Indirect consequences of MR correction:
RV dysfunction in the setting of MR may be further exacerbated by the
presence of TR which occurs due to progressive RV and tricuspid annular
dilatation. While the prognostic importance of TR following surgical and
transcatheter mitral repair is well known [25], relatively little
has been reported on the impact of mitral interventions on severity of
TR. In one study of surgical mitral repair for ischemic MR,> 2+TR was present in 30% of patients
pre-operatively. Post-operatively, there was little change in TR
severity, irrespective of whether or not tricuspid annuloplasty had been
performed [26]. Conversely, in the COAPT trial [27], at 2-year
follow-up, >2+TR was less frequent in the device group
compared with the control group (49.9% vs 81.0%; HR 0.43, 95% CI:
0.25, 0.74). Our study demonstrated a significant reduction in overall
TR burden which was sustained to 3-months. Pulmonary hypertension
secondary to severe MR is also known to exacerbate RV dysfunction by
increasing RV afterload. In our study, there was a progressive reduction
in PASP 3-months after TMVI on echocardiography as we might have
expected (Table 5).