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Submitted: 03 June 2007 Modified: 22 March 2017
HERDIN Record #: PCHRD060207050646

Immediate and long-term outcome of significant tricuspid regurgitation after percutaneous mitral balloon valvotomy.

Ramoncito B. Tria,
Alexander D. Ang

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Moderate and severe tricuspid regurgitation (TR) in patients with severe mitral stenosis may persist after successful percutaneous mitral balloon valvotomy (PMV). Its clinical importance has been well established because its persistence may contribute to a poor outcome after the procedure.

This is a cohort study over a five-year period of cases seen at the Philippine Heart Center. The records of patients with significant TR before successful PMV were reviewed in term of the resolution and its persistence immediately and long after the procedure. Clinical outcome were also analyzed in relation to significant TR in terms of functional impairment, repeated PMV, mitral surgery and death. Factors associated with persistence of TR were also noted. Survival analysis was performed to estimate the event free survival rates while Chi-square, Fisher exact and Mann- Whitney U-test was used to determine association of different variables with outcome.

Seventy-nine patients were included in the study. They were divided into two groups, those with insignificant TR and those with significant TR immediately after successful PMV. Majority of the population were female with mean age of 33 +/- 8 and 32 +/- 9.5 respectively. Tricuspid regurgitation was resolved to trace or mild in 42 (53 percent) patients and persisted in 37(47 percent). On 5 year follow-up TR became insignificant in 15 (41 percent) patients who initially had moderate to severe TR after PMV, while 22 (59 percent) continued to have significant TR. Twelve (29 percent) patients with initially had trace to mild TR after PMV developed significant TR. Patients with moderate to severe TR immediately and after PMV and those who developed significant TR on follow-up had elevated PAP, TVA and RV diameter on the last follow-up. Presence of organic TR was also significantly associated with patients having persistent significant TR. There was a marked reduction of symptoms in almost all of the patients after the procedure, and majority remained remarkably stable on follow-up. However patients with significant TR on follow-up had higher rates of functional impairment compared to those in whom TR resolved to trace or mild. The event free survival rates for trace to mild TR was 80 percent and 52 percent for those with moderate to severe TR.

Over all, there was significant improvement in severity of TR in a good number of patients on both short-term and long-term follow-up after successful PMV. More than two thirds of patients were also found to improve clinically with no note of any major cardiac events on 5 year of follow-up.

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Annual
Publication Date
January-December 2005
Volume
11
Page(s)
1-5

Objectives

The objectives of this study are:

1. to assess the resolution of significant TR (moderate to severe TR on color flow Doppler study) during the immediate and long term period after PMV;

2. to establish factors which are associated with the persistence of TR after PMV;

3. to determine and analyze the association of significant TR in the long term clinical outcome of patient after PMV in terms of death, mitral valve surgery repeated PMV and functional impairment.

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Philippine Council for Health Research and Development Library Abstract Print Format (Request Document)
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