Tricuspid regurgitation by Doppler echocardiography after orthotopic cardiac transplantation.

The incidence and severity of Doppler-detected tricuspid regurgitation (TR) and associated clinical variables was studied in 20 patients who underwent cardiac transplantation. Eighteen of the 20 patients had Doppler detectable TR after cardiac transplantation, 14 had moderate to severe TR and 4 mild TR. Echocardiographic evidence of right ventricular volume overload was present in 13 of 14 patients with moderate to severe TR and in none of the other 6 patients. Patient age, primary disease process, cold ischemic time of the transplanted heart, and the frequency or severity of organ rejection did not correlate with the development of TR. Two patients with significant TR had a torn or partially torn tricuspid chordae, indicating an organic etiology, and the remaining patients had functional TR. All 8 patients with a pulmonary artery systolic pressure of 55 mm Hg or more before transplantation had significant functional TR after transplantation (p less than or equal to 0.05). Pulmonary vascular resistance before transplantation was not predictive; however, after transplantation pulmonary vascular resistance was significantly greater in patients with moderate to severe TR (101.6 +/- 41.3 vs 50.2 +/- 16.6 dynes s cm-5, p less than or equal to 0.01).