Preoperative Right Ventricular Function in Patients with Organic Mitral Regurgitation

AIMS: To assess the right ventricular (RV) function in patients with severe mitral regurgitation (MR); to find a relation between preoperative and postoperative parameters. METHODS: RV function was echocardiographically assessed by determining the tricuspid annular plane systolic excursion (TAPSE) and the peak systolic velocity of the lateral tricuspid annulus (Sa) in 45 patients with severe organic MR (53.3% men, age 58 +/- 10 years). Mean NYHA class was 2.6 +/- 0.4, LVEF was 55.3 +/- 12%, RV end-diastolic diameter was 28.7 +/- 4.7, left ventricular end-systolic diameter (LVESD) was 44.6 +/- 12.6 mm, and LV end-diastolic volume (Simpson) was 160.6 +/- 50.3 ml. All patients underwent mitral valve replacement with posterior chordal sparing. RESULTS: Mean preoperative TAPSE and Sa were 19.4 +/- 4.3 mm and 10.3 +/- 3 cm/sec, respectively. RV dysfunction, defined as TAPSE < 22 mm, had 66.6% of the patients, and Sa < 11 cm/sec was found in 62.2% of the patients preoperatively. Preoperative TAPSE and Sa were significantly correlated (P < 0.00001, r = 0.61). Both TAPSE and Sa were correlated with the RV end-diastolic diameter (P < 0.01), LVESD (P < 0.05) left ventricular dp/dt (P < 0.05), and LVEF (P < 0.0001). Postoperative LVEF was 50% (P < 0.001), Sa 5.3 +/- 2 cm/sec (P < 0.001), and TAPSE 8.7 +/- 3.2mm (P < 0.001). Twenty-one patients (46.6%) reached the study end point of decrease of LVEF by more than 10%. Univariate predictors were age (P = 0.04), male gender (P = 0.01), TAPSE (P = 0.007), and Sa (P = 0.009), while a trend was found for regurgitation fraction (P = 0.058) and LV end-diastolic volume index (P = 0.09). By multivariate analysis, TAPSE (P = 0.01) and Sa (P = 0.01) were predictive for the study end point. CONCLUSION: The assessment of the RV function by echocardiography is a simple tool that provides prognostic information in patients with MR.