scholarly journals Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

2021 ◽  
Author(s):  
Martin Riesenhuber ◽  
Andreas Spannbauer ◽  
Marianne Gwechenberger ◽  
Thomas Pezawas ◽  
Christoph Schukro ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Pacemaker Implantation ◽  
Ventricular Dilatation ◽  
Pacemaker Lead ◽  
Survival Analyses ◽  
Before And After ◽  
Right Ventricular Dilatation ◽  
Survival Predictors

Abstract Background Transcatheter tricuspid valve intervention became an option for pacemaker lead-associated tricuspid regurgitation. This study investigated the progression of tricuspid regurgitation (TR) in patients with or without pre-existing right ventricular dilatation (RVD) undergoing pacemaker implantation. Methods Patients were included if they had implantation of transtricuspid pacemaker lead and completed echocardiography before and after implantation. The cohort was divided in patients with and without RVD (cut-off basal RV diameter ≥ 42 mm). TR was graded in none/mild, moderate, and severe. Worsening of one grade was defined as progression. Survival analyses were plotted for 10 years. Results In total, 990 patients were analyzed (24.5% with RVD). Progression of TR occurred in 46.1% of patients with RVD and in 25.6% of patients without RVD (P < 0.001). Predictors for TR progression were RV dilatation (OR 2.04; 95% CI 1.27–3.29; P = 0.003), pre-existing TR (OR 4.30; 95% CI 2.51–7.38; P < 0.001), female sex (OR 1.68; 95% CI 1.16–2.43; P = 0.006), single RV lead (OR 1.67; 95% CI 1.09–2.56; P = 0.018), mitral regurgitation (OR 2.08; 95% CI 1.42–3.05; P < 0.001), and enlarged left atrium (OR 1.98; 95% CI 1.07–3.67; P = 0.03). Survival-predictors were pacemaker lead-associated TR (HR 1.38; 95% CI 1.04–1.84; P = 0.028), mitral regurgitation (HR 1.34; 95% CI 1.02–1.77; P = 0.034), heart failure (HR 1.75; 95% CI 1.31–2.33; P < 0.001), kidney disease (HR 1.62; 95% CI 1.25–2.11; P < 0.001), and age ≥ 80 years (HR 2.84; 95% CI 2.17–3.71; P < 0.001). Conclusions Patients with RVD receiving pacemaker suffered from increased TR progression, leading to decreased survival. Graphic abstract

Surgically treated pulmonary stenosis: over 50 years of follow-up

2015 ◽  
Vol 26 (5) ◽  
pp. 860-866 ◽  
Author(s):  
Eva A. Nielsen ◽  
Vibeke E. Hjortdal
Keyword(s):  
Right Ventricular ◽  
Valve Replacement ◽  
Tricuspid Regurgitation ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
Ventricular Dilatation ◽  
Right Ventricular Dilatation

AbstractBackgroundSurgical correction was the treatment of choice for pulmonary stenosis until three decades ago, when balloon valvuloplasty was implemented. The natural history of surgically relieved pulmonary stenosis has been considered benign but is actually unknown, as is the need for re-intervention.The objective of this study was to investigate the morbidity and mortality of patients with surgically treated pulmonary stenosis operated at Aarhus University Hospital between 1957 and 2000.ResultsThe total study population included 80 patients. In-hospital mortality was 2/80 (2.5%), and an additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most common re-intervention (67%). Freedom from re-intervention decreased >20 years after the initial repair. In addition, 45% of patients had moderate/severe pulmonary regurgitation, 38% had some degree of right ventricular dilatation, and 40% had some degree of tricuspid regurgitation, which did not require re-intervention at the present stage.ConclusionSurgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured.

Abstract 12929: Pacemaker Lead-induced Tricuspid Regurgitation in Patients With or Without RV Dilatation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Martin Riesenhuber ◽  
Andreas Spannbauer ◽  
Thomas Pezawas ◽  
Christoph Schukro ◽  
Marianne Gwechenberger ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Tricuspid Regurgitation ◽  
Multivariate Regression ◽  
Direct Interaction ◽  
Severe Mitral Regurgitation ◽  
Pacemaker Lead ◽  
Multivariate Regression Model ◽  
Before And After ◽  
Leadless Pacing ◽  
Model Independent

Introduction: Right ventricular (RV) leads of permanent pacemakers (PM) contribute or cause tricuspid regurgitation (TR) in up to 45% of implantations, which is associated with poor outcome. While primary lead-induced TR has its origin in direct interaction of the lead and the valve, secondary lead-induced TR has its origin in RV dilatation (RVD). Hypothesis: We hypothesize differences in lead-induced TR and its associated mortality comparing patients with vs. without RVD. Methods: Patients with first implantation of a cardiac PM with at least one transtricuspid RV-lead between May 2000 and April 2015 were retrospectively included. Echo was performed before and after PM implantation. Results: In total, 990 patients were enrolled (Table 1). Patients with RVD had progression of TR of at least one grade in 50.2%, compared to 35.9% in patients without RVD (p<0.001). In a multivariate regression model, independent predictors for lead-induced progression of TR were RVD (OR 1.46, 95% CI 1.01-2.12, p=0.045), and moderate/severe mitral regurgitation (OR 1.51, 95%CI 1.12-2.02, p=0.006). Independent predictors for 10-year-mortality were lead-induced progression of TR (HR 1.36, 95%CI 1.04-1.78, p=0.023), age > 80 years (HR 2.78, 95%CI 2.14-3.61, p<0.001), PM with single RV-lead (HR 1.35, 95%CI 1.03-1.77, p=0.032), heart failure (HR 1.75, 95%CI 1.32-2.32, p<0.001), chronic kidney disease (HR 1.61, 95%CI 1.24-2.09, p<0.001), moderate/severe mitral regurgitation (HR 1.31, 95%CI 1.03-1.74, p=0.031), and LVEDD > 25mm/m2 (HR 1.37, 95%CI 1.06-1.77, p=0.015). Conclusions: RVD is associated with lead-induced progression of TR, which is associated with decreased survival. Patients with RVD and indication for a PM, leadless pacing could be an alternative. If lead-induced TR occurs, transcatheter tricuspid valve intervention is a possibility, especially in patients with RVD.

