Conservative Management of Tricuspid Regurgitation in Patients Undergoing Mitral Valve Replacement

Among 100 consecutive patients undergoing mitral valve replacement, 28 had clinically and hemodynamically significant tricuspid regurgitation without tricuspid stenosis. In 21 patients the mitral valve was regurgitant, and in eight it was stenotic. The characteristic murmur of tricuspid regurgitation was present in 27 patients; 25 had abnormal venous distention, 14 peripheral edema, and seven ascites; and in 27 the liver was enlarged more than 4 cm below the costal margin. The mean right atrial pressure was abnormally high in every patient (average 11 mm Hg), and 25 had severe pulmonary hypertension (average systolic pressure 75 mm Hg). At the time of mitral replacement, 25 patients had no operative procedure on the tricuspid valve, and three had a tricuspid annuloplasty. Four patients died, a mortality rate (14%) not different from that in the patients without tricuspid regurgitation. Twenty-four patients were reassessed at postoperative intervals of one to four years (average 30 months). All evidenced symptomatic improvement; 16 observed no dietary restriction of sodium, six ate regular diets without added salt, and only two limited sodium intake more stringently. Postoperatively, mean right atrial pressures averaged 5 mm Hg and systolic pulmonary arterial pressures 39 mm Hg. In many patients with advanced mitral valve disease, associated tricuspid regurgitation is of a functional nature and secondary to right ventricular hypertension and dilatation of the tricuspid annulus. The present results indicate that in such patients tricuspid regurgitation will improve or disappear after mitral replacement and that tricuspid valve replacement is seldom necessary.