Does lowering pulmonary arterial pressure eliminate severe functional tricuspid regurgitation?

Sadeghi, H; Kimura, Bruce J.; Raisinghani, Ajit; Blanchard, Daniel G.; Mahmud, Ehtisham; Fedullo, Peter F.; Jamieson, Stuart W.; DeMaria, Anthony N.

doi:10.1016/j.jacc.2003.12.058

Cited by 88 publications

(49 citation statements)

References 29 publications

(32 reference statements)

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“…Pulmonary hypertension aggravates TR severity and TR reportedly diminishes after resolution of pulmonary hypertension, 12,13 which suggests a relationship between pulmonary hypertension and TR. Left-sided heart diseases, such as mitral stenosis, may cause significant pulmonary hypertension, which has been reported as a poor prognostic factor in patients who underwent TV and mitral valve surgery.…”

Section: Isolated Tricuspid Regurgitationmentioning

confidence: 96%

Long-Term Prognosis of Isolated Significant Tricuspid Regurgitation

Lee

Song

Park

et al. 2010

Circ J

152

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Background:The prognostic implications and surgical benefit of isolated significant tricuspid regurgitation (TR) and prognostic factors in patients with TR were investigated. Methods and Results:In 870 consecutive patients with significant isolated TR, all-cause mortality was analyzed over 4.9±2.9 years. It was found that the survival rate tended to be higher in the 57 patients who underwent tricuspid valve (TV) surgery than the 813 patients who did not by using propensity-score matching (P=0.068), although it was not significant. Of the 813 patients that did not undergo TV surgery, the 5-year survival rate was 74%. According to the Cox proportional hazards model, the initial TR jet area (hazard ratio [HR], 1.044; 95% confidence interval [CI], 1.016-1.073), pulmonary artery systolic pressure (HR, 1.024; 95%CI, 1.017-1.032) and presence of right ventricular (RV) dysfunction (HR, 2.256; 95% CI, 1.329-3.828) were predictors of mortality independent of patient age and presence of diabetes mellitus and renal failure in medically managed patients. Conclusions:In patients with isolated significant TR, there was a tendency, although not significant, towards a higher survival rate after TV surgery. The severity of TR and pulmonary hypertension, and the presence of RV dysfunction are independent prognostic factors in medically managed patients. Further prospective randomized studies are necessary to demonstrate the benefit of TV surgery in these poor prognostic populations. (Circ J 2010; 74: 375 - 380)

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Section: Isolated Tricuspid Regurgitationmentioning

confidence: 96%

Long-Term Prognosis of Isolated Significant Tricuspid Regurgitation

Lee

Song

Park

et al. 2010

Circ J

152

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“…Triküspit yetersizliğinin derecesi ile pulmoner hipertansiyonun ciddiyeti ve PAB değerleri her zaman uyumlu değildir. Ancak pulmoner tromboendarterektomi sonrasında PAB' da belirgin düşüş sağlanmasının, triküspit anülüsü dilate olsa da fonksiyonel ağır triküspit yetersizliğinde azalmaya neden olduğu gösterilmiştir (16).…”

Section: Sağ Ventrikül Miyokardiyal Performans Indeksi (Tei Indeksi)unclassified

“…16 Sonuç olarak, PAH' tan şüphelenilen her hastada Doppler ekokardiyografi noninvazif tarama testi olarak kullanılmalıdır (20). Pulmoner arter basıncının tahmin edilmesi dışında sağ kalp boşluklarında genişleme, perikartiyal sıvı varlığı gibi eşlik eden anormallikleri, etiyolojiye yönelik sol kalp yetersizliği, kapak hastalıkları veya intrakardiyak şantları değerlendirmede ve prognoz tahmininde faydalıdır.…”

Section: Sağ Ventrikül Miyokardiyal Performans Indeksi (Tei Indeksi)unclassified

Echocardiography and other imaging modalities in pulmonary arterial hypertension

Özben

Başaran²

2010

Anadolu Kardiyol Derg

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It is essential to diagnose pulmonary arterial hypertension in early stages of the disease. However, most patients have late diagnosis due to the lack of disease-specific symptoms and prominent findings. Although cardiac catheterization is the gold standard in the diagnosis of pulmonary arterial hypertension, noninvasive diagnostic modalities do also have major roles in the diagnosis, risk assessment and follow-up of the patients with pulmonary arterial hypertension. The focus of the present review is the clinical role of echocardiography and other imaging modalities in pulmonary arterial hypertension. ÖZETPrognozu oldukça kötü olan pulmoner arteriyel hipertansiyonda tanının hastalığın erken dönemlerinde konulması oldukça önemlidir. Ancak semptomların spesifik olmaması ve hastalık bulgularının silik olması nedeniyle, birçok hastada tanıyı koymada geç kalınmaktadır. Tanıda altın standart olarak kardiyak kateterizasyon kabul edilse de, pulmoner arteriyel hipertansiyon tanı, risk değerlendirmesi ve tedavi takibinde noninvazif tanı yöntemlerinin yeri büyüktür. Bu derlemenin konusu pulmoner arteriyel hipertansiyon tanısında kullanılan ekokardiyografi ve diğer görüntüleme yöntemleridir.

