Intraoperative echocardiography to detect and prevent tricuspid valve regurgitation after heart transplantation

Tricuspid valve regurgitation (TVR) is frequently observed followingorthotopic heart transplantation. The etiology of this phenomenon remainsunclear. In a prospective study, we tried to identify pre-, intra- andpostoperative factors possibly related to the occurrence of TVR in 15patients (14 male, 1 female). Epicardial echocardiography was used duringthe transplant procedure and transthoracic echocardiography was performedat weekly intervals thereafter, TVR was graded semiquantitatively (grade0-4). If TVR grade greater than 1 was detected after discontinuation ofcardiopulmonary bypass, pericardial reduction plasty was performed (groupR). If no or mild TVR (less than grade 1) was present, simple closure ofthe pericardium was carried out (control group). In group R the mean gradeof TVR was 1.6 +/- 0.3 (SEM) before and 0.6 +/- 0.07 after pericardialclosure (p less than 0.05). Following moderate elevation during the first 5weeks, the degree of TVR reached levels slightly above the initial levelsafter 8 weeks. In the control group, a moderate increase of TVR developedduring the first 8 weeks after surgery and remained at a significantlyhigher level than in group R (p less than 0.05). No preoperative riskfactors for TVR, such as underlying disease or hemodynamic status of therecipients, was identified. Estimation of differences in heart volumebetween recipient and donor organs, by contrast, showed a significantdiscrepancy in group R but not in the controls. We therefore conclude thatTVR in recipients of orthotopic heart transplants may be due to a sizemismatch of donor heart and recipient pericardial cavity, resulting indistortion of the tricuspid valve ring.(ABSTRACT TRUNCATED AT 250WORDS)