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 ...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.展开更多
Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Assoc...Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class. There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement. Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms. TR was markedly reduced;however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the late phase. Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool. The underlying mechanism by which TR exacerbates MR requires further investigation.展开更多
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 muscl...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.展开更多
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 ...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]展开更多
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 valvula...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.展开更多
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 ...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.展开更多
We present a case of a one-day-old newborn,without prenatal diagnosis,referred to our cardiologic intensive care unit in critical condition presenting sub-cyanosis and peripheral oxygen saturation of 80%.Echocardiogra...We present a case of a one-day-old newborn,without prenatal diagnosis,referred to our cardiologic intensive care unit in critical condition presenting sub-cyanosis and peripheral oxygen saturation of 80%.Echocardiography diagnosis was tricuspid valve dysplasia with severe regurgitation,functional pulmonary valve atresia with intact ventricular septum and reversal flow in the large patent ductus arteriosus(PDA).Chest X-ray showed severe cardiomegaly and wall to wall heart.Prostaglandin E1 infusion was started once after birth.After few days,clinical conditions progressively worsened because of right heart failure;a first pharmacological approach to close PDA failed and surgery ligation of PDA was necessary to restore anterograde pulmonary flow and heart size.展开更多
<b><span style="font-family:"">Background</span></b></span><span><span><b><span style="font-family:"">: </span></b></s...<b><span style="font-family:"">Background</span></b></span><span><span><b><span style="font-family:"">: </span></b></span></span><span><span><span style="font-family:"">Concomitant repair of moderate secondary tricuspid regurgitation (STR) during mitral valve surgery is still subject of <span>controverse</span>. </span></span></span><span><span><span style="font-family:"">This </span></span></span><span><span><span style="font-family:"">research </span></span></span><span><span><span style="font-family:"">aims to </span></span></span><span><span><span style="font-family:"">study</span></span></span><span><span><span style="font-family:""> the early </span></span></span><span><span><span style="font-family:"">and mid-term </span></span></span><span><span><span style="font-family:"">postoperative</span></span></span><span><span><span style="font-family:""> influence of tricuspid repair</span></span></span><span><span><span style="font-family:""> on </span></span></span><span><span><span style="font-family:"">the clinical outcomes and</span></span></span><span><span><span style="font-family:""> right ventric</span></span></span><span><span><span style="font-family:"">ular functions. </span></span></span><span><span><b><span style="font-family:"">Methods: </span></b></span></span><span><span><span style="font-family:"">This is a </span></span></span><span><span><span style="font-family:"">retrospective</span></span></span><span><span><span style="font-family:""> cohort study of </span></span></span><span><span><span style="font-family:"">92</span></span></span><span><span><span style="font-family:""> patients with </span></span></span><span><span><span style="font-family:"">moderate STR </span></span></span><span><span><span style="font-family:"">who</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">und<span>erwent tricuspid valve repair</span></span></span></span><span><span><span style="font-family:""> b</span></span></span><span><span><span style="font-family:"">etween </span></span></span><span><span><span style="font-family:"">October</span></span></span><span><span><span style="font-family:""> 20</span></span></span><span><span><span style="font-family:"">14</span></span></span><span><span><span style="font-family:""> and</span></span></span><span><span><span style="font-family:""> December</span></span></span><span><span><span style="font-family:""> 2</span></span></span><span><span><span style="font-family:"">017</span></span></span><span><span><span style="font-family:"">, in the cardiothoracic surgery department</span></span></span><span><span><span style="font-family:"">, Menoufia University Hospital</span></span></span><span><span><span style="font-family:"">. Patients were assessed clinically and by echocardiography </span></span></span><span><span><span style="font-family:"">at one month</span></span></span><span><span><span style="font-family:""> and after </span></span></span><span><span><span style="font-family:"">24 months postoperatively</span></span></span><span><span><span style="font-family:""> for the degree of tricuspid regurgitation</span></span></span><span><span><span style="font-family:""> (TR)</span></span></span><span><span><span