Improvement of Tricuspid Regurgitation after Pulmonary Thromboendarterectomy

Chronic thromboembolic pulmonary hypertension causes right ventricular dilation with various degrees of tricuspid regurgitation, leading to right heart failure. Pulmonary thromboendarterectomy can substantially improve pulmonary hemodynamics and right ventricular dilation. The aim of this study was to determine whether the reduction of tricuspid regurgitation persists during follow-up. We studied 26 patients undergoing pulmonary thromboendarterectomy without repair of tricuspid regurgitation; 24 were followed up for 7 to 59 months after surgery (mean, 33 months). Echocardiographic and right heart catheterization data were obtained before and early after surgery. Severity of tricuspid regurgitation and tricuspid pressure gradient were evaluated at follow-up. Two patients died early after surgery, but none died during follow-up. Pulmonary thromboendarterectomy substantially improved pulmonary hemodynamics and right ventricular dilation. Tricuspid regurgitation graded severe in 5 patients and moderate in another 5, improved to trivial or mild postoperatively. The decreases in tricuspid pressure gradient and regurgitation early after surgery persisted during follow-up.