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

2020 ◽  
Vol 21 (Supplement_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.

scholarly journals P855 Extensive right heart endocarditis in the past

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

Successful Retrieval of a Knotted Pulmonary Artery Catheter Trapped in the Right Ventricle Using a Dormier Basket

1997 ◽  
Vol 42 (6) ◽  
pp. 184-184 ◽  
Author(s):  
S. Hood ◽  
H.M. McAlpine ◽  
J. A. H. Davidson
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Pulmonary Artery Catheter ◽  
Tricuspid Valve ◽  
Right Atrium ◽  
Femoral Vein ◽  
Tricuspid Valve Annulus ◽  
Valve Annulus ◽  
Successful Retrieval ◽  
The Right

We report the case of a 71 year old patient in whom a pulmonary artery catheter (Swan Ganz) formed a knot which was fixed within the right ventricle in the region of the tricuspid valve annulus. The catheter was successfully dislodged to the right atrium, subsequently snared by a dormier basket advanced from the right femoral vein and retrieved by localised cut down of the femoral vein.

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.

scholarly journals Partial PFO Closure for Persistent Hypoxemia in a Patient with Ebstein Anomaly

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
S. A. Zuberi ◽  
S. Liu ◽  
J. W. Tam ◽  
F. Hussain ◽  
D. Maguire ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Atrial Septal Defect Closure ◽  
Ebstein Anomaly ◽  
Severe Tricuspid Regurgitation ◽  
Tricuspid Valve Surgery ◽  
Acute Decompensation ◽  
The Right

Ebstein anomaly is characterized by deformities of the anterior leaflet of the tricuspid valve and atrialization of the right ventricle. Patients with severe tricuspid regurgitation are recommended to have tricuspid valve surgery with concomitant atrial septal defect closure. A 73-year-old female with Ebstein anomaly presented with severe hypoxemia. Transthoracic echocardiography revealed severe tricuspid regurgitation and a patent foramen ovale with right-to-left shunting. Complete percutaneous patent foramen ovale closure led to acute decompensation; however, partial closure led to hemodynamic stability and improved oxygenation. In conclusion, similar patients with “patent foramen ovale dependency” from longstanding shunts may benefit from partial patent foramen ovale closure.

P4716One-year outcomes of the tri-repair study assessing cardioband tricuspid valve reconstruction system for patients with severe tricuspid regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Nickenig ◽  
R S Von Bardeleben ◽  
U Schaefer ◽  
K H Kuck ◽  
A Vahanian ◽  
...  
Keyword(s):  
Heart Disease ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Nyha Class ◽  
Clinical Event ◽  
Heart Team ◽  
Severe Tricuspid Regurgitation ◽  
Valve Reconstruction ◽  
One Year ◽  
Tricuspid Valve Reconstruction

Abstract Background Severe tricuspid regurgitation (TR) is associated with high morbidity and mortality rates with limited treatment options. Objectives We report the one-year outcomes of the Cardioband™ Tricuspid Valve Reconstruction System in the treatment of severe functional TR in 30 patients enrolled in the TRI-REPAIR study. Methods Between October 2016 and July 2017, 30 patients were enrolled in this single-arm, multicenter, prospective study. Patients were diagnosed with severe, symptomatic TR in the absence of untreated left-heart disease and deemed inoperable because of unacceptable risk for open-heart surgery by the local heart team. Clinical, functional, and echocardiographic data were prospectively collected before and up to one year post-procedure. An independent core lab assessed all echocardiographic data and an independent clinical event committee adjudicated the safety events. Results Mean patient age was 75 years, 73% were females, 23% had ischemic heart disease, and 93% had atrial fibrillation. At baseline, 83% were in NYHA Class III-IV, 63% had edema, and LVEF was 58%. Technical success was 100%. Through one year, one patient had a reintervention and exited the study. Five patients died of which one was device-related. Between baseline and one year (paired analyses), echocardiography showed average reductions of annular septolateral diameter of 16% (44mm vs. 37mm; p<0.0001), PISA EROA of 49% (0.73cm2 vs. 0.37cm2, p=0.0037), and mean vena contracta of 30% (1.2cm vs. 0.9cm, p=0.0046). Clinical assessment showed that at one year 78% of patients were in NYHA Class I-II (p=0.0003). Six minute walk distance improved by 42m (p=0.0525). Kansas City Cardiomyopathy Questionnaire score improved by 19 points (p=0.0009). Edema was absent in 70% of the patients. Conclusions These results show that the Cardioband tricuspid system performs as intended and appears to be safe in patients with symptomatic and severe functional TR. At one year significant reduction of TR through a sustained decrease of annular dimensions, improvements in heart failure symptoms, quality of life, and exercise capacity were observed. Further studies are warranted to validate these initial promising results. Acknowledgement/Funding Edwards Lifescieinces

Prolapse of the antero-superior leaflet of the tricuspid valve secondary to congenital anomalies of the valvar and sub-valvar apparatus: a rare cause of severe tricuspid regurgitation

2005 ◽  
Vol 15 (4) ◽  
pp. 417-421 ◽  
Author(s):  
Dominic J. R. Abrams ◽  
Philip Kilner ◽  
Janice A. Till ◽  
Darryl F. Shore ◽  
Babulal Sethia ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Congenital Anomalies ◽  
Surgical Repair ◽  
Volume Loading ◽  
Right Heart ◽  
Severe Tricuspid Regurgitation ◽  
The Right ◽  
Regular Review

Congenital anomalies of the tricuspid valve, and/or its supporting apparatus, leading to severe tricuspid regurgitation are rare. Although well tolerated in early childhood, long-standing and progressive volume loading of the right heart leads to symptoms of decreased exercise tolerance, and may predispose to arrhythmias in the long term. We report three cases of severe tricuspid regurgitation related to anomalies of the cords supporting the antero-superior leaflet of the tricuspid valve. Shortened cords leading to tethering of the leaflet were seen in two cases, and hypoplasia of the leaflet in the other. In all cases, the regurgitant jet was directed posteriorly towards the coronary sinus and atrial septum. Surgical repair was possible in one case, while it proved necessary to replace the valve in a second. The third child is asymptomatic and under regular review.

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