style="font-family:"">,</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">right ventricular diameter <span>and</span> tricuspid annular plane systolic excursion (TAPSE)</span></span></span><span><span><span style="font-family:"">. </span></span></span><span><span><b><span style="font-family:"">Results:</span></b></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">In this study, <span>mean</span> a</span></span></span><span><span><span style="font-family:"">ge </span></span></span><span><span><span style="font-family:"">of patients was </span></span></span><span><span><span style="font-family:"">58.33 ± 4.06 years</span></span></span><span><span><span style="font-family:"">. We had a significant improvement in the grade of TR from <span>preoperative</span> period to <span>follow up</span> data observed at 1-month postoperative and 2-years <span>follow</span></span></span></span><span><span><span style="font-family:"">-</span></span></span><span><span><span style="font-family:"">up</span></span></span><span><span><span style="font-family:""> (P = 0.0001). After one month postoperatively, no TR was detected in 74 cases (80.4%), and in 71 (84.5%) after two years. Mean right ventricular diameter decr</span></span></span><span><span><span style="font-family:"">eased significantly from 23 ± 3.32 mm preoperatively to 21.9 ± 3 mm at 2-years postoperatively. An increase of TAPSE</span></span></span><span><span><span style="font-family:""> was</span></span></span><span><span><span style="font-family:""> from 19.96 ± 3.7 mm preoperatively to 20.3 ± 3.9 mm at 1-month postoperative (p = 0.55) and there was <span>significant</span> increase in late postoperative value. </span></span></span><span><span><b><span style="font-family:"">Conclusion:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span><span><span style="font-family:"">W</span></span></span><span><span><span style="font-family:"">e highly recommend repair for</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">moderate </span></span></span><span><span><span style="font-family:"">TR</span></span></span><span><span><span style="font-family:""> during mitral valve surgery</span></span></span><span><span><span style="font-family:""> t</span></span></span><span><span><span style="font-family:"">o avoid progression of </span></span></span><span><span><span style="font-family:"">TR</span></span></span><span><span><span style="font-family:"">. </span></span></span><span><span><span style="font-family:"">Tricuspid</span></span></span><span><span><span style="font-family:""> repair</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">was</span></span></span><span><span><span style="font-family:""> able to reduce the grade of </span></span></span><span><span><span style="font-family:"">regurgitation</span></span></span><span><span><span style="font-family:""> after </span></span></span><span><span><span style="font-family:"">two years of </span></span></span><span><span><span style="font-family:"">surgery and </span></span></span><span><span><span style="font-family:"">improved</span></span></span><span><span><span style="font-family:""> right ventricular functions.展开更多
Objective Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a prefer...Objective Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using edge-to-edge valve plasty technique to correct severe展开更多
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 r...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.展开更多
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,...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.展开更多
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 ...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.展开更多
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 intervent...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.展开更多
Aim: To report a case of right ventricular myxoma prolapsing through the tricuspid valve with an attachment of vegetation in a 3-year-old male child. Introduction: Right-sided endocarditis commonly involves the tricus...Aim: To report a case of right ventricular myxoma prolapsing through the tricuspid valve with an attachment of vegetation in a 3-year-old male child. Introduction: Right-sided endocarditis commonly involves the tricuspid valve. Low pressure and low oxygen saturation in the right sided cardiac chambers protect the tricuspid and pulmonary valves from being subjected to excessive strained and damage occurs from injected particulate matter, contaminated venous lines and drug solutions causing endocarditis. RV (right ventricular) myxoma harboured the infection due to trauma as a result of friction movement across the tricuspid valve. Case Report: A 3-year-old male child having the spikes of fever for 2 weeks, presented with tumor “plop” and 3/6 systolic murmur in lower left sternal border and echocardiography revealed a tumor-mimicking vegetation visible as a mass lesion across the tricuspid valve, which is attached to the interventricular septum by a pedicle suggesting a RV myxoma. The vegetation was found to be attached with the tumor and it disappeared with antibiotics and aspirin therapy and the child was advised surgical removal of the tumor. Conclusion: A diagnosis of infective endocarditis can be made in tricuspid valve dysfunction with a floating mass and fever. The cardiac myxoma with an attached vegetation is masquerading as vegetation mass on transthoracic echocardiography in this child.展开更多
