scholarly journals Heterotopic caval valve implantation for the management of severe tricuspid regurgitation: a case series

2020 ◽  
Author(s):  
Aidan Sharkey ◽  
Ronny Munoz Acuna ◽  
Kiran Belani ◽  
Ravi K Sharma ◽  
Omar Chaudhary ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Tricuspid Regurgitation ◽  
Surgical Intervention ◽  
Symptom Relief ◽  
Vena Cava ◽  
Case Series ◽  
High Morbidity ◽  
Severe Tricuspid Regurgitation ◽  
Maximal Medical Therapy ◽  
Valve Implantation

Abstract Background Severe tricuspid regurgitation (TR) is a complex condition that can be difficult to treat medically, and often surgical intervention is prohibited due to the high morbidity and mortality associated with this intervention. In patients who have failed maximal medical therapy and have progressive symptoms related to their severe TR, heterotopic caval valve implantation (CAVI) offers potential for symptom relief for these patients. Case summary We present two cases of patients with severe TR with symptoms of heart failure that were refractory to medical therapy. Due to extensive comorbidities in these patient’s surgical intervention was deemed unsuitable and the decision was made to proceed with heterotopic CAVI in order to try and control their symptoms. Both patients successfully underwent the procedure and had an Edwards SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) implanted in the inferior vena cava/right atrium junction. In both patients, there was improvement in the postoperative haemodynamics as measured by invasive and non-invasive methods. Successful discharge was achieved in both patients with improvement in their symptoms. Discussion Selective use of heterotopic CAVI to treat symptomatic severe TR that is refractory to medical therapy may be a viable option to improve symptoms in those patients that are unsuitable for surgical intervention.

scholarly journals Inferior Caval Valve Implantation Versus Optimal Medical Therapy for Severe Tricuspid Regurgitation

2019 ◽  
Vol 74 (3) ◽  
pp. 473-475 ◽  
Author(s):  
Michael Laule ◽  
Isabel Mattig ◽  
Christoph Schöbel ◽  
Fabian Knebel ◽  
Alexander Lauten ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Tricuspid Regurgitation ◽  
Optimal Medical Therapy ◽  
Severe Tricuspid Regurgitation ◽  
Valve Implantation

scholarly journals Caval Valve Implantation (CAVI): An Emerging Therapy for Treating Severe Tricuspid Regurgitation

2021 ◽  
Vol 10 (19) ◽  
pp. 4601
Author(s):  
Omar Abdul-Jawad Altisent ◽  
Rimantas Benetis ◽  
Vaida Mizarien ◽  
Francisco Gual-Capllonch ◽  
Eduard Fernandez-Nofrerias ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Feasibility Studies ◽  
Heart Valve Disease ◽  
Current Evidence ◽  
High Morbidity ◽  
Suitable Alternative ◽  
Severe Tricuspid Regurgitation ◽  
Valve Implantation

Severe tricuspid regurgitation remains a challenging heart-valve disease to effectively treat with high morbidity and mortality at mid-term. Currently guideline-directed medical treatment is limited to escalating dose of diuretics, and the rationale and timing of open-heart surgery remains controversial. Emerging percutaneous therapies for severe tricuspid regurgitation continue to show promising results in early feasibility studies. However, randomized trial data is lacking. Additionally, many patients are deemed unsuitable for these emerging therapies due to anatomical or imaging constraints. Given the technical simplicity of the bicaval valve implantation (CAVI) technique compared to other transcatheter devices, CAVI is postulated as a suitable alternative for a wide variety of patients affected with severe+ tricuspid regurgitation. In this review we illustrate the current evidence and ongoing uncertainties of CAVI, focusing on the novel CAVI-specific devices.

scholarly journals Renal and hepatic function of patients with severe tricuspid regurgitation undergoing inferior caval valve implantation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bernd Hewing ◽  
Isabel Mattig ◽  
Fabian Knebel ◽  
Verena Stangl ◽  
Michael Laule ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Vena Cava ◽  
Clinical Signs ◽  
Hepatic Function ◽  
Venous Congestion ◽  
Abdominal Circumference ◽  
Severe Tricuspid Regurgitation ◽  
Edwards Sapien ◽  
Valve Implantation

AbstractDue to progressive abdominal-venous congestion severe tricuspid regurgitation (TR) is a common cause of cardiorenal and cardiohepatic syndrome. We initiated the TRICAVAL study to compare interventional valve implantation into the inferior vena cava (CAVI) versus optimal medical therapy (OMT) in severe TR. In the present subanalysis, we aimed to evaluate the effects of CAVI on clinical signs of congestion, renal and hepatic function. TRICAVAL was an investigator-initiated, randomized trial. Twenty-eight patients with severe TR were randomized to OMT or CAVI using an Edwards Sapien XT valve. Probands who completed the 3-month follow-up (CAVI [n = 8], OMT [n = 10]) were evaluated by medical history, clinical examination, and laboratory testing at baseline, 3 and 12 months. After 3 months, the CAVI group exhibited a significant reduction of body weight (from 80.7 [69.0–87.7] kg to 75.5 [63.8–84.6] kg, p < 0.05) and abdominal circumference (from 101.5 ± 13.8 cm to 96.3 ± 15.4 cm, p ≤ 0.01) and a trend to lower doses of diuretics compared to OMT. Renal and hepatic function parameters did not change significantly. Within a short-term follow-up, CAVI led to an improvement of clinical signs of venous congestion and a non-significant reduction of diuretic doses compared to OMT.

