Critical tricuspid regurgitation secondary to ruptured chordae tendineae mimicking a mass on the tricuspid valve in a newborn

Historically, the research on the right ventricle (RV) has been neglected by his left equivalent because of the complexity of left ventricle (LV) dysfunction. Tricuspid regurgitation (TR) can be classified as linked to primary valve disease or functional in nature, but most are functional. Although it was historically assumed that such functional Tricuspid regurgitation, i.e. arising from leftsided disease, and it can be resolved after corrective surgery, but after successful surgery, on the aortic or mitral valve annular dilatation, the Tricuspid regurgitation and right ventricular dysfunction may persist.To study the circumference of tricuspid orifice and it’s the diameter in two perpendicular planes and its comparison among the male and female population. The material for the present study comprised of 50 formalin fixed human hearts (35 males and 15 females) which were obtained from the department of anatomy. In this study, it is observed that: The mean value of circumference of a tricuspid orifice is 11.01+/-0.63 cm. The diameter of tricuspid orifice along the frontal dimension is 3.06+/-0.38 cm, and the diameter along the sagittal dimension is 2.26+/-0.23 cm. The measurements of the circumference of tricuspid orifice reported for males and females in western countries were higher than the present study and the diameter along the frontal dimension is greater than the diameter along the sagittal dimension. The tricuspid valve diameter along the frontal dimension was more than the diameter along the sagittal dimension in both males and females.

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Faculty Opinions recommendation of Long-Term Outcomes of the FORMA Transcatheter Tricuspid Valve Repair System for the Treatment of Severe Tricuspid Regurgitation: Insights From the First-in-Human Experience.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736343783.793580323 ◽

2020 ◽

Author(s):

Michele De Bonis ◽

Benedetto Del Forno

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Human Experience ◽

Tricuspid Valve Repair ◽

Repair System ◽

Valve Repair ◽

Long Term Outcomes ◽

Severe Tricuspid Regurgitation

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DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v1i4.89 ◽

2019 ◽

Vol 1 (4) ◽

pp. 133-139

Author(s):

Yasser Hamdy ◽

Mohammed Mahmoud Mostafa ◽

Ahmed Elminshawy

Keyword(s):

Right Ventricular ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Early Postoperative Period ◽

Tricuspid Valve Repair ◽

Ring Annuloplasty ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Right

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

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Valvular heart disease in autoimmune diseases in Mexico

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.071 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

J Aceituno Melgar ◽

JF Fritche-Salazar ◽

ME Soto-Lopez

Keyword(s):

Heart Disease ◽

Mitral Valve ◽

Aortic Valve ◽

Aortic Stenosis ◽

Autoimmune Diseases ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Valvular Heart Disease ◽

