P3655Right ventricular volume off-loading following atrial septal defect closure or pulmonary valve replacement: impact on tricuspid regurgitation and mid-term remodeling

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A C Martin Garcia ◽  
K Dimopoulos ◽  
M Boutsikou ◽  
A Kempny ◽  
R Alonso-Gonzalez ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Valve Replacement ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Valve Surgery ◽  
Tricuspid Valve Surgery ◽  
Asd Closure

Abstract Introduction Cardiac surgery or catheter intervention is nowadays commonly performed to abolish volume loading of the right ventricle (RV) in adults with congenital heart disease (ACHD). Purpose Little is known, however, of their impact on the preexisting tricuspid regurgitation (TR) following such procedures (atrial septal defect [ASD] closure and pulmonary valve replacement [PVR]), which was the aim of our study. Methods Demographics, clinical and echocardiographic characteristics were analyzed from 162 consecutive patients undergoing such interventions between July 2005 and December 2014, who had at least mild preoperative TR. Results Mean age at intervention was 42±16 years (38.3% male); 101 patients underwent ASD closure, whereas 61 patients PVR. Only 11.1% receiving concomitant tricuspid valve surgery (repair). There was significant overall improvement in severity of TR, from 38 (23.5%) patients having moderate or severe TR preoperatively to only 11 (6.8%) and 20 (12.3%) at 6 and 12 months of follow-up, respectively (p<0.05) (Figure 1) (Table 1). Improvement in TR was observed in patients who did not have concomitant TV repair, from 15.3% to 6.9% and 11,8%, 6 and 12 months, respectively (p<0.05). Echocardiographic data Echo 1 (baseline) Echo 2 (6 months) Echo 3 (12 months) p-value† ‡Echo 1 ‡Echo 2 ‡Echo 3 TR grade (none = 1, mild = 2, moderate = 3, severe = 4) 2.3±0.6 1.6±0.6 1.7±0.8 <0.0001 A B B End-diastolic tricuspid annulus diameter (cm) 4.3±0.6 3.6±0.6 3.5±0.5 <0.0001 A B B Systolic tenting area (cm2) 0.7±0.5 0.5±0.2 0.5±0.3 <0.0001 A B B Coaptation distance (cm) 0.6±0.2 0.4±0.2 0.4±0.2 <0.0001 A B B End-diastolic area (cm2) 30.3±7.5 21.7±6.0 20.6±6.0 <0.0001 A B C Fractional area change (%) 39.4±8.4 39.0±8.0 39.9±8.1 0.58 A A A RV mid diameter (cm) 4.2±0.7 3.3±0.7 3.2±0.6 <0.0001 A B B RVOT end-diastolic proximal diameter (cm) 4.4±0.6 3.8±0.6 3.6±0.5 <0.0001 A B C TAPSE (cm) 2.1±0.6 1.4±0.5 1.4±0.4 <0.0001 A B B Lateral TDi S (cm/s) 12.4±3.3 8.8±3.0 9.2±3.0 <0.0001 A B B Systolic pulmonary artery pressure (mmHg) 42.4±13.4 34.8±10.1 35.1±11.6 <0.0001 A B B LVEF (normal = 1, mild LV dysfunction = 2, moderate = 3, severe = 4) 1.0±0.2 1.0±0.2 1.0±0.2 0.80 A A A RA area (cm2) 26.1±9.6 19.5±6.6 19.2±6.7 <0.0001 A B B *One-way ANOVA comparison. ‡Tukey pairwise comparison between Echos 1, 2 and 3: means that do not share a letter are significantly different (i.e. p<0.05). Figure 1 Conclusions ASD closure or PVR are commonly associated with significant reduction of preoperative functional tricuspid regurgitation event amongst patients who did not undergo concomitant tricuspid valve surgery.