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“…7,[20][21][22] However, it is difficult to confirm this because the endpoints vary among the studies, such as recovery of TR jet area, or PAP and pulmonary resistance assessed by cardiac catheterization.…”

Section: Predictive Factors Of Favorable Operative Outcome With the Gmentioning

confidence: 99%

“…Therefore, in the distal type of CTEPH, pulmonary thromboendarterectomy often can not improve the persistent pulmonary hypertension and pulmonary vascular resistance. 6,22 In the present study, pulmonary thromboembolic disease was classified into 2 types based on the intraoperative findings; namely, the proximal and distal types. Patients with the distal type showed short ACT of pulmonary artery flow, which was difficult to improve after pulmonary thromboendarterectomy.…”

Section: Predictive Factors Of Favorable Operative Outcome With the Gmentioning

confidence: 99%

Different Time Course of Changes in Tricuspid Regurgitant Pressure Gradient and Pulmonary Artery Flow Acceleration After Pulmonary Thromboendarterectomy Implications for Discordant Recovery of Pulmonary Artery Pressure and Compliance

Maeba

Nakatani

Sugawara

et al. 2007

Circ J

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hronic thromboembolic pulmonary hypertension (CTEPH) is a rare but life-threatening disease that eventually progresses to right heart failure. In addition, CTEPH is associated with abnormal left ventricular (LV) systolic and diastolic functions caused by ventricular interaction under right ventricular (RV) pressure overload. [1][2][3][4] It has been reported that pulmonary thromboendarterectomy is useful for dramatically reducing pulmonary artery pressure (PAP), 5-7 to improve LV systolic and diastolic functions, 3,4 and to obtain long-term survival. 8,9 On the other hand, few data exist regarding the change in pulmonary Circulation Journal Vol.71, November 2007 artery compliance after pulmonary thromboendarterectomy. Moreover, factors affecting changes in PAP and compliance after thromboendarterectomy are unclear. Because PAP and compliance may affect RV afterload and prognosis, it is of clinical value to define their changes after thromboendarterectomy.Doppler echocardiography is a useful method for estimating PAP and compliance non-invasively, using the tricuspid regurgitant peak pressure gradient (TRPG) calculated by the simplified Bernoulli equation 10 and the acceleration time (ACT) of pulmonary artery flow, respectively. 11 The aims of the present study were to examine the changes in PAP and ACT of pulmonary artery flow before and after pulmonary thromboendarterectomy using echocardiography, and to clarify the factors affecting these changes in patients with CTEPH. Methods SubjectsWe retrospectively analyzed 51 consecutive patients with CTEPH who underwent pulmonary thromboendarterectomy. The exclusion criteria were: (1) moderate or severe Circ J 2007; 71: 1771 -1775 (Received October 23, 2006 revised manuscript received July 20, 2007; accepted July 24, 2007 Different Time Course of Changes in Tricuspid Regurgitant Pressure Gradient and Pulmonary Artery Flow AccelerationAfter Pulmonary Thromboendarterectomy Implications for Discordant Recovery of Pulmonary Artery Pressure and ComplianceHirofumi Maeba**; Satoshi Nakatani; Motoaki Sugawara † ; Jun Mimura**; Norifumi Nakanishi; Hitoshi Ogino*; Masafumi Kitakaze; Toshiji Iwasaka**; Kunio MiyatakeBackground Pulmonary artery pressure (PAP) is reduced dramatically after pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, it is unclear whether pulmonary artery compliance increases in conjunction with the reduction in PAP. Pulmonary artery compliance may affect right ventricular afterload and prognosis. Methods and ResultsIn 33 patients with CTEPH (9 men, 22-76 years), changes in the tricuspid regurgitation pressure gradient (TRPG) and the acceleration time (ACT) of pulmonary artery flow (a surrogate parameter of pulmonary artery compliance) were examined before and after pulmonary thromboendarterectomy using echocardiography to clarify factors affecting the changes. At 6 months, both TRPG and ACT normalized (≤30 mmHg, ≥100 ms, respectively) in 25 patients (group A) but not in 8 (group B). In grou...

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Does lowering pulmonary arterial pressure eliminate severe functional tricuspid regurgitation?

Abstract: After significant PA pressure reduction by PTE, severe functional TR with a dilated annulus may improve without annuloplasty despite dilated tricuspid annulus diameters.

Cited by 88 publications

References 29 publications

Long-Term Prognosis of Isolated Significant Tricuspid Regurgitation

Long-Term Prognosis of Isolated Significant Tricuspid Regurgitation

Echocardiography and other imaging modalities in pulmonary arterial hypertension

Different Time Course of Changes in Tricuspid Regurgitant Pressure Gradient and Pulmonary Artery Flow Acceleration After Pulmonary Thromboendarterectomy Implications for Discordant Recovery of Pulmonary Artery Pressure and Compliance

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