Abstract
Four cases of tricuspid regurgitation (TR) developing late after mitral valve surgery for mitral stenosis (MS), which required surgical management, are reported. Two of the 4 patients underwent open mitral commissurotomy (OMC), and the other two underwent mitral valve replacement (MVR) at the initial operation. The time course of the changes in the effective mitral valve orifice area (MVA) and tricuspid regurgitation grade were assessed by pulsed and color Doppler echocardiography. In the former 2 patients, the TR grade gradually increased as recurrent MS progressed after OMC, and operation for TR was done 10 and 12 years after the initial mitral surgery respectively. In the latter 2 patients MVA became moderately narrow about 2.0 to 2.5cm2 after MVR, and operation for TR was done 14 and 17 years after initial mitral surgery respectively. The operative procedure for TR was tricuspid annuloplasty in 2 patients and tricuspid valve replacement in 2 patients. These results suggest that recurrent TR late after mitral valve surgery is caused by gradually progressive and chronically prolonged mild recurrent MS, even in cases with MVR. Thus, before surgery for recurrent TR, mitral valve function should be assessed in detail. Also, it is necessary that reliable operative procedures for TR, including tricuspid valve repair and replacement, should be selected, considering the possible necessity of mitral valve reoperation.
