Journal compilation C  2009, Wiley Periodicals, Inc. DOI: 10.1111/j.1540-8175.2009.01001.x C  2009, the Authors Preoperative Right Ventricular Function in Patients with Organic Mitral Regurgitation Anton Chrustowicz, M.D., ∗ Andrzej Gackowski, M.D., Ph.D., F.E.S.C. ∗ Nader El-Massri, M.D., Ph.D., ∗ Jerzy Sadowski, M.D., Ph.D., Professor of Medicine,† and Wieslawa Piwowarska, M.D., Ph.D., F.E.S.C, Professor of Medicine ∗ ∗ Department of the Coronary Disease, Institute of Cardiology, Krakow, Poland; and †Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Krakow, Poland Aims: To assess the right ventricular (RV) function in patients with severe mitral regurgitation (MR); to find a relation between preoperative and postoperative parameters. Methods: RV function was echocardiographically assessed by determining the tricuspid annular plane systolic excursion (TAPSE) and the peak systolic velocity of the lateral tricuspid annulus (Sa) in 45 patients with severe organic MR (53.3% men, age 58 ± 10 years). Mean NYHA class was 2.6 ± 0.4, LVEF was 55.3 ± 12%, RV end-diastolic diameter was 28.7 ± 4.7, left ventricular end-systolic diameter (LVESD) was 44.6 ± 12.6 mm, and LV end-diastolic volume (Simpson) was 160.6 ± 50.3 ml. All patients underwent mitral valve replacement with posterior chordal sparing. Results: Mean preoperative TAPSE and Sa were 19.4 ± 4.3 mm and 10.3 ± 3 cm/sec, respectively. RV dysfunction, defined as TAPSE < 22 mm, had 66.6% of the patients, and Sa < 11 cm/sec was found in 62.2% of the patients preoperatively. Preoperative TAPSE and Sa were significantly correlated (P < 0.00001, r = 0.61). Both TAPSE and Sa were correlated with the RV end- diastolic diameter (P < 0.01), LVESD (P < 0.05) left ventricular dp/dt (P < 0.05), and LVEF (P < 0.0001). Postoperative LVEF was 50% (P < 0.001), Sa 5.3 ± 2 cm/sec (P < 0.001), and TAPSE 8.7 ± 3.2mm (P < 0.001). Twenty-one patients (46.6%) reached the study end point of decrease of LVEF by more than 10%. Univariate predictors were age (P = 0.04), male gender (P = 0.01), TAPSE (P = 0.007), and Sa (P = 0.009), while a trend was found for regurgitation fraction (P = 0.058) and LV end-diastolic volume index (P = 0.09). By multivariate analysis, TAPSE (P = 0.01) and Sa (P = 0.01) were predictive for the study end point. Conclusion: The assessment of the RV function by echocardiography is a simple tool that provides prognostic information in patients with MR. (Echocardiography 2010;27:282- 285) Key words: mitral regurgitation, right ventricle, cardiac surgery, Doppler tissue imaging, left ventricular function In patients with mitral regurgitation, preop- erative left ventricular ejection fraction (LVEF) is a powerful predictor of postoperative survival, 1 but it overestimates the left ventricular function, 2 due to activation of the adrenergic system and reduced afterload. A number of studies have pro- vided evidence that right ventricular function is an independent prognostic factor in patients with mitral regurgitation. 3,4 Aims: (1) To assess the right ventricular function in pa- tients with severe mitral regurgitation (MR) and (2) to examine the relationship between preoper- Conflict of interest: none declared. Address for correspondence and reprint requests: Anton Chrustowicz, M.D., Department of the Coronary Disease, John Paul II Hospital, Krakow, Poland. Fax: +48-12-6336744; E-mail: anton_chrustowicz@yahoo.de ative right ventricular function and postoperative left ventricular function. Methods: The prospective analysis included 45 patients who underwent mitral valve replacement (MVR) for severe organic MR. The entire investigation was proactively planned, and no part of this study was a retrospective collection of clinically derived data. The study end point was a postoperative decrease in the LVEF by more than 10% by a follow-up of 6 months. Inclusion criteria were: (1) patients with se- vere mitral regurgitation, symptomatic, or with LV dysfunction and (2) optimized medical ther- apy. Exclusion criteria were: (1) severe aortic valve disease, (2) emergency operation, (3) COPD, (4) severe tricuspid regurgitation, and (5) concomi- tant CABG. No patient had a history of inferior myocardial infarction. 282