scholarly journals RIGHT VENTRICULAR DILATATION POST PERICARDIECTOMY CAUSES TRICUSPID REGURGITATION

2015 ◽  
Vol 65 (10) ◽  
pp. A1315
Author(s):  
Muhammad Umer Tariq ◽  
Wahaj Aman ◽  
Abhishek Karwa ◽  
Rudolfo Benatti ◽  
Allan Klein
Keyword(s):  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Ventricular Dilatation ◽  
Right Ventricular Dilatation

Tricuspid Valve Annulus Tension

2011 ◽  
Author(s):  
Shamik Bhattacharya ◽  
Zhaoming He
Keyword(s):  
Right Ventricular ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Left Ventricular ◽  
Ventricular Dilatation ◽  
Left Ventricular Geometry ◽  
Tricuspid Annulus ◽  
Functional Tricuspid Regurgitation ◽  
Right Ventricular Dilatation ◽  
Annulus Dilatation

Functional tricuspid regurgitation is a direct outcome of right ventricular dilatation and tricuspid annulus dilatation. The mechanism underlying functional tricuspid regurgitation is believed to be multifactorial and related to abnormalities in right ventricular volume, function and shape. Changes in the right ventricle geometry may lead to alterations in the positions of the papillary muscles (PM) of the tricuspid valve (TV). PM displacement happens in right ventricular dilatation but its correlation with tricuspid annulus dilatation is still unknown. The unique structure and orientation of tricuspid PM has role to play in TV annulus mechanics and right ventricular mechanics (Fig.1). It has been already shown that annulus tension (AT) is a parameter to evaluate left ventricular function that, previously, was evaluated via the left ventricular geometry and pressure [1–3].

Prenatal Diagnosis of Pallister-Killian Syndrome Associated with Pulmonary Stenosis and Right Ventricular Dilatation

2009 ◽  
Vol 29 (4) ◽  
pp. 366-370 ◽  
Author(s):  
In Yang Park ◽  
Jong Chul Shin ◽  
Ji Young Kwon ◽  
Bo Kyung Koo ◽  
Myungshin Kim ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Right Ventricular ◽  
Pulmonary Stenosis ◽  
Ventricular Dilatation ◽  
Right Ventricular Dilatation

Tetralogy of Fallot

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Y. d’Udekem ◽  
C. Ovaert ◽  
F. Grandjean ◽  
V. Gerin ◽  
M. Cailteux ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Left Ventricular ◽  
Ventricular Dilatation ◽  
Pulmonary Insufficiency ◽  
Direct Closure ◽  
Long Term Outcome ◽  
Cox Regression Analysis ◽  
Right Ventricular Dilatation

Background —In tetralogy of Fallot, transannular patching is suspected to be responsible for late right ventricular dilatation. Methods and Results —In our institution, 191 patients survived a tetralogy of Fallot repair between 1964 and 1984. Transannular patching was used in 99 patients (52%), patch closure of a right ventriculotomy in 35, and direct closure of a right ventriculotomy in 55. Two had a transatrial-transpulmonary approach. To identify predictive factors of adverse long-term outcome related to right ventricular dilatation, the following events were investigated: cardiac death, reoperation for symptomatic right ventricular dilatation, and NYHA class II or III by Cox regression analysis. Mean follow-up reached 22±5 years. The 30-year survival was 86±5%. Right ventricular patching, whether transannular or not, was the most significant independent predictor of late adverse event (improvement χ 2 =16.6, P <0.001). In patients who had direct closure, the ratio between end-diastolic right and left ventricular dimensions on echocardiography was smaller (0.61±0.017 versus 0.75±0.23, P =0.007), with a smaller proportion presenting severe pulmonary insufficiency (9% versus 40%, P =0.005). There was no difference between right ventricular and transannular patching concerning late outcome (log rank P value=0.6), right ventricular size (0.70±0.28 versus 0.76±0.26, P =0.4), or incidence of severe pulmonary insufficiency (30% versus 43%, P =0.3). Conclusions —In tetralogy of Fallot, transannular patching does not result in a worse late functional outcome than patching of an incision limited to the right ventricle. Both are responsible for a similar degree of long-term pulmonary insufficiency and right ventricular dilatation.

A case of asymptomatic patient with right ventricular dilatation

2016 ◽  
Vol 1 ◽  
pp. 36-36
Author(s):  
Wael AlJaroudi ◽  
Firas El Bitar ◽  
Ghida Mouharram ◽  
Jihad Daher ◽  
Gebrine El-Khoury
Keyword(s):  
Right Ventricular ◽  
Asymptomatic Patient ◽  
Ventricular Dilatation ◽  
Right Ventricular Dilatation
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