Tricuspid regurgitation severity after atrial septal defect closure or pulmonic valve replacement

Heart ◽  
2019 ◽  
Vol 106 (6) ◽  
pp. 455-461 ◽  
Author(s):  
Agustin C Martin-Garcia ◽  
Konstantinos Dimopoulos ◽  
Maria Boutsikou ◽  
Ana Martin-Garcia ◽  
Aleksander Kempny ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Valve Replacement ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
Valve Surgery ◽  
Pulmonic Valve ◽  
Tricuspid Valve Surgery ◽  
Asd Closure ◽  
Pulmonic Valve Replacement

ObjectivesCardiac surgery or catheter interventions are nowadays commonly performed to reduce volume loading of the right ventricle in adults with congenital heart disease. However, little is known, on the effect of such procedures on pre-existing tricuspid regurgitation (TR). We assessed the potential reduction in the severity of TR after atrial septal defect (ASD) closure and pulmonic valve replacement (PVR).MethodsDemographics, clinical and echocardiographic characteristics of consecutive patients undergoing ASD closure or PVR between 2005 and 2014 at a single centre who had at least mild preoperative TR were collected and analysed.ResultsOverall, 162 patients (mean age at intervention 41.6±16.1 years, 38.3% male) were included: 101 after ASD closure (61 transcatheter vs 40 surgical) and 61 after PVR (3 transcatheter vs 58 surgical). Only 11.1% received concomitant tricuspid valve surgery (repair). There was significant reduction in the severity of TR in the overall population, from 38 (23.5%) patients having moderate or severe TR preoperatively to only 11 (6.8%) and 20 (12.3%) at 6 months and 12 months of follow-up, respectively (McNemar p<0.0001). There was a significant reduction in tricuspid valve annular diameter (p<0.0001), coaptation distance (p<0.0001) and systolic tenting area (p<0.0001). The reduction in TR was also observed in patients who did not have concomitant tricuspid valve (TV) repair (from 15.3% to 6.9% and 11.8% at 6 and 12 months, respectively, p<0.0001). On multivariable logistic regression including all univariable predictors of residual TR at 12 months, only RA area remained in the model (OR 1.2, 95% CI 1.04 to 1.37, p=0.01).ConclusionsASD closure and PVR are associated with a significant reduction in tricuspid regurgitation, even among patients who do not undergo concomitant tricuspid valve surgery.

scholarly journals Tricuspid Valve Intervention at the Time of Pulmonary Valve Replacement in Adults With Congenital Heart Disease: A Systematic Review and Meta‐Analysis

2021 ◽  
Author(s):  
Jef Van den Eynde ◽  
Connor P. Callahan ◽  
Mauro Lo Rito ◽  
Nabil Hussein ◽  
Horacio Carvajal ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Right Ventricular ◽  
Valve Replacement ◽  
Tricuspid Valve ◽  
Congenital Heart ◽  
Pulmonary Valve ◽  
Meta Analysis ◽  
Pulmonary Valve Replacement ◽  
Valve Surgery

Background Tricuspid regurgitation (TR) is a common finding in adults with congenital heart disease referred for pulmonary valve replacement (PVR). However, indications for combined valve surgery remain controversial. This study aimed to evaluate early results of concomitant tricuspid valve intervention (TVI) at the time of PVR. Methods and Results Observational studies comparing TVI+PVR and isolated PVR were identified by a systematic search of published research. Random‐effects meta‐analysis was performed, comparing outcomes between the 2 groups. Six studies involving 749 patients (TVI+PVR, 278 patients; PVR, 471 patients) met the eligibility criteria. In the pooled analysis, both TVI+PVR and PVR reduced TR grade, pulmonary regurgitation grade, right ventricular end‐diastolic volume, and right ventricular end‐systolic volumes. TVI+PVR, but not PVR, was associated with a decrease in tricuspid valve annulus size (mean difference, −6.43 mm, 95% CI, −10.59 to −2.27; P =0.010). Furthermore, TVI+PVR was associated with a larger reduction in TR grade compared with PVR (mean difference, −0.40; 95% CI, −0.75 to −0.05; P =0.031). No evidence could be established for an effect of either treatment on right ventricular ejection fraction or echocardiographic assessment of right ventricular dilatation and dysfunction. There was no evidence for a difference in hospital mortality or reoperation for TR. Conclusions While both strategies are effective in reducing TR and right ventricular volumes, routine TVI+PVR can reduce TR grade to a larger extent than isolated PVR. Further studies are needed to identify the subgroups of patients who might benefit most from combined valve surgery.

