Atrial fibrillation in elderly linked to tricuspid regurgitation disorder after mitral valve repair

By: Emily Lunardo | Heart Health | Wednesday, September 21, 2016 - 02:00 PM

atrial fibrillation in the elderlyAtrial fibrillation in elderly is linked to tricuspid regurgitation disorder after mitral valve repair. Tricuspid regurgitation (TR) occurs when the tricuspid valve leaks, which allows blood to flow back from the right ventricle to the right atrium. TR is often secondary to disorders of the left-sided heart valves.

Researcher Tirone E. David said, “Patients who develop TR after MV [mitral valve] repair for degenerative diseases are older, have chronic atrial fibrillation, more advanced functional class, and impaired left ventricular function at the time of the initial surgery. This is yet another compelling reason to correct mitral regurgitation early.”

The study included 1,171 patients who underwent mitral valve repair. Sixty percent of the participants were males. Prior to the surgery, 44 percent were classified as functional classes 3 and 4 by the New York Heart Association (NYHA) measuring heart failure. In addition to the mitral valve repair, 17.1 percent also underwent coronary artery bypass, 11.2 percent underwent surgical ablation, and 4.7 percent tricuspid annuloplasty to surgically repair the tricuspid valve using an annuloplasty ring.

Forty-five patients developed moderate or severe tricuspid regurgitation. Dr. David commented, “Although the number of patients who developed TR after MV repair was small in our study, the effect of severe TR was devastating, with a high mortality at one year after the diagnosis, which usually occurred during an episode of heart failure.”

Two factors were identified in the development of TR: Older age and preperative atrial fibrillation. The diet drug Fen-Phen was also linked to TR.

Symptoms of TR include fatigue, weakness, active pulsing in the neck veins, reduced urinary output, and swelling of the legs, feet, or abdomen.

Tricuspid valve regurgitation treatment in elderly

Tricuspid valve regurgitation can be treated with lifestyle changes along with medical treatments. Lifestyle changes to treat TR include eating a heart-healthy diet, exercising regularly, preventing infective endocarditis, discussing pregnancy with your doctor, and having regular follow-up appointments with your doctor.

Your doctor may also prescribe medications to treat the signs and symptoms related to heart failure such as diuretics or medications to treat heart arrhythmias. Surgery may also help treat TR. Surgical options include valve replacement, valve repair, or a maze procedure in which the surgeon creates a maze of scar tissue to treat irregular heart rhythm.

Your doctor may also recommend catheter ablation in which a catheter is threaded through the blood vessels to the heart. Electrodes at the tip of the catheter use heat, extreme cold, or radiofrequency energy to damage a small spot of the heart tissue and create an electrical block along the pathway that is causing the arrhythmia.

Depending on the severity of your tricuspid valve regurgitation, your doctor will choose the appropriate method of treatment.

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