<strong>Background:</strong> Beh<span style="white-space:nowrap;">ç</span>et’s disease (BD) is a multisystemic, chronic inflammatory disorder with a broad range of manifes...<strong>Background:</strong> Beh<span style="white-space:nowrap;">ç</span>et’s disease (BD) is a multisystemic, chronic inflammatory disorder with a broad range of manifestations including within the cardiovascular system. Cardiac involvement like intracardiac thrombus (ICT) and valvular involvement in BD are rarely seen entities and often associated with poor prognosis. <strong>Case Presentation: </strong>We present the case of a young patient with vascular-Beh<span style="white-space:nowrap;">ç</span>et diagnosed by the presence of intracardiac thrombus in the right ventricle, unresponsive to medical treatment. Even though the intracardiac lesion was successfully treated by surgical excision, he presented a severe tricuspid dysfunction some years later due to the extension of fibrosis with no surgical therapeutic option. <strong>Conclusion:</strong> Intracardiac thrombosis is a rare but early manifestation of Beh<span style="white-space:nowrap;">ç</span>et’s disease, which is difficult to diagnose and has a poor prognosis.展开更多
Background:Closure of an atrial septal defect(ASD)reduces right-side heart volumes by abolishing shunting with simultaneous improvement of the left ventricle(LV)filling and functions due to ventricular interdependence,...Background:Closure of an atrial septal defect(ASD)reduces right-side heart volumes by abolishing shunting with simultaneous improvement of the left ventricle(LV)filling and functions due to ventricular interdependence,thereby improving symptoms.Furthermore,studies conducted on atrial volume changes after ASD closure are limited.Cardiac magnetic resonance(CMR)is considered as the gold standard method for measuring cardiac volume and mass.Objective:We aimed to study the effect of transcatheter and surgical closure of secundum ASD on cardiac volumes and systolic functions as well as the fate of tricuspid regurgitation(TR),using CMR analysis.Methods:We prospectively enrolled 30 adult patients with isolated secundum ASD who were referred to ASD closure.CMR evaluation of cardiac chambers indexed volumes,systolic function,myocardial mass index,and tricuspid regurgitant fraction were done at before and 6 months after closure.Results:RV volumes decreased in both groups when compared to baseline(p-value 0.001),the device group had more reduction in volumes and more improvement in RV function after closure(p-value 0.001)when compared to the surgical arm.The changes in the RV mass index were insignificant between both groups(p-value 0.31).Functional TR improved to the same extent in both groups.Left ventricular end diastolic volume index(LVEDVI)and LV mass index increased sig-nificantly in both groups when compared to baseline in both groups but with no difference between groups p-value 0.01),left ventricular end systolic volume index(LVESVI)changes were insignificant.LV systolic function improved in patients who underwent device closure only(63.53±3.85 vs.67.13±4.34,p-value 0.01).There was a significant reduction in right atrial(RA)volumes and an insignificant decrease in left atrial(LA)volumes,with no difference between groups.Conclusion:Transcatheter and surgical secundum ASD closure resulted in volumetric changes in some cardiac chambers with better improvement in bi-ventricular systolic function in the transcatheter arm and no difference in the TR reduction between the two groups at 6 months follow-up by CMR.展开更多
文摘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.
文摘Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class. There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement. Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms. TR was markedly reduced;however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the late phase. Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool. The underlying mechanism by which TR exacerbates MR requires further investigation.
文摘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.
基金This work was supported by grants from the Planned Science and Technology Project of Zhejiang Province,China(2020KY216)Hangzhou City Health Science and Technique Program(OO20190126).
文摘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]
文摘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.
文摘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.
文摘We present a case of a one-day-old newborn,without prenatal diagnosis,referred to our cardiologic intensive care unit in critical condition presenting sub-cyanosis and peripheral oxygen saturation of 80%.Echocardiography diagnosis was tricuspid valve dysplasia with severe regurgitation,functional pulmonary valve atresia with intact ventricular septum and reversal flow in the large patent ductus arteriosus(PDA).Chest X-ray showed severe cardiomegaly and wall to wall heart.Prostaglandin E1 infusion was started once after birth.After few days,clinical conditions progressively worsened because of right heart failure;a first pharmacological approach to close PDA failed and surgery ligation of PDA was necessary to restore anterograde pulmonary flow and heart size.
