Echocardiography diagnosis and surgical outcome of rheumatic tricuspid valve disease

Objective To review the patients with rheumatic tricuspid valve disease (RTVD) who were confirmed in cardiac operation and underwent tricuspid valve repair, and summarize two and three-dimensional echocardiography (2D-STE, 3D-STE) characteristics of RTVD, and evaluate the surgical procedures and outcomes of RTVD. Methods Between December 2009 and December 2017, 359 patients with rheumatic heart disease (RHD) underwent left-sided valvular replacement were enrolled. During the operation, 56 patients with RTVD were confirmed. All patients underwent 2D-STE and 3D-STE preoperatively. The preoperative echo characteristics of RTVD and the procedure of tricuspid valvular repair were reviewed. The morphology and function of tricuspid valve were followed after operation. Results Fifteen patients with RTVD were diagnosed by transthoracic echocardiography(TTE) preoperatively.Eight patients were presented tricuspid stenosis.Tricuspid annulus diameter [(40.3±5.6)mm], tethering distance [(5.9±2.2)mm], and pulmonary artery systolic pressure [(46.3±15.9)mmHg(1 mmHg=0.133 kPa)] were measured by echocardiography, preoperatively. Moderate and severe tricuspid regurgitation were presented in 32 patients(57.1%). All patients underwent tricuspid valvular repair. During the mean follow-up (78.9 months), tricuspid annulus diameter was reduced and tricuspid regurgitation was relieved. Recurrent tricuspid regurgitation occurred in 8 patients(14.3%). Conclusions Preoperatively 2D-STE and 3D-STE need to evaluate tricuspid valve very carefully. Compared with functional tricuspid regurgitation, RTVD has some characteristics, including more serious tricuspid reflux grade, higher tethering distance, the mismatch between tricuspid reflux degree and tricuspid anmular diameter or pulmonary artery pressure.Tricuspid valve repair shows better early and mid-term outcomes. Key words: Echocardiography; Rheumatic heart disease; Rheumatic tricuspid valve disease; Annulus diameter; Tethering distance