Surgical Strategy in Patients with Atrial Septal Defect and Severe Pulmonary Hypertension

2012 ◽  
Vol 15 (2) ◽  
pp. 111 ◽  
Author(s):  
Yang Hyun Cho ◽  
Tae-Gook Jun ◽  
Ji-Hyuk Yang ◽  
Pyo Won Park ◽  
June Huh ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Atrial Septal Defect ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
Maze Procedure ◽  
Severe Pulmonary Hypertension ◽  
Tricuspid Annuloplasty ◽  
Pulmonary Arterial ◽  
Asd Closure

The aim of the study was to review our experience with atrial septal defect (ASD) closure with a fenestrated patch in patients with severe pulmonary hypertension. Between July 2004 and February 2009, 16 patients with isolated ASD underwent closure with a fenestrated patch. All patients had a secundum type ASD and severe pulmonary hypertension. Patients ranged in age from 6 to 57 years (mean � SD, 34.9 � 13.5 years). The follow-up period was 9 to 59 months (mean, 34.5 � 13.1 months). The ranges of preoperative systolic and pulmonary arterial pressures were 63 to 119 mm Hg (mean, 83.8 � 13.9 mm Hg) and 37 to 77 mm Hg (mean, 51.1 � 10.1 mm Hg). The ranges of preoperative values for the ratio of the pulmonary flow to the systemic flow and for pulmonary arterial resistance were 1.1 to 2.7 (mean, 1.95 � 0.5) and 3.9 to 16.7 Wood units (mean, 9.8 � 2.9 Wood units), respectively. There was no early or late mortality. Tricuspid annuloplasty was performed in 14 patients (87.5%). The peak tricuspid regurgitation gradient and the ratio of the systolic pulmonary artery pressure to the systemic arterial pressure were decreased in all patients. The New York Heart Association class and the grade of tricuspid regurgitation were improved in 13 patients (81.2%) and 15 patients (93.7%), respectively. ASD closure in patients with severe pulmonary hypertension can be performed safely if we create fenestration. Tricuspid annuloplasty and a Cox maze procedure may improve the clinical result. Close observation and follow-up will be needed to validate the long-term benefits.

Combined hybrid pulmonary valve placement and atrial septal defect closure: case report and literature review

2020 ◽  
Vol 30 (5) ◽  
pp. 737-739
Author(s):  
Omar Abu-Anza ◽  
Kaitlin Carr ◽  
Osamah Aldoss
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Volume Overload ◽  
Pulmonary Valve Replacement ◽  
Device Closure ◽  
Atrial Septal Defect Closure ◽  
Valve Placement ◽  
The Right

AbstractWe report a case of a 15-year-old female who underwent combined hybrid pulmonary valve replacement and transcatheter atrial septal defect device closure, which was performed due to severe volume overload of the right side of the heart secondary to pulmonary regurgitation and atrial septal defect.

P5566Prognostic value of quantitative assessment of tricuspid regurgitation. Correlation between echocardiography and cardiac magnetic resonance

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Hinojar Baydes ◽  
A Garcia Martin ◽  
A Gonzalez-Gomez ◽  
G Alonso-Salinas ◽  
M Plaza-Martin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Valve Surgery ◽  
Regurgitant Fraction ◽  
End Point ◽  
Tricuspid Valve Surgery ◽  
Poor Outcomes

Abstract Background Significant tricuspid regurgitation (TR) is related to poor prognosis independently of the etiology. TR severity and right ventricular (RV) size and function are determinant in the evaluation of patients with RT and are independently related to outcomes. While TR severity is commonly evaluated with echocardiography (echo), cardiac magnetic resonance (CMR) is the gold standard to study the RV. The association between CMR and echocardiographic measures of quantitative TR is unknown. Purpose Our aim was to evaluate the association between the most commonly used methods in both techniques: biplane vena contracta (VC) and effective regurgitant orifice (ERO) parameters evaluated by echo and TR volume (TRV) and TR regurgitant fraction (TRF) by CMR; secondly we aimed to evaluate the prognostic value of each parameter. Methods Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 with a contemporaneous echo and CMR were included. TR severity was evaluated by VC and ERO method, using EPIQ system and by VRF and TRF using a 1.5 Tesla CMR Philips scanner. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure. Results A total of 36 patients were included (mean age was 72±7 years, 72% females, 94% functional TR). Both VC and ERO showed moderate to strong and significant correlations with VRF and TRF (table). During a median follow up of 20 months [IQR: 10–29], 38% of the patients reached the combined end point (n=7 developed right heart failure, n=11 underwent tricuspid valve surgery, and n=2 died). Patients with events showed a larger ERO and higher VRF and TRF (p<0.01 for all) and a tendency to larger VC (p=0.06). PISA, VRF and TRF were prognostic factors of the combined endpoint (PISA per 0.1 cm2, HR: 282 [3.9–20362], p=0.01; VC per 1 mm, HR 1.27 [0.98–1.64] p=0.06; VRF per 1ml: HR: 1.02 [1.005–1.025], p=0.003; FRT per 1%, HR: 219.5 [4.8–9897], p=0.06). A value of PISA of 0.42, of VRF of 46 ml and FRV of 43% reached the best accuracy to predicted poor outcomes (p<0.01 for all). Table 1. Bivariate correlations ERO VC Regurgitant volume by CMR R=0.57, p=0.004 R=0.55, p=0.003 Regurgitant fraction by CMR R=0.61, p<0.001 R=0.56, p=0.01 Conclusion Validated echocardiographic parameters of TR are significantly correlated with quantitative measures by CMR. PISA by echo, and VRF and FRV by CMR are predictive of impaired prognosis. Further studies confirming our CMR cut-off values of poor outcomes are needed for clinical implementation.