文摘<b><span style="font-family:"">Background</span></b></span><span><span><b><span style="font-family:"">: </span></b></span></span><span><span><span style="font-family:"">Concomitant repair of moderate secondary tricuspid regurgitation (STR) during mitral valve surgery is still subject of <span>controverse</span>. </span></span></span><span><span><span style="font-family:"">This </span></span></span><span><span><span style="font-family:"">research </span></span></span><span><span><span style="font-family:"">aims to </span></span></span><span><span><span style="font-family:"">study</span></span></span><span><span><span style="font-family:""> the early </span></span></span><span><span><span style="font-family:"">and mid-term </span></span></span><span><span><span style="font-family:"">postoperative</span></span></span><span><span><span style="font-family:""> influence of tricuspid repair</span></span></span><span><span><span style="font-family:""> on </span></span></span><span><span><span style="font-family:"">the clinical outcomes and</span></span></span><span><span><span style="font-family:""> right ventric</span></span></span><span><span><span style="font-family:"">ular functions. </span></span></span><span><span><b><span style="font-family:"">Methods: </span></b></span></span><span><span><span style="font-family:"">This is a </span></span></span><span><span><span style="font-family:"">retrospective</span></span></span><span><span><span style="font-family:""> cohort study of </span></span></span><span><span><span style="font-family:"">92</span></span></span><span><span><span style="font-family:""> patients with </span></span></span><span><span><span style="font-family:"">moderate STR </span></span></span><span><span><span style="font-family:"">who</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">und<span>erwent tricuspid valve repair</span></span></span></span><span><span><span style="font-family:""> b</span></span></span><span><span><span style="font-family:"">etween </span></span></span><span><span><span style="font-family:"">October</span></span></span><span><span><span style="font-family:""> 20</span></span></span><span><span><span style="font-family:"">14</span></span></span><span><span><span style="font-family:""> and</span></span></span><span><span><span style="font-family:""> December</span></span></span><span><span><span style="font-family:""> 2</span></span></span><span><span><span style="font-family:"">017</span></span></span><span><span><span style="font-family:"">, in the cardiothoracic surgery department</span></span></span><span><span><span style="font-family:"">, Menoufia University Hospital</span></span></span><span><span><span style="font-family:"">. Patients were assessed clinically and by echocardiography </span></span></span><span><span><span style="font-family:"">at one month</span></span></span><span><span><span style="font-family:""> and after </span></span></span><span><span><span style="font-family:"">24 months postoperatively</span></span></span><span><span><span style="font-family:""> for the degree of tricuspid regurgitation</span></span></span><span><span><span style="font-family:""> (TR)</span></span></span><span><span><span style="font-family:"">,</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">right ventricular diameter <span>and</span> tricuspid annular plane systolic excursion (TAPSE)</span></span></span><span><span><span style="font-family:"">. </span></span></span><span><span><b><span style="font-family:"">Results:</span></b></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">In this study, <span>mean</span> a</span></span></span><span><span><span style="font-family:"">ge </span></span></span><span><span><span style="font-family:"">of patients was </span></span></span><span><span><span style="font-family:"">58.33 ± 4.06 years</span></span></span><span><span><span style="font-family:"">. We had a significant improvement in the grade of TR from <span>preoperative</span> period to <span>follow up</span> data observed at 1-month postoperative and 2-years <span>follow</span></span></span></span><span><span><span style="font-family:"">-</span></span></span><span><span><span style="font-family:"">up</span></span></span><span><span><span style="font-family:""> (P = 0.0001). After one month postoperatively, no TR was detected in 74 cases (80.4%), and in 71 (84.5%) after two years. Mean right ventricular diameter decr</span></span></span><span><span><span style="font-family:"">eased significantly from 23 ± 3.32 mm preoperatively to 21.9 ± 3 mm at 2-years postoperatively. An increase of TAPSE</span></span></span><span><span><span style="font-family:""> was</span></span></span><span><span><span style="font-family:""> from 19.96 ± 3.7 mm preoperatively to 20.3 ± 3.9 mm at 1-month postoperative (p = 0.55) and there was <span>significant</span> increase in late postoperative value. </span></span></span><span><span><b><span style="font-family:"">Conclusion:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span><span><span style="font-family:"">W</span></span></span><span><span><span style="font-family:"">e highly recommend repair for</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">moderate </span></span></span><span><span><span style="font-family:"">TR</span></span></span><span><span><span style="font-family:""> during mitral valve surgery</span></span></span><span><span><span style="font-family:""> t</span></span></span><span><span><span style="font-family:"">o avoid progression of </span></span></span><span><span><span style="font-family:"">TR</span></span></span><span><span><span style="font-family:"">. </span></span></span><span><span><span style="font-family:"">Tricuspid</span></span></span><span><span><span style="font-family:""> repair</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">was</span></span></span><span><span><span style="font-family:""> able to reduce the grade of </span></span></span><span><span><span style="font-family:"">regurgitation</span></span></span><span><span><span style="font-family:""> after </span></span></span><span><span><span style="font-family:"">two years of </span></span></span><span><span><span style="font-family:"">surgery and </span></span></span><span><span><span style="font-family:"">improved</span></span></span><span><span><span style="font-family:""> right ventricular functions.
