Prognostic Role of Preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) in Mitral Valve Replacement (MVR) for Rheumatic Mitral Stenosis Patients

Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.

Safety of an improved patent ductus arteriosus occluder for transcatheter closure of perimembranous ventricular septal defects with abnormally attached tricuspid chordae tendineae

BACKGROUND The off-label use of various devices has been reported for the transcatheter closure of perimembranous ventricular septal defects(PmVSD) because of serious complications, such as heart block and tricuspid regurgitation(TR),associated with conventional ventricular septal defect devices. However, whether certain defects such as PmVSD with abnormally attached tricuspid are fit for interventional treatment is still disputable.AIM To explore the feasibility and safety of transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae using an improved patent ductus arteriosus(PDA) occluder.METHODS We retrospectively analyzed 20 patients diagnosed with PmVSD with abnormally attached tricuspid chordae tendineae who underwent interventional treatment using an improved PDA occluder at our center from January 2012 to January 2016. Baseline characteristics and procedural and follow-up data were analyzed.RESULTS All 20 patients achieved procedure success. No heart block occurred during the operation. One patient had a transient complete right bundle branch block within48 h post-procedure and reverted to normal rhythm after intravenous injections of dexamethasone for 3 d. For all 20 patients, no residual shunt was observed by transthoracic echocardiography post-procedure. During the average follow-up period of 2.4 years, no severe TR was observed.CONCLUSION Using of the improved PDA occluder for the transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae is a safe and promising treatment option. However, long-term follow-up in a large group of patients is still warranted.

Clinical results of tricuspid valve replacement—a 21-case report

Objective： To summarize the clinical experiences of 21 patients treated with tricuspid valve replacement （TVR） and investigate the surgical indications and methods. Methods： Data from 21 patients who underwent TVR from December 2002 to March 2009 were retrospectively collected and analyzed. The mean age was 48.86± 15.37 years （range： 20-72 years）. The underlying disease of the patients was classified as rheumatic （n = 10）, congenital （n = 8）, endocarditis （n = 2） or chest trauma （n = 1）. Previous cardiac surgery had been performed in 12 patients （57.14%）. Results： In-hospital death occurred in two patients （9.52%）. Postoperative morbidities included cardiac failure （n = 2）, bleeding related re-operation （n = 1）, and plural effusion （n = 2）. Conclusion： The early outcomes of TVR were acceptable. At the present time TVR can be performed through optimal perioperative management.

Clinical outcomes of tricuspid valve repair accompanying left-sided heart disease

AIM To determine whether the need for additional tricuspid valve repair is an independent risk factor when surgery is required for a left-sided heart disease.METHODS One hundred and eighty patients(68 ± 12 years,79 males) underwent tricuspid annuoplasty.Cox proportionalhazards regression model for multivariate analysis was performed for variables found significant in univariate analyses.RESULTS Tricuspid regurgitation etiology was functional in 154 cases(86%),organic in 16 cases(9%),and mixed in10 cases(6%),respectively.Postoperative mortality at 30 days was 11.7%.Mean follow-up was 51.7 mo with survival at 5 years of 73.5%.Risk factors for mortality were acute endocarditis [hazard ratio(HR) = 9.22(95%CI:2.87-29.62),P < 0.001],ischemic heart disease requiring myocardial revascularization [HR = 2.79(1.26-6.20),P = 0.012],and aortic valve stenosis [HR = 2.6(1.15-5.85),P = 0.021].Significant predictive factors from univariate analyses were double-valve replacement combined with tricuspid annuloplasty [HR = 2.21(1.11-4.39),P = 0.003] and preoperatively impaired ejection fraction [HR = 1.98(1.04-3.92),P = 0.044].However,successful mitral valve repair showed a protective effect [HR = 0.32(0.10-0.98),P = 0.046].Additionally,in instances where tricuspid regurgitation required the need for concomitant tricuspid valve repair,mortality predictor scores such as Euroscore 2 could be shortened to a simple Euroscore-tricuspid comprised of only 7 inputs.The explanation may lie in the fact that significant tricuspid regurgitation following leftsided heart disease represents an independent risk factor encompassing several other factors such as pulmonary arterial hypertension and dyspnea.CONCLUSION Tricuspid annuloplasty should be used more often as a concomitant procedure in the presence of relevant tricuspid regurgitation,although it usually reveals an overly delayed correction of a left-sided heart disease.

