Atrial Functional Tricuspid Regurgitation as a Distinct Pathophysiological and Clinical Entity: No Idiopathic Tricuspid Regurgitation Anymore

Functional tricuspid regurgitation (FTR) is a strong and independent predictor of patient morbidity and mortality if left untreated. The development of transcatheter procedures to either repair or replace the tricuspid valve (TV) has fueled the interest in the pathophysiology, severity assessment, and clinical consequences of FTR. FTR has been considered to be secondary to tricuspid annulus (TA) dilation and leaflet tethering, associated to right ventricular (RV) dilation and/or dysfunction (the “classical”, ventricular form of FTR, V-FTR) for a long time. Atrial FTR (A-FTR) has recently emerged as a distinct pathophysiological entity. A-FTR typically occurs in patients with persistent/permanent atrial fibrillation, in whom an imbalance between the TA and leaflet areas results in leaflets malcoaptation, associated with the dilation and loss of the sphincter-like function of the TA, due to right atrium enlargement and dysfunction. According to its distinct pathophysiology, A-FTR poses different needs of clinical management, and the various interventional treatment options will likely have different outcomes than in V-FTR patients. This review aims to provide an insight into the anatomy of the TV, and the distinct pathophysiology of A-FTR, which are key concepts to understanding the objectives of therapy, the choice of transcatheter TV interventions, and to properly use pre-, intra-, and post-procedural imaging.

Risk Factors of Pregnancy Outcome in Patients with Pulmonary Hypertension

OBJECTIVE: The purpose of this study is to explore the factors affecting the pregnancy outcome of patients with pulmonary hypertension, and to design a digital model predicting the pregnancy outcome of patients and judge whether patients have the conditions to continue pregnancy. METHODS: The clinical data of patients with pregnancy complicated with pulmonary hypertension hospitalized in Guangdong Provincial People's Hospital from January 1, 2014 to December 31, 2020 were retrospectively analyzed. The severity of pulmonary hypertension, the structural and functional indexes measured by echocardiography were compared, and the effects on maternal and neonatal outcomes were analyzed. RESULTS: A total of 158 patients met the inclusion and exclusion criteria. The results showed that tricuspid regurgitation velocity (P<0.001), right ventricular diameter (P<0.05), right atrial diameter (P<0.05), pulmonary artery diameter (P<0.001) and cardiac function classification (P<0.001) were risk factors for maternal outcomes; Tricuspid regurgitation velocity (P<0.001) and structural changes of right heart were risk factors for neonatal outcomes. By multivariate logistic regression analysis, tricuspid regurgitation velocity (P<0.001), cardiac function (P<0.05) and superior inferior diameter of right atrium (P<0.05) were significant risk factors for maternal outcomes, while tricuspid regurgitation velocity (P<0.001) and superior inferior diameter of right atrium (P<0.05) were significant risk factors for neonatal outcomes. Using significant risk factors, a risk score system was established to predict the pregnancy outcome. CONCLUSION: in this study, we analyzed the clinical data of patients with pregnancy complicated with pulmonary hypertension in our hospital in recent years, and found that the changes of right heart structure (the acceleration of tricuspid regurgitation velocity, and the increase of right atrium, right ventricular diameter, right ventricular outflow tract anteroposterior diameter and main pulmonary artery diameter), are influencing factors of pregnancy outcomes in patients with pulmonary hypertension. In addition, we preliminarily designed a risk score through multi factor analysis, which is helpful to predict the possible outcome of puerperium and neonatal outcomes of patients, and to provide some reference for clinicians and patients to make decisions on whether to continue pregnancy in clinical practice.

Esquirol-Séguin-Down Syndrome Associated with Atrial Septal Defect plus Tricuspid Regurgitation

Background: Esquirol-Séguin-Down syndrome (Trisomy 21) was first described by Jean-Etienne Dominique Esquirol in 1838 and later by Edouard Séguin in 1846. Thereafter, in 1862, John Langdon Down, a British physician emphasized that the syndrome is a distinct form of mental retardation. Congenital cardiac defects are observed in more than one third of the patients with Esquirol-Séguin-Down syndrome, and in approximately 80% these cardiac defects are atrioventricular septal defect or ventricular septal defect with the former being more common. The association of Esquirol-Séguin-Down syndrome with atrial septal defect plus tricuspid regurgitation has been rarely reported. The aim of this paper is to report the rare association of Esquirol-Séguin-Down syndrome with atrial septal defect plus tricuspid regurgitation. Patients and methods: Two and half years old boy with Esquirol-Séguin-Down syndrome, developmental delay and abnormal echocardiography was studied, and the recent relevant literatures were reviewed. Results: Dysmorphic facial features included hypertelorism, oblique palpebral fissures, epicanthic folds, depressed nasal bridge and low set ears. Echocardiography showed atrial septal defect with tricuspid regurgitation. Conclusion: This paper reports the first case of Esquirol-Séguin-Down syndrome in Iraq associated with atrial septal defect plus tricuspid regurgitation.