Surgery for rheumatic tricuspid valve disease: A 30-year experience

Abstract

Organic tricuspid valve disease associated with rheumatic mitral or aortic lesions increases hospital and late mortality, but valve repair compared favorably with valve replacement. Long-term results may be considered acceptable for otherwise incurable valve disease.

Combined Mitral and Tricuspid Valve Repair in Rheumatic Valve Disease

“…A historical comparison with a subset of 149 patients with double mitral and tricuspid rheumatic valve disease undergoing mitral valve replacement (mechanical, 98; bioprosthesis, 51) and tricuspid repair in the same time period illustrates this point. 13 There were no differences in the 30-day mortality rate, but at 15 years, the probability of survival and freedom from valve dysfunction-related reoperation were less favorable. Besides these data based on our experience, other studies of rheumatic heart disease have shown that patients with mitral valve repair (or open mitral commissurotomy) survived longer than those undergoing mitral valve replacement with any type of prosthesis.…”

“…The size of the ring was selected according to the intertrigonal distance of the anterior mitral leaflet and the size of the septal tricuspid annulus as previously described. 12,13 Mitral valve operations included open mitral commissurotomy in 24 patients, Duran flexible annuloplasty and mitral commissurotomy in 108, and isolated Duran flexible annuloplasty in 21. Associated procedures were repair of chordae tendineae according to previously described techniques 12 in 16 patients and papillotomy in 34.…”

“…[1][2][3] When rheumatic fever became rare in wealthy countries, it disappeared from the scientific literature. In Spain, a large population of patients with rheumatic valve disease have undergone diagnosis and treatment during the past 30 years 13,16,17 not only because eradication of rheumatic fever occurred later there than in other developed countries but also because there has been a resurgence of the disease as a result of the influx of immigrants from countries where rheumatic fever is prevalent.…”

Minimized Cardiopulmonary Bypass

“…Isolated tricuspid rheumatic valve disease is infrequent; due to this, clinical results of isolated tricuspid valve disease when appears with normal functioning left side valves are not known in detail (35). This is due to the scarce information available opposite to tricuspid regurgitation later after left side valve repair or replacement, which entails a high risk and very bad prognosis (36). This lack of information prompted us to review a series of patients over a long period of time that underwent surgery for isolated TV disease.…”

Long-term results of treatment of corrected and uncorrected mild functional tricuspid insufficiency in patients operated for rheumatic mitral defect

“…Функциональная недостаточность (ФН) трикуспидального клапана (ТК) встречается у 8-35% па-циентов с пороками левых отделов сердца, является не-благоприятным прогностическим показателем и связана с худшей отдаленной выживаемостью и функциональным статусом пациентов [3,11,25]. В развитых странах число пациентов с ревматическими пороками сердца невелико [13], в России число пациентов с ревматическими порока-ми МК остается еще достаточно большим. Тактика лече-ния пациентов с умеренной ФТН и умеренной дилатаци-ей ФК в национальных рекомендациях по ведению, диа-гностике и лечению клапанных пороков сердца детально не рассматривается [2].…”