Transcatheter interventions for severe tricuspid regurgitation:a literature review

The prevalence of tricuspid regurgitation(TR)increases with age,affecting 65%-85%of adults.Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus(leaflets,chordae,papillary muscles,or annulus).Secondary TR is due to insufficient coaptation from dilation of tricuspid valve annulus due to the right ventricle(RV)or right at-rium(RA)remodeling and increased RV pressures.Isolated TR is without increased RV pressures and is associated with atrial fibrillation.Mild TR is a benign disease.Moderate to severe tricuspid regurgitation has independently been associated with in-creased mortality.Most of these patients are treated medically due to poor outcomes with surgical repair of isolated TR.The in-hospital mortality rate is 8.8%,and the median length of stay in hospital is 11 days resulting in higher healthcare costs.Even if the patients undergo surgical repair or replacement,available data do not show improvement in survival.With a more detailed un-derstanding of the complex anatomy and physiology of the tricuspid valve and significant complications from untreated tricusp-id valve disease,the approach to the management of TR has shifted from a conservative approach to a process of prevention and intervention.In the past decade,transcatheter tricuspid valve interventions and tricuspid annuloplasty rings have been de-veloped,contributing to decreased mortality from surgical repair.Transcatheter tricuspid valve intervention techniques have im-proved survival,quality of life,and reduced heart failure rehospitalization.This review summarizes normal anatomy,types of TR,etiology and different mechanisms of TR,echocardiographic assessment of the severe TR,and highlights various percu-taneous transcatheter techniques for tricuspid valve repair.

A valve-in-valve approach to manage severe bioprosthetic tricuspid valve stenosis

severe symptomatic tricuspid stenosis often requires intervention.When the etiology is bioprosthetic valve failure,a challenging situation is met.Surgical valve replacement is the gold standard of treatment for severe tricuspid valve(TV)disease.[1]However,a redo sternotomy is rarely performed for isolated TV disease due to very high perioperative mortality.[2]Evolving percutaneous technology presents new frontiers in treatment,with the valveinvalve procedure emerging as an alternative.We present a case of a 65year woman with progressive symptoms due to failure of a bioprosthetic valve in the tricuspid position who was not a surgical candidate but underwent percutaneous intervention with significant clinical improvement.

Infiltrative cardiac lymphoma with tricuspid valve involvement in a young man

Cardiac metastases are among the topics with limited systematic reviews.Theoretically,the heart can be infiltrated by any malignancy with the ability to spread to distant structures.Thus far,no specific tumors are known to have a predilection for the heart,but some do metastasize more often than others,for example,melanoma and primary mediastinal tumors.We report a case of cardiac metastasis from a diffuse large B cell lymphoma in a young man.The peculiarity of this case is that besides the involvement of right ventricle and atrium,the tricuspid valve was also infiltrated.Valvular metastasis is rarely reported in the medical literature.

Tricuspid valve endocarditis:Cardiovascular imaging evaluation and management

Right-sided infective endocarditis is an increasingly recognized disease entity,with tricuspid valve being most frequently involved.Risk factors for tricuspid valve endocarditis(TVIE)include intravenous drug use,cardiac implantable electronic devices and indwelling catheters.Staphylococcus aureus is the predominant causative organism in TVIE.The diagnosis of infective endocarditis(IE)is based on clinical manifestations,blood cultures,and the presence of valvular vegetations detected by echocardiography.Complementary imaging is helpful when there is ongoing clinical suspicion for IE following initially negative echocardiography.Multislice computed tomography allows for assessment of extra-cardiac complications in TVIE,including pulmonary septic emboli.18F-fluorodeoxyglucose positron emission tomography/computed tomography and radiolabelled white blood cell,single-photon emission computed tomography provide important clinical information concerning the presence of IE in right-sided prosthetic valves or cardiac implantable electronic devices.The aim of this review is to provide an update on TVIE,discussing the role of multimodality imaging in TVIE and the management of these patients.

