Long-term follow-up of patients with severe rheumatic tricuspid stenosis

doi:10.1016/S0002-8703(98)70189-9

American Heart Journal

Volume 136, Issue 1, July 1998, Pages 103-108

https://doi.org/10.1016/S0002-8703(98)70189-9 Get rights and content

Abstract

Background Tricuspid stenosis is a part of the chronically rheumatic heart. Although rare, when tricuspid stenosis does occur, it occurs in the setting of coexistent mitral and aortic valve disease. The natural course of patients with severe tricuspid stenosis is not well defined. The aim of this study is to present close follow-up of patients with chronic rheumatic heart disease and severe tricuspid stenosis.

Methods and Results We retrospectively studied 13 patients (11 women and 2 men) with severe tricuspid stenosis who were followed closely for 6 to 31 years. The mean tricuspid pressure gradient ranged from 3 to 9 mm Hg. Twelve patients underwent surgery for mitral and/or aortic valve lesions without complications. Concomitant tricuspid valve surgery was performed on six patients: two De Vega procedures, two Kay plications, and two implantations of Carpentier rings. All these also had leaflet commissurotomy. After surgery, the mean tricuspid gradient decreased in three patients, did not change in two, and increased in one. All 13 patients were treated with diuretics, digoxin, warfarin, and spirinolactone or ACE inhibitors. On their last follow-up visit, every patient had increased jugular venous pressure. Hepatomegaly was found in 6 of 13, leg edema in 4 of 13, and ascites in 1 of 13.

Conclusions Most tricuspid stenosis patients are women with severe mitral and aortic valve disease. After successful repair of the mitral or aortic valve, and regardless of the type of tricuspid valve surgery, severe tricuspid stenosis was found to be very well tolerated by all the patients over many years of follow-up. (Am Heart J 1998;136:103-8.)

Section snippets

Patient selection

By December 1996, 248 patients with chronic rheumatic valvular disease were being followed in our Heart Valve Disease Outpatient Clinic. Tricuspid valve involvement was found on echocardiography in 99 (40%) of 248 patients. Organic tricuspid valve disease, manifested by tricuspid leaflet thickening with limited mobility, was found in 18 (7%) patients. Severe tricuspid stenosis, defined as organic tricuspid valve disease with a mean transvalvular pressure gradient of >3 mm Hg, was found in 13

Patient population

Severe tricuspid stenosis was found in 13 patients (11 women and 2 men). Today, the members of the group range in age from 29 to 65 years (mean 41 ± 12). Age at first visit was 6 to 44 years (mean 21 ± 10), and follow-up time ranged from 6 to 31 years (mean 20 ± 8). Tricuspid stenosis was diagnosed 1 to 23 years (mean 15 ± 8) after the diagnosis of chronic rheumatic heart disease at the mean age of 30 ± 10 years (Table I).

Surgical procedures

Twelve of 13 patients (92%) underwent surgery for mitral and/or aortic

Patient population with rheumatic tricuspid disease

By using Doppler echocardiography, we detected tricuspid valve involvement in 40% of 248 patients with chronic rheumatic heart disease. Most patients had “functional” tricuspid regurgitation, resulting from mitral and aortic valve disease, with increased pulmonary artery pressure but without evidence of rheumatic tricuspid valve involvement. Organic tricuspid disease, manifested by tricuspid leaflet thickening with limited mobility, was found in only 7% of our patients with chronic rheumatic

Acknowledgements

We thank Mrs. M. Perlmutter for assistance in the preparation of this paper.

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^☆: From the Departments of Cardiology and Cardiac Surgery, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology.

^☆☆: Reprint requests: Ariel Roguin, MD, Department of Cardiology, Rambam Medical Center, P.O. Box 9602, Haifa 31096, Israel.

^★: 4/1/89406

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Long-term follow-up of patients with severe rheumatic tricuspid stenosis☆,☆☆,★

Abstract

Section snippets

Patient selection

Patient population

Surgical procedures

Patient population with rheumatic tricuspid disease

Acknowledgements

Mayo Clin Proc

Am J Cardiol

Am J Cardiol

J Thorac Cardiovac Surg

J Am Coll Cardiol

Am Heart J

J Thorac Cardiovac Surg

Am J Cardiol

J Thorac Cardiovasc Surg

Am J Cardiol

J Thorac Cardiovasc Surg

Isolated tricuspid stenosis

Circulation

Valvular heart disease