Severe tricuspid regurgitation secondary to dislodgement of the atrial loop into the right ventricle: an unusual complication of pacemaker implantation in a young adult

Background: Adult congenital heart disease is most commonly complicated by arrhythmias and very rarely by acute coronary syndromes. We present a rare case of ST elevation myocardial infarction (STEMI) in a young 35-year-old patient with congenital transposition of great vessels. Case Presentation: A 35-year-old female with a past medical history of transposition of the great vessels (d-TGA) status post arterial baffle operation in infancy, with prior atrial arrhythmias and severe RV failure, presented to our facility with crushing substernal chest pain radiating down her left arm. ECG was significant for ST elevation in the inferior leads and high sensitivity troponin was elevated. She was taking Rivaroxaban. She was taken emergently to the catheterization lab where she was found to have 100% occlusion of the apical left anterior descending artery secondary to an embolus with no angiographic disease in any other epicardial vessel. Transthoracic echocardiography showed severe dilation of the right ventricle with severe tricuspid regurgitation. The embolic lesion was deemed not amenable to percutaneous intervention and the patient was treated conservatively with a heparin drip. The embolus was presumed to originate from the hyper-trabeculated and distended right ventricle in spite of chronic rivaroxaban therapy and she was started on warfarin. Presently she is stable, awaiting a heart transplant. Discussion: Extensive literature review revealed four reported cases of acute coronary syndrome secondary to emboli in patients with surgically corrected TGA. Patients with d-TGA are most often surgically corrected with an arterial switch procedure. But in Baffle procedures (Mustard or Senning) such as the one in this patient, the right ventricle becomes the systemic ventricle. The most common complications as an adult are right ventricular dilation, severe tricuspid regurgitation and atrial arrhythmias, all three of which were noted in our patient. Conclusion: Our patient developed all three of the most common adult complications of surgically corrected d-TGA, ultimately resulting in the rare and extreme manifestation of an embolic STEMI.

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A Case of Blunt Chest Trauma and Delayed Severe Tricuspid Regurgitation

Surgical Case Reports ◽

10.31487/j.scr.2021.08.16 ◽

2021 ◽

pp. 1-3

Author(s):

Seyed Mohammad Saeid Ghiasi ◽

Seyed Tayeb Moradian ◽

Seyed Mohammad Saeid Ghiasi

Keyword(s):

Right Ventricle ◽

Tricuspid Regurgitation ◽

Transthoracic Echocardiography ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Anterior Leaflet ◽

Cardiac Valves ◽

Severe Tricuspid Regurgitation ◽

Deformation And Failure ◽

The Right

Blunt chest trauma could lead to the cardiac valves damage. Flail anterior leaflet with severe tricuspid regurgitation is usually due to blunt chest trauma. This condition is very rare and can lead to deformation and failure of the right ventricle. The tricuspid regurgitation is usually easily diagnosed with transthoracic echocardiography. In this study, we want to present a case with delayed tricuspid damage following blunt chest trauma.

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P855 Extensive right heart endocarditis in the past

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1187 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

E Dobrzanska ◽

M Tomaszewski ◽

R Zarczuk ◽

A Tomaszewski ◽

E Czekajska-Chehab

Keyword(s):

Pulmonary Embolism ◽

Right Ventricle ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Right Atrium ◽

Pulmonary Valve ◽

Pulmonary Trunk ◽

Right Heart ◽

Severe Tricuspid Regurgitation ◽

The Right

Abstract A 38y. old woman was admitted to a Cardiology Department due to increased exertional dyspnea and decreased exercise tolerance. Echocardiography performed in an outpatient setting has found a substantial enlargement of the right ventricle and severe tricuspid regurgitation. Physical examination significantly enlarged liver, pulsation of jugular veins and numerous scars in the pits elbow. ECG sinus rhythm 85 / min. Right axis deviation. LPH. Hypertrophy of the right atrium. QS in V1-V4. Transthoracic and Transesophageal Echocardiography (TTE,TEE) EF 64%, a significant increase in a right heart chambers (RVDD 4.1 cm, severe tricuspid regurgitation with completely disappearing of tricuspid valve ( only part of septal leaflet was present, which was a consequence of pressure equalization between the right atrium and the right ventricle). In addition, it revealed the structure connected with the pulmonary valve leaflet and moving between the right ventricular outflow tract and pulmonary trunk (most probably healed vegetation, 1.2 x 0.5 cm ). Computed tomography (CT) confirmed the significant enlargement of right heart chambers (EDV 335 ml, ESV 143 ml, SV 192 ml, EF ∼ 58%) with displacement of interatrial septum to the left and the flattening of the interventricular septum . Complete destruction of the tricuspid valve leaflets, with the remaining residual part of septal leaflet was observed. The pulmonary valve was connected mobile irregular structure 2,5 cm x 0,5 cm. Laboratory tests revealed a history of cytomegalovirus infection (p / body IgG> 500,000U / ml). Other tests (HIV, hepatitis B, reaction W-R) - were negative. There was no laboratory and clinical signs of active infection at present. Patient demanded to be discharged from the hospital and refused operation. DISCUSSION Echocardiography did not confirm diagnosis of pulmonary hypertension. D-dimer values of 396 ng / ml (normal <500 ng / ml) excluded suspicion of pulmonary embolism. Left ventricular ejection fraction was normal (EF ∼ 64%), BNP reached the value of 153 pg / ml (normal 0-100pg / ml). This case deserves attention because it documents severe right heart endocarditis by the person using drugs intravenously with an extremely rare takeover of both right heart valves and septic pulmonary embolism. Despite such a large morphological change in the heart of a patient remains in a relatively good clinical condition (NYHA class II/ III). The observed structure of the pulmonary trunk should be considered as healed vegetation. In the absence of consent to the surgery the patient is still treated pharmacologically. Abstract P855 Figure. Pic.1

