CONTEMPORARY NATURAL HISTORY OF ISOLATED SEVERE TRICUSPID REGURGITATION BY ETIOLOGY AND MANAGEMENT

Surgical intervention for severe tricuspid regurgitation secondary to remote infective endocarditis has been infrequent, especially in patients also infected with the human immunodeficiency virus (HIV). We describe the case of a 62-year-old HIV-positive man, with a 24-year history of endocarditis caused by intravenous heroin use, who presented with severe tricuspid regurgitation. The patient was initially asymptomatic, was taking antiretroviral medications, and had a satisfactory CD4 count and an undetectable viral load, so we decided to manage the regurgitation conservatively. Two years later, he presented with biventricular heart failure and dyspnea. After surgical tricuspid valve replacement, his condition improved substantially. This case illustrates that HIV-infected patients with complex medical conditions can successfully undergo cardiac surgery.

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Abstract 16851: Simultaneous Mitral Valve Replacement, Aortic Valve Replacement, Tricuspid Valve Repair, Left Atrial Appendage Ligation, Maze Procedure And Cabg In A 57-year Old Female With History Of Tavr And Severe Mitral Annular Calcification

Circulation ◽

10.1161/circ.144.suppl_2.16851 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Hassan Mehmood Lak ◽

Joshua Cohen ◽

Jean Pierre Iskandar ◽

Mohamed Gad ◽

Sanchit Chawla ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Tricuspid Regurgitation ◽

Mitral Stenosis ◽

Maze Procedure ◽

Mitral Annular Calcification ◽

Severe Tricuspid Regurgitation ◽

History Of ◽

Annular Calcification

Background: Open heart surgery is preferred for patients with multiple valvular issues with conflicting physiology. Case: A 57-year-old female with a past medical history of Type I Diabetes Mellitus complicated by kidney & pancreatic transplant in 1999 s/p failed kidney transplant in 2016 subsequently back on dialysis, aortic stenosis leading to Transcatheter Aortic Valve Replacement (TAVR) in 2016 who presented to the hospital for profound cardiogenic shock and was found to have severe tricuspid regurgitation, severe mitral stenosis secondary to mitral annular calcification with severe concentric hypertrophy of left ventricle. Decision Making: Her conflicting right and left heart physiology due to Tricuspid Regurgitation and Mitral Stenosis was very difficult to manage medically. She was not deemed a candidate for a heart transplant due to a history of a failed kidney transplant. She underwent surgery which included Mitral Valve Replacement, explant TAVR and repeat aortic valve replacement, Tricuspid repair, Left atrial appendage ligation and maze procedure, and CABG x1 with saphenous vein graft to PDA. She stayed on V-V extracorporeal membrane oxygenation (ECMO) post-operatively and was discharged on post-operative Day # 14. Conclusion: Severe tricuspid Regurgitation & coexisting mitral stenosis pose a dilemma for medical management and only feasible option is surgery which could be extremely challenging.

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Indications for Surgery for Tricuspid Regurgitation

Interventional Cardiology Review ◽

10.15420/icr.2015.10.1.58 ◽

2015 ◽

Vol 10 (1) ◽

pp. 58 ◽

Cited By ~ 2

Author(s):

Yan Topilsky ◽

Keyword(s):

Cardiac Surgery ◽

Natural History ◽

Tricuspid Regurgitation ◽

Surgical Repair ◽

Valve Surgery ◽

Surgical Approaches ◽

Indications For Surgery ◽

History Of

Despite the fact that tricuspid regurgitation (TR) can result in significant symptoms, patients are rarely referred for isolated surgical repair, or replacement, and most surgeries are performed in the context of other planned cardiac surgery. In this article, we review the different causes of TR, the natural history of untreated severe TR, indications and timing for isolated TR surgery, indications for TR surgery performed at the time of left-sided valve surgery, and surgical approaches for correction of TR.

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Natural History of Functional Tricuspid Regurgitation

Functional Mitral and Tricuspid Regurgitation ◽

10.1007/978-3-319-43510-7_19 ◽

2016 ◽

pp. 163-165

Author(s):

K. M. John Chan

Keyword(s):

Natural History ◽

Tricuspid Regurgitation ◽

Functional Tricuspid Regurgitation ◽

History Of

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Prevalence & Natural History of Tricuspid Regurgitation in Ischemic Mitral Regurgitation Patients

10.21203/rs.3.rs-128018/v1 ◽

2020 ◽

Author(s):

Ofir Koren ◽

Henda Darawsha ◽

Ehud Rozner ◽

Yoav Turgeman

Keyword(s):

Natural History ◽

Mitral Regurgitation ◽

Tricuspid Regurgitation ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Impact Risk ◽

Heart Pathology ◽

History Of ◽

Artery Disease

Abstract BackgroundFunctional tricuspid regurgitation (FTR) is most often secondary to left-sided heart pathology involving the mitral valve. We studied the incidence, clinical impact, risk factors, and natural history of patients who developed FTR due to an ischemic cause of mitral regurgitation (IMR). We conducted a retrospective cohort study based on data collected from January 2012 to December 2014. Patients diagnosed with IMR were eligible for the study. The mean follow-up was five years.RESULTSThe study group consisted of 134 patients with IMR divided into two groups based on FTR development (FTR vs non-FTR group). Forty patients were diagnosed with FTR (30.1%). FTR patients were older (63.0 ± 10.4 vs 57.1 ± 11.0, respectively, p<0.05) with a high incidence of previous coronary artery disease (p<.006). Severe IMR, high pulmonary arterial pressure (PAP), and failed revascularization were significant predictors of FTR development (p<.001, p<.005, p<.003, respectively). Low systolic left ventricle function was a predictor for FTR progression.CONCLUSIONClinical observations showed that FTR development due to IMR is common. Elderly patients with ischemic heart disease are at particularly high risk. FTR incidence and severity are directly proportional to the severity of IMR. FTR tends to deteriorate in about one-fifth of IMR patients and is mainly affected by the left ventricular systolic function.

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How is the moral stance related to the intentional stance and group thinking?

Behavioral and Brain Sciences ◽

10.1017/s0140525x19002413 ◽

2020 ◽

Vol 43 ◽

Author(s):

Hannes Rakoczy

Keyword(s):

Natural History ◽

Social Cognitive ◽

Intentional Stance ◽

Cognitive Capacities ◽

Shared Intentionality ◽

History Of ◽

Group Thinking ◽

Moral Stance

Abstract The natural history of our moral stance told here in this commentary reveals the close nexus of morality and basic social-cognitive capacities. Big mysteries about morality thus transform into smaller and more manageable ones. Here, I raise questions regarding the conceptual, ontogenetic, and evolutionary relations of the moral stance to the intentional and group stances and to shared intentionality.

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