scholarly journals Dynamics of right ventricle contractility after cardiac surgery of tricuspid valve

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Zagatina ◽  
N Zhuravskaya ◽  
G Kim ◽  
R Kappushev ◽  
D Shmatov
Keyword(s):  
Cardiac Surgery ◽  
Right Ventricle ◽  
Tricuspid Valve ◽  
Clinical Status ◽  
Right Atrial ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Funding Sources ◽  
Valve Operation ◽  
Valve Diseases

Abstract Funding Acknowledgements Type of funding sources: None. Background The function of right ventricle (RV) is an independent prognostic factor for patients with valvular heart disease. However, changes in RV function parameters in patients with and without tricuspid valve operations after cardiac surgery are lack known. The aim of the study was to define changes in RV parameters after cardiac surgery in patients with left-sided valve diseases. Methods Fifty-five consecutive patients (33 men, 61 ± 10 years old), who were referred for the repair and/or replacement of left-sided valves, were included in the study. A transthoracic echocardiography assessment before and an average of 109 days (91-114) following the operation was performed. Tricuspid annular plane systolic excursion (TAPSE), fractional area change RV (FAC), strain of the RV free wall (SRV), and right atrial volume were assessed in groups of patients with and without tricuspid valve repair. Results Valve repair for secondary tricuspid regurgitation was performed in nineteen patients undergoing left-sided valve surgery. Thirty-six patients had repair and/or replacement of left-sided valves without a tricuspid valve operation. There was a strong correlation between TAPSE, FAC, and RV strain before the operation (R = 0.62-0.77, p < 0.000002). However, there was no correlation between TAPSE and FAC; TAPSE and RV strain after the operation. TAPSE and RV strain significantly decreased after the operations and were below the normal range in both the groups of patients with and without tricuspid valve repair. TAPSE was 21 ± 5mm before the operation vs. 14 ± 4 mm after operation, p < 0.0000001 for all patients (20 ± 5mm vs. 13 ± 3 mm, p < 0.0003 for the group which underwent tricuspid valve repair; 22 ± 4mm vs. 14 ± 4 mm, p < 0.000001 for tricuspid valves which were not operated on). RV strain was -19 ± 6 mm before operating vs. -16 ± 5mm after operating, p < 0.0004 for all patients (-20 ± 6mm vs. -15 ± 5mm, p < 0.006 for tricuspid valve repair; -19 ± 6mm vs. -16 ± 4 mm, p < 0.02 for the tricuspid valves which were not operated on).  There was no difference in TAPSE and SRV among patients with and without tricuspid valve repair. Decreased longitudinal function parameters (TAPSE and SRV) didn’t correlate with patients’ clinical status or with normalized right chambers volumes. FAC was 39 ± 11% before operating vs. 41 ± 9% after the operation, p = 0.45 for all patients (37 ± 13% vs. 40 ± 8%, p = 0.69 for the group which underwent tricuspid valve repair; 40 ± 10% vs. 41 ± 9%, p = 0.52 for the group with tricuspid valves which were not operated on). An increase in FAC correlated with a decrease in right chamber sizes after operations (R=-0.37, p < 0.03). Conclusion Longitudinal right ventricle parameters (TAPSE, SRV) significantly decrease after valve operations in groups with and without tricuspid valve repair. However, there is no correlation with the clinical status of patients. Global function parameters (FAC) correlates with the normalization of right chamber size after cardiac operation.

scholarly journals Right ventricle dysfunction assessment for transcatheter tricuspid valve repair: a matter of debate

2021 ◽  
Author(s):  
Alberto Preda ◽  
Francesco Melillo ◽  
Luca Liberale ◽  
Fabrizio Montecucco ◽  
Eustachio Agricola
Keyword(s):  
Right Ventricle ◽  
Tricuspid Valve ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Right Ventricle Dysfunction

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

2015 ◽  
Vol 65 (08) ◽  
pp. 612-616 ◽  
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.

Chordal Replacement in Tricuspid Valve Repair in Children

1998 ◽  
Vol 6 (1) ◽  
pp. 45-48
Author(s):  
Jacques AM van Son ◽  
Jörg Hambsch ◽  
Michael D Black ◽  
Friedrich W Mohr
Keyword(s):  
Sinus Rhythm ◽  
Ventricular Function ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Right Atrial ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Artificial Chordae ◽  
Traumatic Tricuspid Regurgitation ◽  
Chordal Replacement

Congenital or traumatic tricuspid regurgitation in the pediatric population, although generally well tolerated initially, may lead ultimately to right atrial and ventricular dilation and dysfunction with dysrhythmias. In order to preserve right atrial and ventricular function and maintain sinus rhythm, it is our objective to repair the regurgitant tricuspid valve at an early stage. In 5 children (mean age 8.8 years) with congenital tricuspid regurgitation (2 with Ebstein's anomaly, 1 each with ventricular septal defect, tetralogy of Fallot, and partial agenesis of chordae), and in 1 child with traumatic tricuspid regurgitation, the shortened (n = 4), congenitally absent (n = 1), and ruptured (n = 1) chordae tendineae of the anterior or septal leaflets or both, were repaired with polytetrafluoroethylene artificial chordae. The tricuspid valve was successfully reconstructed in all 6 patients. De Vega's (n = 3) or Danielson's (n = 2) plication of the tricuspid valve annulus was performed in 5 patients. At a mean follow-up time of 15.7 months, tricuspid valve function was normal in 2 patients and the other 4 had mild residual tricuspid regurgitation. The mean diameter of the tricuspid annulus decreased from 36.7 mm preoperatively to 30.0 mm postoperatively, which is in the range for children with a normal tricuspid valve. In congenital or traumatic tricuspid regurgitation, chordal replacement using polytetrafluoroethylene artificial chordae is a useful adjunct to the armamentarium of tricuspid valve repair. Early repair avoids deterioration of right atrial and ventricular function and promotes maintenance of sinus rhythm.