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Right Ventricle Mass Removal from Tricuspid Valve Apparatus: An Unusual Thromboembolic Complication of Severe Ketoacidosis

The Heart Surgery Forum ◽

10.1532/hsf.1378 ◽

2016 ◽

Vol 19 (2) ◽

pp. 077

Author(s):

Ireneusz Haponiuk ◽

Maciej Chojnicki ◽

Konrad Paczkowski ◽

Wojciech Kosiak ◽

Radosław Jaworski ◽

...

Keyword(s):

Right Ventricle ◽

Tricuspid Valve ◽

Mild Hypothermia ◽

Heart Function ◽

Thromboembolic Complication ◽

Surgical Removal ◽

Unusual Complication ◽

Type I ◽

Definitive Therapy ◽

The Right

The presence of a pathologic mass in the right ventricle (RV) may lead to hemodynamic consequences and to a life-threatening incident of pulmonary embolism. The diagnosis of an unstable thrombus in the right heart chamber usually necessitates intensive treatment to dissolve or remove the pathology. We present a report of an unusual complication of severe ketoacidosis: thrombus in the right ventricle, removed from the tricuspid valve (TV) apparatus. A four-year-old boy was diagnosed with diabetes mellitus (DM) type I de novo. During hospitalization, a 13.9 × 8.4 mm tumor in the RV was found in a routine cardiac ultrasound. The patient was referred for surgical removal of the floating lesion from the RV. The procedure was performed via midline sternotomy with extracorporeal circulation (ECC) and mild hypothermia. Control echocardiography showed complete tumor excision with normal atrioventricular valves and heart function. Surgical removal of the thrombus from the tricuspid valve apparatus was effective, safe, and a definitive therapy for thromboembolic complication of pediatric severe ketoacidosis.<br /><br />

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Importance of Preserved Tricuspid Valve Function for Effective Soft Robotic Augmentation of the Right Ventricle in Cases of Elevated Pulmonary Artery Pressure

Cardiovascular Engineering and Technology ◽

10.1007/s13239-021-00562-7 ◽

2021 ◽

Author(s):

Isaac Wamala ◽

Christopher J. Payne ◽

Mossab Y. Saeed ◽

Daniel Bautista-Salinas ◽

David Van Story ◽

...

Keyword(s):

Pulmonary Artery ◽

Right Ventricle ◽

Tricuspid Regurgitation ◽

Diastolic Pressure ◽

Right Heart Failure ◽

Lower Grade ◽

Ventricular Assist ◽

Valve Function ◽

Right Ventricular Assist Device ◽

The Right

Abstract Purpose In clinical practice, many patients with right heart failure (RHF) have elevated pulmonary artery pressures and increased afterload on the right ventricle (RV). In this study, we evaluated the feasibility of RV augmentation using a soft robotic right ventricular assist device (SRVAD), in cases of increased RV afterload. Methods In nine Yorkshire swine of 65–80 kg, a pulmonary artery band was placed to cause RHF and maintained in place to simulate an ongoing elevated afterload on the RV. The SRVAD was actuated in synchrony with the ventricle to augment native RV output for up to one hour. Hemodynamic parameters during SRVAD actuation were compared to baseline and RHF levels. Results Median RV cardiac index (CI) was 1.43 (IQR, 1.37–1.80) L/min/m2 and 1.26 (IQR 1.05–1.57) L/min/m2 at first and second baseline. Upon PA banding RV CI fell to a median of 0.79 (IQR 0.63–1.04) L/min/m2. Device actuation improved RV CI to a median of 0.87 (IQR 0.78–1.01), 0.85 (IQR 0.64–1.59) and 1.11 (IQR 0.67–1.48) L/min/m2 at 5 min (p = 0.114), 30 min (p = 0.013) and 60 (p = 0.033) minutes respectively. Statistical GEE analysis showed that lower grade of tricuspid regurgitation at time of RHF (p = 0.046), a lower diastolic pressure at RHF (p = 0.019) and lower mean arterial pressure at RHF (p = 0.024) were significantly associated with higher SRVAD effectiveness. Conclusions Short-term augmentation of RV function using SRVAD is feasible even in cases of elevated RV afterload. Moderate or severe tricuspid regurgitation were associated with reduced device effectiveness.

