Abstract

The objective of this study was to report our experience on mitro-tricuspid valve disease treated surgically. Material and Methods: 72 patients with mitro-tricuspid valve disease were collected between December 1983 and November 2009. We have studied the epidemiological, clinical, paraclinical and therapeutic data. Only patients with mitral disease (mitral regurgitation and mitral stenosis) associated with tricuspid insufficiency (TI) or mitral stenosis associated with tricuspid regurgitation were included. All patients with an isolated tricuspid stenosis were excluded from the study. Retrospectively, we analyzed surgical results with a statistic significance level of 0.05. Results: Median age of patients was 19 years old. Sex ratio was 2 Women / 1Homme. 61.1% of patients had a functional class NYHA III or IV. The dominant etiology was the Acute Rheumatic Disease in all cases. The mean cardiothoracic ratio (RCT) was 0.67 ± 0.12 with a sinus rhythm (44.4%) and atrial fibrillation (56.6%). The bi-dimensional echocardiography was contributory in all patients. At Cardiac catheterization with Angiocardiography, Mean diastolic pressure of the Right Ventricle was 40.20 ± 20.75 mmHg and Mean pulmonary arterial hypertension was 41.15 ± 11,81mmHg. The surgical procedures were a replacement (n = 68) or valvuloplasty (n = 4) of the mitral valve associated with a tricuspid Annuloplasty (AT) or not. 42 AT of De Vega and 10 AT of Carpentier-Edwards were performed. Then, 20 TI were surgically neglected. Operative mortality was 2.8 % (n = 2). It was mainly due to the neglected TI. 2 deaths were due to a cardiogenic shock secondary a global cardiac failure (n = 2) to (n = 1). Post-operatively, 12.5 % and 7.14 % of the earliest complications were respectively observed in case of neglected TI and in case of TA of De Vega (p = 0.045). Post-operatively, the latest global morbidity was 27.8 %. These complications have happened differently in case of neglected TI or of TA of De Vega (P = 0.039). A clinical and radiological improvement were observed at least for 4 out of 5 patients treated by the TA of De Vega during the mitral valve replacement. Echocardiographic regression of the tricuspid leak was 1 ± 0,75 rank. In the long term follow up, the risk factor significantly associated with the arisen of complications was the neglected TI (RR = 5.77; P = 0.03). 10 years follow-up, the late cardiac catheterization showed tricuspid leaks were small (grad I = 36; 56.3 %), moderated (grad II = 20; 31.3 %), important (grad III = 6; 9.4 %) and very important (grad IV = 2; 3.1 %). Conclusion: Our results show that the neglected IT seems to aggravate the evolution of mitro-tricuspid valve disease after surgery. Nevertheless, more important series will be necessary to confront assertion.

Keywords: Tricuspid regurgitation– mitral valve Surgery.