Valve Disease ◽

Calcium Deposit

Abstract Funding Acknowledgements Type of funding sources: None. Background The autoimmune diseases (AD) have high morbidity and mortality due to their affection to the heart. Purpose Our objective was to describe the valvular heart disease (VHD) in patients with AD. Methods Patients with systemic lupus erythematous (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SS) diagnosis were included, from January 1st 2008 to December 31th 2018. Prevalence rates of valve involvement were calculated. Results A total of 163 patients (57.6% with SLE, 23.3% with RA, 19.0% with SS) were included. The global prevalence of VHD was 5.4% in SLS, 23.6% en RA, and 15.9% in SS. The more affected valve in SLS was the tricuspid valve in 24% (12% with severe tricuspid regurgitation (STR), p = 0.028), in RA was the aortic valve in 26% (13% with severe aortic stenosis (SAS), p = 0.02), and with SS was the tricuspid valve in 48% (29% with moderate tricuspid regurgitation (MTR)). The calcium deposit was present in 66% in RA (37% in aortic valve, p < 0.001). The valve thickening (>5 mm) was higher in RA (50%, p < 0.001), with predominance in mitral valve (26%). Conclusions We found significant higher rates of STR in SLE, SAS in RA, and MTR in SS compared with the literature. Moreover, calcification and valve thickening were found more often in RA. Early diagnosis of subclinical VHD is mandatory to improve the long-term prognosis of these patients. Valvular heart disease. Autoimmune Disease (n = 163) P value* SLE (n = 94) RA (n = 38) ES (n = 31) Demographic characteristics Age, years. Gender, Male / Female, n Body Mass Index (kg/m2) Arterial hypertension, n (%) Diabetes Mellitus, n (%) 38.8 (12.6) 9/85 26.2 (5.9) 21(22.3%) 6 (6.3%) 62.45 (12.3) 7/31 26.6 (7.1) 14(36.8%) 4 (10.5%) 53.8 (13.3) 2/29 25.4 (4.7) 12 (38.7) 5 (16.1%) <0.001 NS NS NS NS Echocardiographic findings. Valve thickening Aortic Mitral 8 (9%) 1 (1%) 7 (7%) 19 (50%) 9 (24%) 10 (26%) 1 (3%) 0 1 (3%) <0.001 Calcium Deposit Aortic Mitral 4 (4%) 2 (2%) 2 (2%) 25 (66%) 14 (37%) 11 (29%) 8 (26%) 4 (12.8%) 4 (12.9%) <0.001 Aortic valve disease 4 (4%) 10 (26%) 0 Aortic stenosis Moderate Severe 0 0 0 7 (18%) 2 (5%) 5 (13%) 0 0 0 0,02 Moderate Aortic Regurgitation 4 (4%) 3 (8%) 0 NS Mitral valve disease 8 (9%) 2 (5%) 2 (6%) Mitral stenosis Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Mitral Regurgitation Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Tricuspid Regurgitation Moderate Severe 22 (24%) 11 (12%) 11 (12%) 8 (21%) 7 (18%) 1 (3%) 15 (48%) 9 (29%) 6 (19%) 0,028 Pulmonic valve disease Moderate Pulmonic Stenosis Moderate Pulmonic Regurgitation 6 (6%) 1 (1%) 5 (5%) 1 (3%) 0 1 (3%) 0 0 0 NS * Not Significant.

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The tricuspid valve annulus: study of size and motion in normal subjects and in patients with tricuspid regurgitation.

Circulation ◽

10.1161/01.cir.66.3.665 ◽

1982 ◽

Vol 66 (3) ◽

pp. 665-671 ◽

Cited By ~ 165

Author(s):

C Tei ◽

J P Pilgrim ◽

P M Shah ◽

J A Ormiston ◽

M Wong

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Normal Subjects ◽

Tricuspid Valve Annulus ◽

Valve Annulus

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Tricuspid Valve Repair for the Poor Right Ventricle: Tricuspid Valve Repair in Patients with Mild-to-Moderate Tricuspid Regurgitation Undergoing Mitral Valve Repair Improves In-Hospital Outcome

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0034-1399783 ◽

2015 ◽

Vol 65 (08) ◽

pp. 612-616 ◽

Cited By ~ 2

Author(s):

Michele Genoni ◽

Kirk Graves ◽

Dragan Odavic ◽

Helen Löblein ◽

Achim Häussler ◽

...

Keyword(s):

United States ◽

Mitral Valve ◽

Blood Transfusion ◽

Right Ventricle ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Operation Time ◽

