THE EFFECT OF RIGHT VENTRICULAR’S FUNCTION ON THE IMMEDIATE RESULTS OF SURGICAL TREATMENT FOR PATIENTS WITH SEVERE TRICUSPID VALVE INSUFFICIENCY AND PULMONARY HYPERTENSION IN PATHOLOGY OF LEFT HEART SIDE VALVES

Highlights

Right ventricular (RV) dysfunction can be observed in patients with left heart valve pathology and severe functional tricuspid valve insufficiency. The study of RV function parameters allows for the prediction of the early postoperative period. TAPSE proved to be the most sensitive indicator, including in patients with high pulmonary hypertension.

Background. Severe functional tricuspid insufficiency is often found when surgical treatment of valve pathology of the left heart chambers is necessary. Timely correction of the pathology before the development of right ventricular failure can reduce the surgical interventions risk, improve immediate results and the quality of life of patients in the remote period.

Aim. The study was to identify the correlation between clinical parameters, parameters of right ventricular function and the immediate results of surgical treatment of patients with severe functional tricuspid valve insufficiency.

Methods. The study included 40 patients. The average age is 64.5 ± 8.5 (34–86) years. In 20 – MV insufficiency, in 11 – aortic stenosis and relative MC insufficiency, and in 9 M-A malformation. Grade 3 TR insufficiency – 35 (78%) patients, grade 4 TR – 5 (22%) patients. All of them had class III–IV symptoms to NYHA. In the preoperative period, a general clinical and echocardiography examination was performed. Measures of RV function included: fractional change in right ventricular area (FAC), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler sonography (RV FWS), pulmonary artery systolic pressure (PASP), and of the tricuspid annular plane systolic excursion ratio in pulmonary artery systolic pressure (TAPSE/PASP). To assess the closeness of the bond (r), the Chaddock scale was used. For all statistical results, a significance level of < 0.05 was adopted.

Results. The average LV EF was 60.5 ± 6.8 (46–75) %, PASP: 64.7 ± 14.4 (31–110) mm Hg. 25 (63%) patients had high PASP (PASP > 60 mm Hg). Mean TAPSE/PASP: 0.28 ± 0.09 (0.11–0.52), FAC: 33.04 ± 6.2 (20–64) %, TAPSE: 16.47 ± 3.1 (11–20.6) mm, RV FWS: –17.04 + 3.9 (–5.4 – –26.2) %. In-hospital mortality of 3 (7,5%) patients. Statistical analysis showed a moderate correlation between mortality, TAPSE: –-0.3483 (p = 0.030) and LVEF: –0.3387 (p = 0.035), a very weak correlation between mortality and RV FWS: –0.1307 (p = 0.434), the absence between mortality, FAC: 0.0445 (p = 0.791) and pulmonary hypertension: –0.0521 (p = 0.753).

Conclusions. TAPSE can be considered as the most sensitive indicator of pancreatic function in patients with severe tricuspid valve insufficiency, pulmonary hypertension did not affect the immediate outcome of surgical treatment.

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