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Time course of heart failure in patients after a surgery for rheumatic mitral valve disease complicated with relative tricuspid insufficiency

Tolpygin D. S., Tishkova V. M., Prokopova L. V., Maystrenko N. S., Gordeev M. L.
Federal State Budgetary Institution, "V. A. Almazov Federal Medical Research Center" of the RF Ministry of Health Care, Akkuratova 2, St.-Petersburg 197341

Keywords: relative tricuspid insufficiency, heart failure, heart valve prosthetic replacement, modified suture tricuspid valve annuloplasty, rheumatic mitral valve disease

DOI: 10.18087/rhfj.2015.4.2065

Background. Rheumatic disease is one of the most common causes for development of mitral valve (MV) disease. More than one third of patients with mitral stenosis have moderate tricuspid insufficiency (TI). In absence of timely surgical treatment, HF progresses rapidly in such patients. At the same time, there is no uniform approach to surgical treatment of relative tricuspid insufficiency (RTI) in mitral valve disease. Aim. To evaluate the time course of HF after surgical treatment of rheumatic mitral valve disease complicated with grade >2 RTI based on the fact of performed correction and immediate and remote outcomes of the surgery. Materials amd methods. The study was based on retrospective and prospective evaluations of 130 cases of surgical treatment for rheumatic mitral valve disease complicated with grade 2-4 RTI. MV replacement with mechanical prosthesis was performed for all patients. Correction of TI was performed using modified suture annuloplasty. HF severity was evaluated using the Clinical Condition Scale (CCS). Results. At the preoperative stage, the most severe HF manifestations were observed in the group of patients with grade 3-4 ETI. Modified suture tricuspid valve (TV) annuloplasty did not increase the early postoperative mortality. After the surgical correction of RTI, patients demonstrated better remote postoperative survival and less pronounced HF. The major predictors of HF progression included preserved moderate TI after the surgery and pulmonary artery blood pressure after the surgery. Conclusion. The surgery stage of modified suture TV annuloplasty was beneficial for survival and HF course in the remote postoperative period. Surgical correction of grade 204 RTI is necessary in all cases of surgical treatment for rheumatic mitral valve disease.
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Tolpygin D. S., Tishkova V. M., Prokopova L. V., Maystrenko N. S., Gordeev M. L. Time course of heart failure in patients after a surgery for rheumatic mitral valve disease complicated with relative tricuspid insufficiency. Russian Heart Failure Journal. 2015;16 (4):218–223

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