Department of Adult Congenital Heart Diseases, Institute of Cardiology, Warszawa, Poland.
Cardiol J. 2010;17(1):29-34.
The development of significant tricuspid regurgitation (TR) is associated with an unfavorable clinical outcome in patients with systemic right ventricles. Increased knowledge about the factors contributing to its presence would help prevent its progression.
This was a retrospective analysis of the factors predictive of significant TR in 60 patients with systemic right ventricles following an atrial switch procedure for complete transposition of the great arteries. Data from echocardiographic examinations, exercise radionuclide angiography, and myocardial perfusion imaging were analyzed.
Significant TR was present in 20% of patients. Compared to patients without significant TR, patients with significant TR were older at the time of surgery (p < or = 0.001), with a higher body mass index (p < or = 0.005), lower right ventricular ejection fraction (RVEF; p < or = 0.01), higher exercise perfusion abnormalities score on radionuclide angiography (p < or = 0.03), and higher systolic blood pressure (p < or = 0.02). At univariate logistic regression analysis systolic blood pressure (p = 0.03), increasing age at surgery (p = 0.01), and RVEF (p = 0.02), were predictors of significant tricuspid regurgitation. The latter two remained significant at multivariate analysis.
Patients operated upon later in life, with decreased RVEF and higher blood pressure, are at risk of significant tricuspid regurgitation and therefore warrant special attention. Prospective studies are needed to ascertain whether appropriate pharmacological intervention would prevent the development and/or progression of TR in these patients.
在患有系统性右心室的患者中，三尖瓣重度反流（TR）的发展与不利的临床结果相关。增加对导致其存在的因素的了解将有助于预防其进展。
这是对 60 例完全性大动脉转位患者行房间隔转换术后出现系统性右心室的患者进行的预测三尖瓣重度反流的因素的回顾性分析。分析了超声心动图检查、运动放射性核素血管造影和心肌灌注显像的数据。
20%的患者存在三尖瓣重度反流。与无三尖瓣重度反流的患者相比，有三尖瓣重度反流的患者在手术时年龄更大（p < 0.001），体重指数更高（p < 0.005），右心室射血分数（RVEF）更低（p < 0.01），运动放射性核素血管造影异常灌注评分更高（p < 0.03），收缩压更高（p < 0.02）。在单变量逻辑回归分析中，收缩压（p = 0.03）、手术时年龄增加（p = 0.01）和 RVEF（p = 0.02）是三尖瓣重度反流的预测因素。多变量分析时后两者仍有意义。
生命后期手术、RVEF 降低和血压升高的患者有发生三尖瓣重度反流的风险，因此需要特别关注。需要前瞻性研究确定适当的药物干预是否会预防这些患者 TR 的发生和/或进展。