文摘Objective Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using edge-to-edge valve plasty technique to correct severe
文摘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.
文摘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.
文摘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.
文摘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.
文摘Aim: To report a case of right ventricular myxoma prolapsing through the tricuspid valve with an attachment of vegetation in a 3-year-old male child. Introduction: Right-sided endocarditis commonly involves the tricuspid valve. Low pressure and low oxygen saturation in the right sided cardiac chambers protect the tricuspid and pulmonary valves from being subjected to excessive strained and damage occurs from injected particulate matter, contaminated venous lines and drug solutions causing endocarditis. RV (right ventricular) myxoma harboured the infection due to trauma as a result of friction movement across the tricuspid valve. Case Report: A 3-year-old male child having the spikes of fever for 2 weeks, presented with tumor “plop” and 3/6 systolic murmur in lower left sternal border and echocardiography revealed a tumor-mimicking vegetation visible as a mass lesion across the tricuspid valve, which is attached to the interventricular septum by a pedicle suggesting a RV myxoma. The vegetation was found to be attached with the tumor and it disappeared with antibiotics and aspirin therapy and the child was advised surgical removal of the tumor. Conclusion: A diagnosis of infective endocarditis can be made in tricuspid valve dysfunction with a floating mass and fever. The cardiac myxoma with an attached vegetation is masquerading as vegetation mass on transthoracic echocardiography in this child.
文摘<strong>Background:</strong> Beh<span style="white-space:nowrap;">ç</span>et’s disease (BD) is a multisystemic, chronic inflammatory disorder with a broad range of manifestations including within the cardiovascular system. Cardiac involvement like intracardiac thrombus (ICT) and valvular involvement in BD are rarely seen entities and often associated with poor prognosis. <strong>Case Presentation: </strong>We present the case of a young patient with vascular-Beh<span style="white-space:nowrap;">ç</span>et diagnosed by the presence of intracardiac thrombus in the right ventricle, unresponsive to medical treatment. Even though the intracardiac lesion was successfully treated by surgical excision, he presented a severe tricuspid dysfunction some years later due to the extension of fibrosis with no surgical therapeutic option. <strong>Conclusion:</strong> Intracardiac thrombosis is a rare but early manifestation of Beh<span style="white-space:nowrap;">ç</span>et’s disease, which is difficult to diagnose and has a poor prognosis.
文摘Background:Closure of an atrial septal defect(ASD)reduces right-side heart volumes by abolishing shunting with simultaneous improvement of the left ventricle(LV)filling and functions due to ventricular interdependence,thereby improving symptoms.Furthermore,studies conducted on atrial volume changes after ASD closure are limited.Cardiac magnetic resonance(CMR)is considered as the gold standard method for measuring cardiac volume and mass.Objective:We aimed to study the effect of transcatheter and surgical closure of secundum ASD on cardiac volumes and systolic functions as well as the fate of tricuspid regurgitation(TR),using CMR analysis.Methods:We prospectively enrolled 30 adult patients with isolated secundum ASD who were referred to ASD closure.CMR evaluation of cardiac chambers indexed volumes,systolic function,myocardial mass index,and tricuspid regurgitant fraction were done at before and 6 months after closure.Results:RV volumes decreased in both groups when compared to baseline(p-value 0.001),the device group had more reduction in volumes and more improvement in RV function after closure(p-value 0.001)when compared to the surgical arm.The changes in the RV mass index were insignificant between both groups(p-value 0.31).Functional TR improved to the same extent in both groups.Left ventricular end diastolic volume index(LVEDVI)and LV mass index increased sig-nificantly in both groups when compared to baseline in both groups but with no difference between groups p-value 0.01),left ventricular end systolic volume index(LVESVI)changes were insignificant.LV systolic function improved in patients who underwent device closure only(63.53±3.85 vs.67.13±4.34,p-value 0.01).There was a significant reduction in right atrial(RA)volumes and an insignificant decrease in left atrial(LA)volumes,with no difference between groups.Conclusion:Transcatheter and surgical secundum ASD closure resulted in volumetric changes in some cardiac chambers with better improvement in bi-ventricular systolic function in the transcatheter arm and no difference in the TR reduction between the two groups at 6 months follow-up by CMR.