| Objective:To analyze the clinical data of patients with rheumatic mitral stenosis, and to explore the clinical characteristics and the impact factors of functional tricuspid regurgitation (TR).Methods:Two hundred and ten patients with rheumatic mitral stenosis performing percutaneous balloon mitral valvuloplasty (PBMV) are hospitalized in the First Affiliated Hospital of Guangxi Medical University from January 2012 to September 2015. We collected these patients’preoperative clinical information, transthoracic Echocardiography (TTE) examination data and intraoperative hemodynamic data. According to tricuspid regurgitation (TR) volume,200 cases with TR were divided into three groups:TR1 group (<10ml), TR2 group (10ml≤<20ml), TR3 group (≥20ml). We analyzed the clinical characteristics of functional TR and related impact factors.Results:(1) Most patients were female (82.4%,173/210).94.3% patients have clinical symptoms, mainly showing exertional chest tightness, shortness of breath. Mean disease duration was 5.0±3.0 years. The heart function was divided into in I to IV were respectively accounted for:13.3%,59.0%,23.8% and 3.8%. There were 102 patients with atrial fibrillation (AF) (102/210,48.6%). (2)Two hundred cases of 210 patients with TR accounted for 95.2%. TR volume below 10ml,between 10ml and 20ml, above 20ml were respectively accounted for:65.5% (131/200),24.0%(48/200) and 10.5%(21/200). Five cases had reached severe functional TR (≥45ml). (3) The pulmonary artery systolic pressure (PASP) values of 56 cases were measured by TTE and right heart catheter. Correlation was existed between these two methods(r=0.73, P=0.001), but the PASP values by TTE was greater than those measured by right heart catheter (P< 0.05). (4) The TR volume and TR velocity were significant higher in the patients with right ventricular enlargement (P< 0.05). (5) The disease duration of TR3 group was significantly longer than that of TR1 group and TR2 group (P< 0.05), but there was no significant difference between the TR1 group and the TR2 group. The incidence of atrial fibrillation and left atrial diameter (LAD) of TR2 group and TR3 group were significantly higher than that of group TR1 (P< 0.05), while their mitral valve orifice area (MVA) were significantly less than TR1 group (P< 0.05), but there were no significant difference between the TR2 group and the TR3 group (P>0.05). The cardiothoracic ratio and right ventricular diameter (RVD) of 3 groups were positive related to TR volume (P< 0.05). There was no significant difference of left ventricular ejection fractional (LVEF), left ventricular end-diastolic diameter (LVEDD) and PASP in three group patients (P< 0.05). (6) Linear correlation analysis show that disease duration, cardiothoracic ratio, atrial fibrillation (AF), MVA, RVD, PASP and LAP were positively correlated with functional TR volume (P< 0.05). (7) Multiple linear regression analysis showed that:disease duration, cardiothoracic ratio and RVD were the impact factors of functional TR (R 2=0.232).Conclusion:(1) The majority of patients with rheumatic mitral stenosis were female, admitting to hospital with clinical symptoms, in grade 2 and below of the NYHA, and almost half of the patients had atrial fibrillation. (2) Most of patients with rheumatic mitral stenosis had functional TR, nearly two-thirds of patients with TR volume below 10 ml, but very few were severe TR. (3) There was a certain correlation between PASP measured by TTE and right heart catheterization, but PASP may be overestimated by TTE. (4)With the cardiothoracic ratio and RVD increasing, TR volume of patients with rheumatic mitral stenosis increased; In patients with TR volume more than 10ml, the incidence of atrial fibrillation was high, with small MVA and large left atrial size. (5) The functional TR volume in patients with rheumatic mitral stenosis was related to the disease duration and the change of the right ventricle structure. |
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