Clinical efficacy of two different tricuspid annuloplasty techniques in left cardiac valve surgery

Objective: To investigate the mid-and long-term clinical effects of tricuspid valvuloplasty with the implantation of an artificial plastic ring.Methods: Data of 677 patients who had functional tricuspid regurgitation and left cardiac valve disease and underwent tricuspid valvuloplasty and left cardiac valve surgery were retrospectively.Among these patients, 353 underwent simple suture annuloplasty(group A) while the rest 324 patients underwent artificial plastic ring annuloplasty(group B).The two-year and more-than-two-year clinical and ultrasonocardiograph(UCG) follow-up data of the two groups were obtained and compared.Results: A total of 600 patients(88.6%) completed the long-term follow-up(more than two years).The two-year follow-up showed no significant difference in the incidence of mild tricuspid regurgitation between the two groups(82.2% vs.92.7%, P=0.37).However, there were significantly more cases that developed into moderate to severe tricuspid regurgitation in group A than in group B(17.8% vs.7.3%, P=0.031).The long-term follow-up revealed that the recurrence rate of tricuspid regurgitation in group B was significantly lower than that in group A(11.0% vs.25.0%, P=0.029), and the ratio of cases developing into moderate to severe tricuspid regurgitation in group A was significantly higher than that in group B(28.9% vs.9.9%, P=0.007).The comparison between the two intra-group time segments showed that the development of tricuspid regurgitation in group A was significantly increased(28.9% vs.17.8%, P=0.022), but in group B it was relatively stable(9.9% vs.7.3%, P=0.52).Conclusions: Artificial ring annuloplasty is associated with significantly less tricuspid regurgitation than simple suture annuloplasty.

Aorto-right atrial fistula: Late complication of tricuspid valve infective endocarditis

Abnormal connections between the ascending aortaand the cardiac chambers are rare, especially in thecontext of right-sided infective endocarditis(IE). Trans-thoracic echocardiography(TTE) with color-flow Dop-pler, transesophageal echocardiography(TEE), or bothmay be required for diagnosis. We present the case ofa woman admitted with right-sided heart failure(HF)symptoms. She had a previous history of tricuspid valveIE 30 years ago. TTE and TEE revealed an aorto-rightatrium fistula located just under the non-coronary cuspinto the right atrium at the level of the previously af-fected tricuspid valve. The Patient refused surgery andwas discharged home on HF medications. She has beenstable for the last 3 years. The peculiarity of this caseis the late symptomatic presentation of the aorto-atrialfistula and the unusual association to tricuspid valve IE.

Intravenous drug abuse and tricuspid valve endocarditis: Growing trends in the Middle East Gulf region

Traditionally, tricuspid valve endocarditis is uncommon in the Middle East region. However, recent global data indicate growing trends in the use of illicit drug abuse, specifically injectable heroin, in the Middle East Gulf region. The presence of many transit port services in the Middle East Gulf States has led to smuggling of substance abuse drugs in the region. The Middle East Gulf States, currently a transit market, are also becoming a growing consumer market in view of the increased substance abuse in the youth. However, there is a paucity of data with respect to the prevalence or incidence of tricuspid valve endocarditis in the region, probably due to underdiagnosis or underreporting. A high index of suspicion of tricuspid valve endocarditis is essential in patients with a history of intravenous drug abuse. This article reviews the epidemiology of illicit drug abuse in the Middle East Gulf region, as well as the diagnosis and treatment of tricuspid valve endocarditis, and calls for all physicians in the region to be vigilant while dealing with intravenous drug abuse.

Pericardial Strip versus Ring Annuloplasty for Repair of Functional Tricuspid Regurgitation

Background: Functional tricuspid regurgitation is a challenge regarding indications for repair and proper surgical technique. Aim of the study: We reviewed our midterm results of tricuspid valve repair for functional regurgitation comparing pericardial strip versus ring annuloplasties. Patients and methods: From January 2008 to December 2013, we operated 59 patients (male:female, 41:18, with a mean age of 34 ± 14 years) for functional tricuspid regurgitation. Tricuspid annuloplasty was done using pericardial strip in 39 patients and ring in 20 patients. Concomitant procedures were mitral valve replacement in 66% of patients, aortic valve replacement in 5% and double valve replacement in 29%. Clinical and echocardiographic data were collected. Results: Preoperative characteristics of the two groups were similar regarding age, percentage of female patients, New York Heart Association functional class and pulmonary artery pressure. More patients with preoperative right ventricular dysfunction were found in pericardial annuloplasty group although this was not statistically significant (13 versus 5;P = 0.52). Operative times were similar in both groups. We had one mortality case (1.69%) due to low cardiac output in the pericardial group. Postoperative complications included reexploration for bleeding in one patient and chronic heart failure in another patient. The average follow up period was 3 years and it was complete in 100% of patients. Postoperative freedom from recurrent moderate tricuspid regurgitation was 90% in both groups. Conclusion: Pericardial strip annuloplasty is a simple, inexpensive, reproducible and efficient technique that has comparable results to ring annuloplasty.