P5567Clinical characteristics, diagnosis and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for transcatheter tricuspid valve repair

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Lurz ◽  
K P Rommel ◽  
M Orban ◽  
C Besler ◽  
D Braun ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Clinical Status ◽  
Tricuspid Valve Repair ◽  
Systolic Pulmonary Artery Pressure ◽  
Clinical Endpoint ◽  
Valve Repair ◽  
Severe Tricuspid Regurgitation ◽  
Regurgitant Orifice Area

Abstract Objective To assess the role of pulmonary hypertension (PHT) in severe tricuspid regurgitation (TR) and its implications for transcatheter tricuspid valve repair (TTVR). Background PHT patients are often excluded from surgical TR therapies. TTVR with the MitraClipTM technique is a novel treatment option for these patients. Methods A total of 164 patients at high surgical risk (median age 78 years) and TR underwent TTVR at two centers. Seventy patients were grouped as iPHT+, defined as invasive systolic pulmonary artery pressure (PAPs) >50 mmHg. Patients were similarly stratified according to echocardiographic PAPs (ePHT). The occurrence of the combined clinical endpoint (death, heart failure hospitalization, reintervention) was investigated. Results iPHT+ patients were at higher pre-operative risk (p<0.01), had more severe symptoms (p=0.01), higher NT-pro-BNP levels (p<0.01) and more impaired biventricular function (left: p=0.03; right: p=0.02). Procedural TTVR success was achieved in 86 vs. 82% in iPHT+ and iPHT- patients respectively (p=0.52). Tricuspid valve effective regurgitant orifice area (EROA) was reduced from 0.49 cm2 to 0.20 cm2 (p<0.01) similarly in both groups. While iPHT+ conveyed risk (HR 1.7 (95% CI 1.1–2.8), p=0.03) for the occurrence of the clinical endpoint, ePHT+ paradoxically conveyed protection (HR 0.61 (95% CI 0.36–0.98), p=0.04). This discrepancy was explained by the highest event rates in patients with iPHT+/ePHT- (n=28). Conversely, iPHT+/ePHT+ patients had comparable outcomes to iPHT- patients. Conclusions PHT in TR is associated with worse clinical status and advanced HF, but not procedural failure. Symptomatic benefit can be achieved irrespective of PHT status by TTVR. Although echocardiographic PHT diagnosis is unreliable, the combination of echocardiographic and invasive assessment may identify ideal candidates for TTVR among PHT patients.

OP-202 GLENN OPERATION IN ASSOCIATION WITH TRICUSPID VALVE REPAIR FOR EBSTEIN ANONAMY AND FAILING RIGHT VENTRICLE

2013 ◽  
Vol 163 (3) ◽  
pp. S78-S79
Author(s):  
E. Prifti ◽  
A. Veshti ◽  
A. Baboci ◽  
M. Bonacchi ◽  
G. Giunti ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Tricuspid Valve ◽  
Tricuspid Valve Repair ◽  
Valve Repair

Surgical Treatment of an Aorto-Right Atrial Fistula as a Complication of Tricuspid Valve Repair

2011 ◽  
Vol 59 (04) ◽  
pp. 250-252 ◽  
Author(s):  
P. Menon ◽  
T. Doenst ◽  
J. Ender ◽  
F. Mohr ◽  
D. Mathioudakis
Keyword(s):  
Surgical Treatment ◽  
Tricuspid Valve ◽  
Right Atrial ◽  
Tricuspid Valve Repair ◽  
Valve Repair

scholarly journals Aorto-Right Atrial Fistula after Minimally Invasive Tricuspid Valve Repair: A Report of Two Cases

2020 ◽  
Vol 09 (01) ◽  
pp. e55-e57
Author(s):  
Kouhei Ishidou ◽  
Aina Hirofuji ◽  
Naohiro Wakabayashi ◽  
Hiroyuki Kamiya
Keyword(s):  
Minimally Invasive ◽  
Tricuspid Valve ◽  
Right Atrial ◽  
Tricuspid Valve Repair ◽  
Sinus Of Valsalva ◽  
Valve Repair ◽  
Conventional Surgery ◽  
Coronary Cusp ◽  
Right Coronary Cusp

AbstractWe experienced two cases of postoperative iatrogenic aorto-right atrial fistula (ARAF) after tricuspid valve repair (TVR) using minimally invasive cardiac surgery (MICS) technique. In both the cases, the flow of ARAF passed through the sinus of Valsalva near the noncoronary cusp (NCC)/right coronary cusp (RCC) commissure or NCC to right atrium. The quality of the fine needle used in the MICS technique may be inferior to that used in conventional surgery; ARAF after TVR could be a unique pitfall with the MICS technique.

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