Tricuspid Valve Repair ◽

Cell Saver ◽

Valve Repair

Background Tricuspid regurgitation (TR) in patients undergoing surgery for mitral valve (MV) increases morbidity and mortality, especially in case of a poor right ventricle. Does repair of mild-to-moderate insufficiency of the tricuspid valve (TV) in patients undergoing MV surgery lead to a benefit in early postoperative outcome? Methods A total of 22 patients with mild-to-moderate TR underwent MV repair and concomitant TV repair with Tri-Ad (Medtronic ATS Medical Inc., Minneapolis, Minnesota, United States) and Edwards Cosgrove (Edwards Lifesciences Irvine, California, United States) rings. The severity of TR was assessed echocardiographically by using color-Doppler flow images. The tricuspid annular plane systolic excursion (TAPSE) was under 1.7 cm. Additional procedures included coronary artery bypass (n = 9) and maze procedure (n = 15). The following parameters were compared: postoperative and peak dose of noradrenaline (NA), pre/postoperative systolic pulmonary pressure (sPAP), extubation time, operation time, cross-clamp time, cardiopulmonary bypass (CPB) time, pre/postoperative ejection fraction (EF), intensive care unit (ICU)-stay, hospital stay, cell saver blood transfusion, intra/postoperative blood transfusion, and postoperative TR. Results The mean age was 67 ± 14.8 years, 45% were male. Mean EF was 47 ± 16.2%, postoperative 52 ± 12.4%. sPAP was 46 ± 20.1 mm Hg preoperatively, sPAP was 40.6 ± 9.4 mm Hg postoperatively, NA postoperatively was 12 ± 10 μg/min, NA peak was 18 ± 11 μg/min, operation time was 275 ± 92 minutes, CPB was 145 ± 49 minutes, ICU stay was 2.4 ± 2.4 days, hospital stay was 10.8 ± 3.5 days, cell saver blood transfusion was 736 ± 346 mL, intraoperative transfusions were 2.5 ± 1.6. Two patients needed postoperative transfusions. A total of 19 patients were extubated at the 1st postoperative day, 2 patients at the 2nd day, and 1 at the 4th postoperative day. Two patients required a pacemaker. No reintubation, no in-hospital mortality, and one reoperation because of bleeding complications. Conclusion Correction of mild-to-moderate TR at the time of MV repair does maintain TV function and avoid right ventricular dysfunction in the early postoperative period improving the clinical outcome.

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Abstract 15817: Tricuspid Valve Imaging by 3D Transesophageal Echocardiography: Feasibility of Coaptation Length Measurement and Its Relationship With Severity of Regurgitation

Circulation ◽

10.1161/circ.130.suppl_2.15817 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Kikuko Obase ◽

Lynn Weinert ◽

Victor Mor-Avi ◽

Roberto M Lang

Keyword(s):

Transesophageal Echocardiography ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Three Dimensional ◽

The Other ◽

Tricuspid Valve Repair ◽

Mitral Valve Leaflet ◽

2D Echocardiography ◽

3D Transesophageal Echocardiography ◽

Leaflet Coaptation

Background: The coaptation length (CL) of the mitral valve leaflet decreases with increasing mitral regurgitation. Visualization of the CL of the tricuspid valve (TV) is challenging using conventional 2D echocardiography. The aims of this study were: (1) to test the feasibility of visualizing and quantifying the CL of the TV using three-dimensional (3D) transesophageal echocardiography (TEE), and (2) to study it relationship with the severity of tricuspid regurgitation (TR). Methods: Full-volume 3D TEE datasets of the TV were obtained in 24 patients from the transgastric approach. Using multiplanar reconstruction, short-axis plane depicting an en-face view of the TV was used to mark the central coaptation point (Fig. A). Three planes cutting through this point were then selected to view the 3 coaptation lines between: (1) anterior and posterior, (2) septal and anterior, and (3) septal and posterior TV leaflets (Figs. B-D). The CL was measured in each of these planes to obtain mean CL. The severity of tricuspid regurgitation was graded qualitatively as “none”, “trace”, “mild” and “moderate”. Results: Visualization of leaflet coaptation was feasible in 17/24 patients (71%). The mean CL was 0.89±0.03 cm in patients with no TR (N=4), 0.64±0.13 with trace TR (N=6), 0.50±0.07 with mild TR (N=3) and 0.13±0.11 with moderate TR (N=4). Since there was no overlap between the “moderate” group and the other 3 groups, the threshold of average CL for moderate TR was estimated to be between 0.25 (highest value in the “moderate” group) and 0.39 cm (lowest value in the other groups) (Fig. E). Conclusion: Visualization of the TV leaflet coaptation length from transgastric 3D TEE images is feasible in the majority of patients. TV coaptation length is inversely related to the severity of TR. The ability to visualize and quantify the CL of the TV may be useful when planning tricuspid valve repair surgery. Our findings suggest that CL below the threshold may indicate clinically significant TR.

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