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Tricuspid dysfunction during the rheumatic disease.
MedLine Citation:
PMID:  21049412     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background: Rheumatic tricuspid valve dysfunction is the rarest of all valvular disease and is often associated or secondary to left-sided valvular disease. She often realize tricuspid regurgitation. The surgical treatment is generally conservative but also it can be radical generally using bioprothèses. Aim : to assess the epidemiology of the rheumatic tricuspid dysfunction, the average diagnoses and its therapeutic. To evaluate the results of the surgical techniques, the factors of prognostis and to determine the therapeutic regarding an in front of important and symptomatic residual tricuspid regurgitation a long time after a valvular surgery first of the left heart. Methods: A retrospective, single center of 84 consecutive patients having one significant tricuspid dysfunction regurgitation and/or significant stenosis of rheumatic origin. Hospitalized and followed between January 1992 and March 2008 in cardiology to the hospital Habib Thameur. Results: The prevalence of the rheumatic tricuspid dysfunction was 8,42%. 70% of the patients had a tricuspid regurgitation. The average Age of our patients was 40 years. Our population consisted of 65,5% women. 21% of the patients had benefited at least from a percutaneous mitral dilation. 31% of the patients had antecedents of valvular cardiac surgery. 53% of the patients presented clinical signs of preoperative right cardiac failure and 58% of the patients were in permanent auricular fibrillation. The tricuspid regurgitation was major at 12% of the patients, severe at 88% of the patients, organics at 21% of the patients and functional at 31% of the patients. The average of the systolic pulmonary blood pressure was with 55 +-16,8 mm Hg. All the patients had an associated left valvulopathy. The average of the ejection fraction of the left ventricle was 56 + 12,6%. The dilation of the right cavities was noted at 70% of the patients. The patients of our series were subdivided in two distinct groups. The first group gathers 30 patients who were operated of tricuspid in same operational time as the surgery of the left valves. The surgical gesture on the tricuspid was always conservative. 70% of the patients profited from a tricuspid annuloplasty. Hospital mortality is 10%. 26% of the patients presented a significant residual tricuspid regurgitation after 60 months. 26% of the patients presented late cardiac failure. Late mortality was from 30% to 5 years and 43% to 10 years. The second group is represented by 54 patients not operated on the tricuspid. 30 patients (81%) presented one or more episodes of late cardiac failure. 50% of the patients died during the late follow-up. Among operated patients of the tricuspid, the predictive factors of the residual tricuspid regurgitation post operational are the age < 35 years and the mitral disease. The stage NYHA = 4 was the only predictive factor of hospital mortality. The predictive factors of late right congestive heart failure postoperative are the clinical signs of preoperative right heart failure and the antecedents of mitral replacement . The predictive factors of late total congestive heart failure postoperative l are the functional tricuspid regurgitation and stage 4 of the NYHA. Conclusion: The benefit of a systematic initial correction of a voluminous tricuspid regurgitation and even of average importance realized prematurely in same operation time that the left valvular gesture was largely shown. The late appearance of functional tricuspid regurgitation after mitral valve surgery is a pejorative marker in the evolution of these patients.
Authors:
Youssef Ben Ameur; Ihsen Zairi; Kamel Kamoun; Mahdi Ben Sassi; Salma Longo; Kais Battikh; Ml Slimane
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  La Tunisie médicale     Volume:  88     ISSN:  0041-4131     ISO Abbreviation:  Tunis Med     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0413766     Medline TA:  Tunis Med     Country:  Tunisia    
Other Details:
Languages:  eng     Pagination:  820-8     Citation Subset:  IM    
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