Pulmonary and tricuspid regurgitation after Tetralogy of Fallot repair: A case report

BACKGROUND Tetralogy of Fallot(TOF)is one of the most common congenital heart defects,and surgery is the primary treatment.There are no precise guidelines on the treatment protocol for tricuspid regurgitation(TR)as a common complication of TOF repair.The timing for treatment in patients presenting with valve regurgitation after TOF repair is often difficult to determine.Here,we report the first case of sequential treatment of pulmonary and TR using interventional therapy.CASE SUMMARY We present the case of a 52-year-old female patient,who had a history of TOF repair at a young age.A few years later,the patient presented with pulmonary and tricuspid regurgitation.The symptoms persisted and TR worsened following percutaneous pulmonary valve implantation.Preoperative testing revealed that the patient’s disease had advanced to an intermediate to advanced stage and that her general health was precarious.Because open-heart surgery was not an option for the patient,transcatheter tricuspid valve replacement was suggested.This procedure was successful,and the patient recovered fully without any adverse effects.This case report may serve as a useful resource for planning future treatments.CONCLUSION Treatment of both valves should be considered in patients with tricuspid and pulmonary regurgitations following TOF repair.The interventional strategy could be an alternative for patients with poor general health.

Impact of prosthesis-patient mismatch on early and late outcomes after mitral valve replacement:a meta-analysis

Background Prognostic significance of prosthesis-patient mismatch(PPM)after mitral valve replacement(MVR)remains uncertain because of the limited studies reporting inconsistent or even contrary results.This meta-analysis pooled results of all available studies comparing early and late prognoses between patients with significant mitral PPM and those without.Methods Studies were identified by searching Pubmed,Excerpta Medica Database,Cochrane Central Register of Controlled Trials,and Clinical Trials.gov.Impact of PPM on postoperative hemodynamic results,thirty-day mortality,overall mortality,mortality of thirty-day survivors,and primary morbidity after MVR was evaluated via meta-analysis.Robustness of pooled estimates,source of heterogeneity,and publication bias were assessed via sensitivity analyses,meta-regression as well as subgroup analysis stratified according to methodological or clinical heterogeneity,or sequential omission method,and funnel plot or Begg's and Egger's tests,respectively.Results Nineteen cohort studies involving 9302 individuals(PPM group:n=5109,Control group:n=4193)were included for meta-analysis.Total PPM and severe PPM prevalence were 3.8%–85.9%and 1%–27%,with a mean value of 54.9%and 14.1%,respectively.As compared with control group,mitral PPM group demonstrated a poorer postoperative hemodynamic status of higher mean and peak residual transprosthetic pressure gradients(TPG),higher postoperative systolic pulmonary artery pressure(SPAP)and less reduction,higher postoperative pulmonary hypertension(PH)prevalence and less PH regression,smaller net atrioventricular compliance,less NYHA class decrease,higher postoperative functional tricuspid regurgitation prevalence and less regression.The PPM group also revealed a higher thirty-day mortality,long-term overall mortality,mortality of thirty-day survivors,and postoperative congestive heart failure prevalence,which were positively correlated with the severity of PPM if it was classified into tri-level subgroups.Left ventricular end-diastolic diameter,postoperative atrial fibrillation(AF)prevalence,and the AF regression were analogous between groups.Most pooled estimates were robust according to sensitivity analyses.Male patients and bioprosthesis implantation proportion were prominent source of between-study heterogeneity on thirty-day mortality.Publication bias was not significant in tests for all the outcomes,except for SPAP and TPG.Conclusions Mitral PPM would result in poorer postoperative hemodynamics and worse early and late prognosis.Severe PPM must be avoided since deleterious impact of mitral PPM was severity dependent.

Surgical Treatment of Coronary Malperfusion with Acute Type A Aortic Dissection

Coronary malperfusion associated with aortic dissection is relatively rare,which has been reported at 5.7%-11.3%,[1]but when it occurs,it is fatal to the patient.Despite improved therapeutic techniques for aortic dissection over the years,surgical treatment for the uncommon condition of aortic dissection with coronary malperfusion is still premature.Prompt coronary revascularization and concomitant surgical repair of the aorta are essential for dealing with this problem.To date,the surgical management for this condition relies on various techniques,which include coronary artery bypass grafting （CABG） and repair coronary vessels.[1,2] However,the optimal surgical strategy for coronary revascularization is still debated.In this study,we reviewed our experience with aortic dissection involving the coronary artery in 36 patients,which evolved over a 14-year period,aiming to provide alternative options in the face of this scenario.

Total arch replacement with stented elephant trunk technique for syphilitic thoracic aortic aneurysm

After the advent of antibiotic treatment,tertiary syphilis is rarely observed over the last several decades,and its cardiovascular manifestations are particularly rare.Syphilitic aortitis typically involves the tubular portion of the ascending aorta,aortic arch and descending thoracic aorta,sparing the sinuses of Valsalva.[1]Although exceptional cases of treatment of syphilitic thoracic aortic aneurysm have been reported,[2-4]the optimal technique for treatment is not established.Total arch replacement combined with stented elephant trunk technique was proven to be feasible in patients with type A aortic dissection.Herein,we described our experience of total arch replacement with stented elephant trunk technique in three patients presenting with syphilitic thoracic aortic aneurysm involving the aortic arch and proximal descending aorta.