In all patients with preoperative VTR < 10 cc (18 patients of VHD and 10 patients of ASD), VTR decreased postoperatively without any triscuspid valve repair. In paitents with VTR = 10 7s 20 cc (19 patients of VHD and 5 of ASD), VTR showed a decrease to below 10 cc after tricuspid annuloplasty (TAP) by Kay's method in 18 patients of VHD and 5 of ASD, and with no tricuspid valve repair in one patient of VHD. In patients with VTR .gtoreq. 20 cc (13 patients of VHD and 5 of ASD), the postoperative VTR diminished to below 10 cc after kay's TAP in 8 patients of VHD and 5 of ASD, and VTR disappeared after valve replacement (TVR) in 2 patients of VHD. However, 3 patients of VHD in this group showed a 10 .apprx. 20 residual VTR even after TAP. These 3 patients with TAP and 2 patients with TVR showed preoperative tricuspid annular diameter (TAD) at end-diastole above 50 mm, which was clearly different value from th eothers of VHD. In contrast, 4 patients of ASD, whose preoperative TAD was above 50 mm, showed a decrease to below 10 cc in the VTR after TAP. There was a significant correlation between preoperative VTR (x axis) and TAD (y axis) in ADS (r = 0.86) as well as in VHD (r = 0.83), but the slope of the correlation line was steeper in ASD (y = 0.75x + 35.2) than in VHD (y = 0.50 + 34.4). That is, the patient of ASD has a tendency to have a similar VTR than the patient of VHD in the same preoperative TAD. This might be the reason why TAP was more effective on the functional TR associated with ASD than VHD.

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