The effect of tricuspid insufficiency on right ventricular performance in patients with valvular heart disease (author's transl)

The hemodynamic effect of tricuspid insufficiency on right ventricular function was studied in 25 patients with rheumatic heart valve disease. 10 patients had mixed valve disease without tricuspid insufficiency (group A), and 15 patients had mixed mitral valve disease with tricuspid insufficiency (group B). Mitral valve area (1.76 vs. 1.66 cm2) and mitral regurgitant fraction (55 vs. 45%) were not significantly (p greater than 0.05) different between groups. Patients of group B revealed higher right atrial and right ventricular end-diastolic pressures than patients of group A. Right ventricular ejection fraction was lower in group B as compared to group A (44 vs. 52%, p less than 0.05). During ergometric exercise right atrial pressure was higher in group B as compared to group A (19 vs. 14 mm Hg, p less than 0.05), but mean pulmonary artery pressure (48 vs. 51 mm Hg, p greater than 0.05), cardiac index (3.3 vs. 3.31/min . mi2, p greater than 0.05) and stroke index (27 vs. 25 ml/m2, p greater than 0.05) were not significantly different. In mixed mitral valve disease associated with tricuspid regurgitation, right ventricular function is impaired when compared to mixed mitral valve disease of equal severity but without tricuspid regurgitation. Exercise induces a further augmentation of right atrial pressure in these patients with tricuspid regurgitation. We conclude, right atrial pressure elevation is not only the consequence of tricuspid regurgitation in group B but also the consequence of impaired right ventricular function. Impairment of right ventricular function is further augmented during exercise.