Percutaneous pulmonary and tricuspid valve implantations: An update

The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology.Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status.Although techniquesof percutaneous pulmonary valve implantation have been described just a decade ago,two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide.In contrast,percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status.Taking into account that an "interdisciplinary challenging",heterogeneous population of patients previously treated by corrective,semi-corrective or palliative surgical procedures is growing inexorably,there is a rapidly increasing need of treatment options besides redo-surgery.Therefore,the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures,to update on current devices,to discuss indications and patient selection criteria,to report on clinical results and finally to consider future directions.

Accessory Leaflet of Tricuspid Valve Masquerading as Infective Endocarditis Preoperatively and Causing RVOT Obstruction Postoperatively

Accessory tricuspid valve tissue is a rare congenital anomaly. We report a case where preoperative echocardiogram was suggestive of infective vegetations over the tricuspid valve but intra-operatively it was found to be accessory tricuspid valve leaflets which were causing right ventricular outflow tract obstruction.

Left Ventricular Pacing in a Patient with a Mechanical Tricuspid Prosthesis and High Surgical Risk

Transvenous endocardial pacemaker (PM) implantation is contraindicated in patients with a mechanical tricuspid prosthesis. These patients usually undergo epicardial lead implantation. This case shows the implant of left ventricular (LV) pacing lead through the coronary sinus (CS) in a patient with high surgical risk. A 77-year-old woman with slow atrial fibrillation, left anterior hemi-block and right bundle brunch block, who previously underwent surgical replacement of the mitral and tricuspid valves, was admitted for PM implantation. After 1 month, all the electric parameters were stable. To the best of our knowledge, this is the first Italian case reported of LV pacing in a patient with a mechanical tricuspid prosthesis. The use of LV pacing leads implanted through the CS provides a minimal invasive, safe and effective strategy of pacing in patients with a mechanical tricuspid prosthesis.

Tricuspid Valve Reconstruction in a Patient with Ventricular Septal Defect and Subacute Endocarditis

Objective Tricuspid valve reconstruction was advocated as the operative method for the treatment of tricus-pid valve endocarditis recently. Many people accept that valve replacement therapy should be performed if more than two valve leaflets are involved. The aim of the study to discuss if reconstructive surgery could be done to treat two valve leaflets involved in tricuspid valve endocarditis. Methods A 17-year-old boy with ventricular septal defect (VSD) and tricuspid valve subacute endocarditis was surgical treated through extra-corporeal circulation. two-thirds of the defective septal cusp, and half of the defective anterior cusp were ex-cised during operation. The tricuspid valve was reconstructed with autologous pericardial strip, cusp com-missuroplasty and 4-0 prolene sutures made as chordae tendineaes. VSD was repaired using a pericardial patch. Results The patient was discharged post-operation with excellent restoration of the tricuspid valve ac-tivity. Cardiac ultrasound revealed normal tricuspid valve activity and low degree of regurgitation two years follow-up. Conclusions It seems that tricuspid valve reconstruction could be performed for two defective leaflets or half of the tricuspid valve.

Association between cardiovascular implantable electronic devices and tricuspid regurgitation: a case- control study

Cardiovascular implantable electronic devices(CIEDs)are widely used in the modern era.Every year,about 730,000 permanent pacemakers and 330,000 CIEDs are implanted worldwide.CIEDs have been known to increase the life expectancy of millions of people and improve their quality of life by controlling the heart rate and atrioventricular and interventricular synchronization and preventing sudden cardiac death.[1]The tricuspid valve consists of the annulus,leaflets,chordae tendineae,and papillary muscles.Interaction between the endocardial lead and any component of this structure can lead to tricuspid valve dysfunction,thereby resulting in tricuspid regurgitation(TR).[2]CIED-related TR has been shown to be an independent predictor of hospitalization for heart failure.[3,4]

Valve Repair Using Autologous Pericardium in Tricuspid Valve Endocarditis

Tricuspid valve endocarditis is a significant cause of valve-related morbidity and mortality. Prosthetic valve reconstruction can be costly and requires life-long anticoagulation. We present our experience with surgical management of an endocarditis damaged tricuspid valve leaflet in an intravenous drug user. We were able to excise the infected tissue and successfully repair the native valve using autologous pericardium, effectively eliminating the need for prostheses and associated complications. Our case report demonstrates that tricuspid valve reconstruction, using autologous pericar-dium, is a suitable option in patients with tricuspid endocarditis.

