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Functional Tricuspid Regurgitation in Rheumatic Heart Disease: results of De Vega annuloplasty

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Functional Tricuspid Regurgitation in Rheumatic Heart Disease: results of De Vega annuloplasty
Z.ZOUIZRA,Y. BOUKAIDI, R.EL HOUATI, D.BOUMZEBRA.
Unit – Centre Hopitalier Universitaire Mohammed VI-Marrakech.

 

 

 

Tricuspid regurgitation (TR) in patients with rheumatic  heart disease is associated with poor outcome and predicts poor survival, heart failure, and reduced functional capacity.

Objectives

The objective of this study is to review our surgical outcomes with tricuspid De Vega annuloplasty’s for functional tricuspid regurgitation in rheumatic heart disease.

Patients and Methods

Number of Patients: 520

Age :    37 ( 18 – 67 Y)

Gender (Male/Female): F: 52%  M: 48%

NYHA Status:

                               II  : 78 paients  (15% )    

                               III: 296 patients (57%)

                               VI: 146 patients (28%)

 

Valve surgery:                    Numbre of patients

MVR                                      306 ( 59%)

MVP                                       43 ( 8%)

MVR and AVR                      150 ( 29%)

MVP and AVR                      21 (4%)

MVR : mitral valve replacement, MVP : mitral valve plasty, AVR : aortic valve replacement

 

De Vega annuloplasty:

   - Annuular size per tricuspid annuloplasty:   Tightening over 2 fingers of the surgeon               

  - The tricuspid competence was checked with saline  test : all patients

Result (1): Early  post-operative

Operative mortality : 23 ( 4,4%)

complications of annuloplasty De Vega:      

     - Right sided Heart failure 1 to 2 weeks after   De Vega annuloplasty: 7(1,4%)  patients (with severe pulmonary hypertension and or right ventricular dysfunction).

     -Tricuspide stenosis: 4 patients (0,7%)

Dyspnea NYHA Class improvement: grade III- IV to grade I and II in 85,5% patients.

Post-operative echo study:

     - Midl or less TR:  453 patients (87%)   

      Moderate TR : 37 patients (7%)

      Severe TR: 7 patients (1.34%)

   - Pylmonary hypertention :  47 (35- 85mmhg)

Result (3): Follow up: 5 years after surgery

Late mortality: 17 patients (3.2%):

        -  Lower LVFE: 3 P

        -  Heart failure with severe TR: 3 P

        -  Prosthetic valve endocarditis: 2 P

        - Anticoagulation-related hemorrhage: 6 P

        -  Thromboembolism of Prosthetic valve: 1 P

        -  Sudden death (unexplained): 2 P

NYHA Status for surviving patients:  320 patients

                              - I  -  II  : 295 Patients (92% )    

                              -  III : 16 Patients (5 %)

                              -  VI : 10 Patients (3 %)

 

Conclusions:

De Vega annuloplasty:  is a simple, short, and inexpensive procedure with few complications.

Preoperative Pylmonary hypertention is one of risk factors to attribute to recurrent TR.

 In a developing country like Morocco, De Vega annuloplasty remains the procedure of choice in the management of functional tricuspid valve incompetence.

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