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).