Functional Tricuspid Regurgitation and Ring Annuloplasty Repair

Functional tricuspid regurgitation(TR)primarily arises from asymmetric dilation of the tricuspid annulus in the setting of right ventricular dysfunction and enlargement in response to left-sided myocardial and valvular abnormalities.Even if the TR is not severe at the time of mitral valve surgery,it can worsen and even appear late after successful mitral valve surgery,which portends a poor prognosis.Despite data demonstrating inferior outcomes in the presence of residual TR,surgical repair for functional TR remains underused.Acceptance of TR,in the presence of tricuspid annular dilation,may be unacceptable.Surgical repair should consist of placement of a rigid or semirigid annular ring,which has been shown to provide superior durability as compared with suture and flexible band techniques.Finally,percutaneous annuloplasty for correction of functional TR may allow treatment of patients with recurrent TR at high risk of reoperation.

Application effect of thoracoscopic tricuspid valvuloplasty in geriatric patients with tricuspid valve disease

BACKGROUND Thoracoscopic-assisted technology can ensure that doctors can implement minimally invasive treatment through the right intercostal incision or small incision of the lower sternum.This approach not only can achieve a cardiac correction effect equivalent to that of a thoracotomy but also has the benefit of a clear surgical field ensuring the safety of surgical treatment.AIM To investigate the effect of thoracoscopic tricuspid valvuloplasty in patients with tricuspid valve disease.METHODS A total of 41 patients with tricuspid valve disease underwent traditional thoracotomy treatment between January 2018 and June 2020.Forty-one patients with tricuspid valve disease who underwent thoracoscopic tricuspid valvuloplasty treatment between July 2020 and June 2021 in our hospital were selected as controls for our retrospective analysis.The study group underwent thoracoscopic tricuspid valvuloplasty,while traditional thoracotomy was performed in the control group.The operation conditions(the duration of extracorporeal circulation,aorta blocking,endotracheal intubation,and surgery),inflammatory response-related indices(C-reactive protein and white blood cell count)before and after surgery,parameters related to myocardial injury(myocardial troponin T,creatine kinase isoenzyme,creatine kinase,and lactate dehydrogenase),and the incidence of adverse events in the two groups was counted.RESULTS The duration of extracorporeal circulation(109.35±50.31 min),aortic occlusion(94.26±59.61 min),endotracheal intubation(12.59±3.54 h),and hospital stay(5.29±2.34 d)in the study group were shorter than those in the control group(114.91±46.98 min,101.37±61.44 min,13.11±4.01 h,7.09±3.11 d,respectively).The difference in hospital stay between the two groups was statistically significant(P<0.05).Serum C-reactive protein level(4.69±1.35 mg/L)and white blood cell count(6.21±1.97×10^(9)/L)in the study group were found to be not significantly different than those in the control group(5.01±1.18 mg/L,5.98±2.01×10^(9)/L,respectively;P>0.05).Myocardial troponin T(0.04±0.02 ng/mL),creatine kinase isoenzyme(4.02±1.11 mg/mL),creatine kinase(91.35±10.44 U/L),and lactate dehydrogenase(179.81±60.04 U/L)in the study group were also not statistically significant different than those in the control group(0.05±0.03 ng/mL,3.97±1.05 mg/mL,89.69±13.05 U/L,186.35±56.96 U/L;P>0.05).After the operation,serum C-reactive protein level(7.89±1.73 mg/L)and white blood cell count(10.76±2.35×10^(9)/L)in the study group were significantly lower than those in the control group(9.96±2.04 mg/L,14.84±3.07×10^(9)/L,respectively)(P<0.05).In addition,myocardial troponin T(0.89±0.32 ng/mL),creatine kinase isoenzyme(26.96±4.95 mg/mL),creatine kinase(608.32±202.33 U/L),and lactate dehydrogenase(282.56±101.34 U/L)in the study group were lower than those in the control group(2.61±0.69 ng/mL,34.37±6.87 mg/mL,689.94±214.64 U/L,369.15±114.46 U/L)(P<0.05).The incidence of adverse events in the study group(4.88%)was lower than that in the control group(19.51%)(P<0.05).CONCLUSION Thoracoscopic tricuspid valvuloplasty can achieve good results in treating patients with tricuspid valve disease,reduce the risk of adverse events,and promote the rapid recovery of patients.