scholarly journals Severe tricuspid regurgitation due to valvular entrapment of an inferior vena cava stent

2017 ◽  
Vol 5 (2) ◽  
pp. 130-133 ◽  
Author(s):  
Kirstin Hesterberg ◽  
Ashok Babu ◽  
Maria Frank ◽  
Shea Hogan ◽  
Mori J. Krantz
Keyword(s):  
Inferior Vena Cava ◽  
Tricuspid Regurgitation ◽  
Inferior Vena ◽  
Vena Cava ◽  
Severe Tricuspid Regurgitation

scholarly journals A case series on post-covid deadly fungal infection: mucormycosis

2021 ◽  
Vol 7 (9) ◽  
pp. 1503
Author(s):  
Kalpana G. ◽  
Amol A. Patil ◽  
Manohar Shaan ◽  
Mitusha Verma ◽  
Gayatri Harshe
Keyword(s):  
Fungal Infection ◽  
Opportunistic Infection ◽  
Surgical Intervention ◽  
Case Series ◽  
Medical Intervention ◽  
Morbidity And Mortality ◽  
Diabetic Patients ◽  
High Morbidity ◽  
Per Se

<p class="abstract">The prevailing pandemic situation by SARS-CoV-2 infection is not only worrisome by the disease per se but also for the accompanying opportunistic infection are in the rise especially in diabetic patients. We presented a case series of post-covid rhino orbital cerebral mucormycosis infection in diabetic patients resulting in high morbidity. The need to present this was to emphasis on the timely surgical and medical intervention needed to reduce morbidity and mortality by the infection. The study highlighted the importance of surgical intervention in the deadly infection.</p>

Management Patterns in Pediatric Complicated Sinusitis

2020 ◽  
Vol 163 (4) ◽  
pp. 814-821
Author(s):  
Sean M. McDermott ◽  
Amanda Onwuka ◽  
Charles Elmaraghy ◽  
Patrick C. Walz
Keyword(s):  
Medical Therapy ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Early Stage ◽  
Tertiary Care ◽  
Case Series ◽  
Hospital Charges ◽  
Intracranial Extension ◽  
Disease Characteristics ◽  
Outcome Differences

Objectives Sinusitis is a common pediatric illness that can be complicated by periorbital or intracranial extension. Patients can be managed with antimicrobials alone or in conjunction with surgical intervention. This article examines management patterns and outcomes in pediatric patients presenting with complicated sinusitis. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods An evaluation of 168 pediatric patients with complicated sinusitis with periorbital complications presenting at a single institution from 2008 to 2018 was performed. Demographics, disease characteristics, in-hospital management, and outcomes were recorded and analyzed. Results The most common complication was orbital cellulitis, seen in 49% of children. Surgical intervention occurred in 49% of patients, with 36% receiving medical therapy followed by surgery (MTS). Chandler I patients underwent surgical intervention 30% of the time, Chandler II patients 29%, and Chandler III patients 83%. Nineteen percent of initially nonoperative patients started on ampicillin-sulbactam required MTS vs 57% of those started on other antibiotic regimens ( P = .01). Twelve percent of initially nonoperative Chandler I to II patients started on ampicillin-sulbactam needed MTS vs 40% started on other antibiotic regimens. Hospital charges for operative patients were $45,056 vs $14,311 for nonoperative patients ( P < .01). Hospital charges for patients with surgery followed by medical therapy (SMT) were $45,563 vs $44,393 for MTS ( P = .92). Conclusion Nonoperative early stage patients started on ampicillin-sulbactam had a lower risk of MTS. MTS did not cost significantly more than SMT, and there were no significant outcome differences seen.

scholarly journals Homozygous Familial Hypercholesterolemia: Case Series and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Carlos H. Palacio ◽  
Theresa R. Harring ◽  
N. Thao T. Nguyen ◽  
John A. Goss ◽  
Christine A. O'Mahony
Keyword(s):  
Familial Hypercholesterolemia ◽  
Medical Therapy ◽  
Serum Cholesterol ◽  
Clinical Manifestations ◽  
Case Series ◽  
High Serum ◽  
Lipid Lowering ◽  
Lifestyle Modifications ◽  
Maximal Medical Therapy ◽  
Atherosclerotic Changes

Introduction. Familial hypercholesterolemia (FH) is caused by nonfunctioning low-density lipoprotein (LDL) receptors, resulting in high serum cholesterol. Two types of FH are described: the heterozygous form is diagnosed in adults and responds well to medical therapy; the homozygous form is rare, diagnosed in children, and often requires multiple treatments to prevent complications. Cholesterol accumulation in tissues produces common clinical manifestations including cutaneous xanthomas, coronary artery disease, and aortic stenosis. Treatment options consist of lifestyle modifications, lipid-lowering medications, LDL aphaeresis, and orthotopic liver transplantation (OLT).Case Presentation. Two patients with FH presented at young ages due to characteristic cutaneous xanthomas. The patients underwent cardiac testing that revealed atherosclerotic changes. The patients received maximal medical therapy, but only experienced a small decrease in serum cholesterol and LDL levels. After several years of medical treatment without improvement of symptoms, the patients were listed for OLT. The transplantations were successful, and only one patient had a postoperative complication of acute rejection, treated successfully. Currently, both patients are doing well with regression of the cutaneous xanthomas and atherosclerotic changes.Conclusion. OLT is a safe and effective option for patients with homozygous FH refractory to maximal medical therapy and may represent the optimal treatment for these patients.

Sign in / Sign up

Export Citation Format

Share Document