The Outcome of Tricuspid Regurgitation after Mitral Balloon Valvutomy for Severe Mitral Stenosis

Background: Severe mitral stenosis is occasionally associated with significant tricuspid regurgitation (TR)
and this association has an adverse impact on morbidity and mortality in patients undergoing mitral valve intervention.
However, the effect of successful mitral balloon valvotomy (MBV) on significant TR is not fully
elucidated. The aim of this study was to investigate the course of TR after MBV in patients with severe mitral
stenosis with TR.
Methods: The present study was performed in Tabriz Madani heart center from March 2007 to February 2008.
Among 110 patients with mitral stenosis who were candidates of MBV, 68 cases with more than mild TR were
selected and the fate of TR after MBV and its predictors were evaluated.
Results: Among 68 patients who were enrolled in this study, 58 individuals (85.3%) were female with mean age
of 36.85± 14.32 years. Before intervention, 48 patients (70.6%) had severe TR and 20 (29.4%) cases had moderate
TR. After intervention, 14 patients suffered from mild TR, 22 from moderate TR and 32 patients from severe
TR (P<0.05). There were significant changes in mitral valve area (MVA) (from 0.82±0.22 to 1.70±0.21 cm2;
P<0.0005) and pulmonary artery systolic pressure (PASP) (from 53.00±12.04 to 34.91±11.26 cm2; P<0.0005)
and right ventricle dimension (RVD) varying from 2.97±0.64 to 2.20±0.58 cm; P<0.0005). This study showed
significant relationship between MVA, RVD, and PASP as TR regression determinants. In 6-month follow up
no patient needed mitral valve surgery or repeated MBV. There was no procedure related mortality and no death
was seen in 6 months follow up in the study group. Significant decrease of symptoms was observed in almost all
patients after intervention which persisted during follow up period.
Conclusions:Significant number of patients with severe MS and moderate or severe TR showed TR regression
following MBV which persisted during 6 months follow up. Severity of MS, PASP and RVD were most important
predictors of this regression.