Elsevier

Mayo Clinic Proceedings

Volume 63, Issue 9, September 1988, Pages 851-863
Mayo Clinic Proceedings

Surgical Pathology of the Tricuspid Valve: A Study of 363 Cases Spanning 25 Years

https://doi.org/10.1016/S0025-6196(12)62687-1Get rights and content

Surgical pathologic features of the tricuspid valve were reviewed in 363 patients who had undergone tricuspid valve replacement at our institution during the period 1963 through 1987. Valves were purely regurgitant in 74%, stenotic and regurgitant in 23%, and purely stenotic in 2%; two valves were neither stenotic nor regurgitant. Among 269 purely insufficient tricuspid valves, the four most common causes were postinflammatory disease (41%), congenital disorder (32%), pulmonary venous hypertension (21%), and infective endocarditis (4%). Of 92 cases of tricuspid stenosis, with or without regurgitation, postinflammatory disease was observed in 92%. Female patients accounted for 66% of the 363 cases, including 84% of those with postinflammatory disease and 64% of those with pulmonary venous hypertension. In contrast, male patients accounted for 73% of cases with endocarditis and 61% with congenital heart disease. Although postinflammatory disease accounted for 53% of the 363 cases, its relative frequency diminished from 79% during 1963 through 1967 to only 24% during 1983 through 1987. This trend may reflect the decreasing incidence of acute rheumatic fever reported in Western countries. During the same time interval, the relative frequency of congenital heart disease as a cause of tricuspid dysfunction increased from 7% to 53%, and it is currently the most common cause in our surgical population. This finding apparently reflects changes in patient referral practices and the development of new operative procedures.

Section snippets

Study Group.

From the tissue registry at our institution, 363 tricuspid valves that had been excised surgically during the 25 years between January 1963 and December 1987 were examined. For gross examination of the valves, we used the methods described by Davies16 and by Roberts.17 Patients in this study may also have had replacement or surgical repair of additional cardiac valves. Excluded from this study, however, were patients who underwent repair, rather than excision and replacement, of tricuspid

Functional Classification.

Of the 363 tricuspid valves reviewed (Table 1), 269 (74%) were purely insufficient, 84 (23%) were both insufficient and stenotic, 8 (2%) were purely stenotic, and 2 (0.6%) were neither insufficient nor stenotic (Table 2). Two functionally normal valves were removed, one during repair of a double-outlet left ventricle because of straddling chordae tendineae and the other to allow septation during correction of a double-inlet left ventricle.

Morphologic Classification.

Postinflammatory changes were the most common cause of

Postinflammatory Disease.

In patients who have undergone a tricuspid valve surgical procedure, tricuspid valve dysfunction is most commonly caused by postinflammatory disease, which is presumably a manifestation of chronic rheumatic disease in most instances. It accounted for 39 of 41 cases (95%) of valve replacement or repair reported by Kratz and associates,9 for 194 of 363 valve replacements (53%) in the current study, and for 9 of 21 valve replacements (43%) reported by Waller.19 A striking female preponderance has

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