Surgically treated pulmonary stenosis: over 50 years of follow-up

2015 ◽  
Vol 26 (5) ◽  
pp. 860-866 ◽  
Author(s):  
Eva A. Nielsen ◽  
Vibeke E. Hjortdal
Keyword(s):  
Right Ventricular ◽  
Valve Replacement ◽  
Tricuspid Regurgitation ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
Ventricular Dilatation ◽  
Right Ventricular Dilatation

AbstractBackgroundSurgical correction was the treatment of choice for pulmonary stenosis until three decades ago, when balloon valvuloplasty was implemented. The natural history of surgically relieved pulmonary stenosis has been considered benign but is actually unknown, as is the need for re-intervention.The objective of this study was to investigate the morbidity and mortality of patients with surgically treated pulmonary stenosis operated at Aarhus University Hospital between 1957 and 2000.ResultsThe total study population included 80 patients. In-hospital mortality was 2/80 (2.5%), and an additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most common re-intervention (67%). Freedom from re-intervention decreased >20 years after the initial repair. In addition, 45% of patients had moderate/severe pulmonary regurgitation, 38% had some degree of right ventricular dilatation, and 40% had some degree of tricuspid regurgitation, which did not require re-intervention at the present stage.ConclusionSurgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured.

scholarly journals Outcomes of Isolated Tricuspid Valve Surgery

2020 ◽  
Vol 23 (6) ◽  
pp. E763-E769
Author(s):  
Gemma Sánchez-Espín ◽  
Jorge Rodríguez-Capitán ◽  
Juan José Otero Forero ◽  
Víctor Manuel Becerra Muñoz ◽  
Emiliano Andrés Rodríguez Caulo ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Functional Class ◽  
Valve Surgery ◽  
Perioperative Mortality ◽  
Severe Tricuspid Regurgitation ◽  
Tricuspid Valve Surgery ◽  
Long Term Mortality

Background: Isolated tricuspid valve surgery is a rarely performed procedure and traditionally is associated with a bad prognosis, although its clinical outcomes still are little known. The aim of this study was to assess the short- and long-term clinical outcomes obtained at our center after isolated tricuspid valve surgery as treatment for severe tricuspid regurgitation. Methods: This retrospective study included 71 consecutive patients with severe tricuspid regurgitation who underwent isolated tricuspid valve surgery between December 1996 and December 2017. Perioperative and long-term mortality, tricuspid valve reoperation, and functional class were analyzed after follow up. Results: Regarding surgery, 7% of patients received a De Vega annuloplasty, 14.1% an annuloplasty ring, 11.3% a mechanical prosthesis, and 67.6% a biological prosthesis. Perioperative mortality was 12.7% and no variable was shown to be predictive of this event. After a median follow up of 45.5 months, long-term mortality was 36.6%, and the multivariate analysis identified atrial fibrillation as the only predictor (Hazard Ratio 3.014, 95% confidence interval 1.06-8.566; P = 0.038). At the end of follow up, 63.6% of survivors had functional class I. Conclusions: Isolated tricuspid valve surgery was infrequent in our center. Perioperative mortality was high, as was long-term mortality. However, a high percentage of survivors were barely symptomatic after follow up.

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