Impact of Successful Balloon Mitral Valvotomy on the Severity of Functional Tricuspid Regurgitation in Patients with Rheumatic Mitral Stenosis

Background: Significant rheumatic mitral stenosis is frequently associated with functional tricuspid regurgitation (TR) and when it is severe it adversely impact morbidity and mortality in patients undergoing mitral valve surgery. However, the effect of successful balloon mitral valvotomy (BMV) on significant TR is not fully established, so we sought to evaluate the effect of BMV on the severity of associated functional TR.Methods: This study included 46 consecutive patients with moderate-severe rheumatic mitral stenosis (valve area 1.5cm²), and at least moderate pre-procedural functional TR (≥ grade II/IV) by Doppler echocardiography, who had been underwent successful BMV by either Inoue or multi-track system at our center. Post-procedural Doppler echocardiography was performed at hospital discharge, 3 months, and 18 months later.Results: Significant regression of TR (≥ 1 grade) was reported in 24 (31%) patients at 3 months follow-up with no further significant regression at 18 months. There was a parallel reduction in pulmonary artery systolic pressure (PASP) starting immediately after the procedure and continued through 18 months (from 64±22 to 25±14mmHg, p .002). Predictors of significant TR regression in this study included: Younger age, higher preprocedural PASP, absent atrial fibrillation, and larger post-procedural mitral valve area.Conclusions: In patients with moderate-severe symptomatic rheumatic mitral stenosis and significant functional TR, successful BMV could lead to significant regression of TR severity paralleled with reduction in PASP.