The Ventricular Morphology And Hemodynamic Study Of Severe Functional Tricuspid Regurgitation

Objective: Analysis of left and right ventricular morphology, hemodynamicand treatment results in patients with severe functional tricuspidregurgitation(FTR) after left heart valve replacement, to explore theessence of FTR.Methods:67patients with severe FTR (Group A) and30patients with noor mild FTR (Group B) who underwent left heart valve replacement for morethan7years and followed up in outpatient-room or treated in hospitalfrom February2011to March2013. All of the97patients were examinedby echocardiography. In Group A,12patients have a Swan-Ganz floatingcatheter examination and18patients treated in hospital,6patientsaccept the tricuspid valve replacement(TVR), and12patients acceptconservative treatment by medicine. Observed the two groups of patientswith clinical symptoms and signs, left and right ventricular morphology,analyse their hemodynamic and treatment results.Result:(1) There are statistical significance (P <0.05) between the twogroups with preoperative heart function(NYHA), signs of right cardiacdysfunction;(2) The indicators of LVPW and IVS thickness, inner diameterof pulmonary artery, PASP are no obvious statistical significance (P>0.05) between the two groups;(3) The inner diameter of LA, LV, RA, RV,LVEDV, LVEF, FS, CO, indicators of right ventricular function (includeof RVPCA, RVEF, TVAD, TAPSE, Sm, E/A, Tei index)are statisticalsignificance (P <0.05) between the two groups；(4) The measurement ofPASP from Swan-Ganz floating catheter and echocardiography have a goodcorrelation (r=0.71); Except1case of patients of severe pulmonary hypertension (95/67(73) mmHg), the PASP of remaining11patients is37～60mmHg(averaged34.08±2.57mmHg), all the12patients have a obviouslyincreased CVP and PCWP;(5)6of the18hospitalized patients with severeFTR have TVR(4biological valve replacement and2mechanical valvereplacement),3patients are dead （2biological valve replacement and1mechanical valve replacement）for postoperative right cardiacinsufficiency;3of the12patients treat by medicine are dead for severeright heart failure, though their lower extremity edema alleviate bydiuretics, they are still in bad exercise tolerance and need cardiotonicand diuretics for a long time.Conclusion: Severe FTR is a clinical manifestation of the change ofseries of ventricular morphology and function. The changes of leftventricular morphology and function, as a initiating factor, influencethe right ventricular morphology and function. What is more, it changesthe tricuspid annulus and causes tricuspid regurgitation. The pulmonaryartery pressure are between40-50mmHg for most of the patients with severeFTR. Neither the conservative treatment by medicine nor the surgical fortricuspid get a satisfactory result. From our own perspective, the essenceof FTR is a “ventricular disease”. The proposal of the concept of"ventricular disease" not only make a comprehensive understanding of TVR,but also provide a new direction for our future research.