Prevalence and Importance of Tricuspid Valve Prolapse in Patients with Primary Mitral Regurgitation

The presence and impact of tricuspid valve (TV) prolapse in patients with mitral valve (MV) prolapse and severe mitral regurgitation (MR) have not been widely reported. The aim of our study was to describe the prevalence of TV prolapse, and the associated echocardiography features, in a large cohort of patients with MV prolapse undergoing surgery, and to explore its potential clinical impact. A total of 803 patients were included, of which 87 (11%) were diagnosed with TV prolapse, while 716 (89%) patients showed no TV prolapse. Patients with TV prolapse were more often diagnosed with Barlow's disease compared to patients without TV prolapse, and also had more frequently significant TR, a larger right chamber size and TV annulus; they also underwent concomitant TV annuloplasty more often. During follow-up, there was no difference in terms of TR progression or all-cause mortality after surgery between the patients with or without TV prolapse. In conclusion, TV prolapse was associated with a more severe phenotype in terms of baseline cardiac remodeling and TR severity in our large study cohort of MV prolapse patients undergoing MV repair. However, when successfully treated, TV prolapse was not associated with worse outcomes after surgery, also in terms of TR progression.