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An overlooked cause for reversible severe tricuspid regurgitation and pulmonary hypertension: Hibernating right ventricle

Echocardiography ◽

10.1111/echo.15138 ◽

2021 ◽

Author(s):

Kadriye Memic Sancar ◽

Cagdas Topel ◽

Selahattin Turen ◽

Mehmet Erturk ◽

Gamze Babur Guler

Keyword(s):

Pulmonary Hypertension ◽

Right Ventricle ◽

Tricuspid Regurgitation ◽

Severe Tricuspid Regurgitation

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Traumatic severe tricuspid regurgitation diagnosis after the progression of right ventricle function deterioration

Trauma Case Reports ◽

10.1016/j.tcr.2019.100239 ◽

2019 ◽

Vol 23 ◽

pp. 100239

Author(s):

Hanna Jung ◽

Joon Yong Cho ◽

Gun-Jik Kim ◽

Young ok Lee ◽

Kyoung Hoon Lim ◽

...

Keyword(s):

Right Ventricle ◽

Tricuspid Regurgitation ◽

Right Ventricle Function ◽

Severe Tricuspid Regurgitation ◽

Ventricle Function

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Incidence and predictors of moderate to severe tricuspid regurgitation after dual-chamber pacemaker implantation

Pacing and Clinical Electrophysiology ◽

10.1111/pace.13543 ◽

2018 ◽

Vol 42 (1) ◽

pp. 85-92 ◽

Cited By ~ 1

Author(s):

Min Soo Cho ◽

Jun Kim ◽

Jung-Bok Lee ◽

Gi-Byoung Nam ◽

Kee-Joon Choi ◽

...

Keyword(s):

Tricuspid Regurgitation ◽

Pacemaker Implantation ◽

Dual Chamber ◽

Dual Chamber Pacemaker ◽

Severe Tricuspid Regurgitation

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P189 Duplication of the tricuspid valve (DOTV): case report of a rare congenital anomaly

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.059 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Cited By ~ 1

Author(s):

S Moscatelli ◽

G Trocchio ◽

N Stagnaro ◽

A Siboldi ◽

M Derchi ◽

...

Keyword(s):

Pulmonary Artery ◽

Atrial Flutter ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Right Atrium ◽

Rare Condition ◽

Systolic Pulmonary Artery Pressure ◽

Severe Tricuspid Regurgitation ◽

One Year ◽

The Right

Abstract Introduction Tricuspid valve duplication is an extremely rare condition and in most of the cases it is associated with other congenital cardiac malformations. Because of its rarity, the clinical presentation and the management are not defined yet. Clinical Case We report the case of an 18 y/o caucasian male, who was admitted to our Hospital in February 2018 for rapid atrial flutter not responsive to medical therapy (propanolol and digossin). He had a pre-natal diagnose of ventricular septum defect (VSD) and tricuspid straddling. At 1 year of age he underwent pulmonary artery bandage and one year later VSD closure was performed. Blood test showed sub-clinic hypothyroidism, probably related to previous amiodaron therapy. A transthoracic echocardiogram was obtained. The right atrium (RA) was severely dilated and the atrial septum dislocated towards left ventricle (LV); two right atrioventricular valves (tricuspid valves) were detected: the ‘true’ tricuspid opening was inside the right ventricle, and an ‘accessory‘ opening was located inside the LV and severely regurgitant into the RA; the mitral valve was morphologically and functionally normal; both ventricles were dilated with preserved systolic function; systolic pulmonary artery pressure was not detectable. A Cardiac Magnetic Resonance clearly delineated the anomaly. Atrial flutter radio frequency transcatheter ablation was succesfully performed before corrective surgery. The regurgitant accessory tricuspid orifice was closed with an heterologous pericardial patch and a right reduction atrioplasty was also done. The post-operative course was uneventful and only a mild paraseptal tricuspid jet with LV to RA shunt was present at post op echocardiography. After one year follow-up the patient remained asymptomatic, without arrhythmia recurrence. Conclusion DOTV is an extremely rare condition that could be responsible of severe tricuspid regurgitation. At the moment, there are not sufficient data to establish the correct timing for surgical intervention. In our case, the presence of severe tricuspid regurgitation, right atrium dilatation, biventricular overload and atrial flutter guided the clinical management and suggested surgical correction. Abstract P189 Figure.

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