scholarly journals 732 TEE role in patients selection for transcatheter edge to edge tricuspid repair

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Aurelio De Filippis ◽  
Edoardo Nobile ◽  
Luca Paolucci ◽  
Luka Vitez ◽  
Maria Caterina Bono ◽  
...  
Keyword(s):  
Ct Scan ◽  
Tricuspid Valve ◽  
Vena Cava ◽  
Real Life ◽  
Pacemaker Lead ◽  
Catheterization Laboratory ◽  
Functional Tricuspid Regurgitation ◽  
Dismal Prognosis ◽  
Procedural Success ◽  
The Right

Abstract Aims The natural history of tricuspid valve (TV) regurgitation is characterized by dismal prognosis and high in-hospital mortality when treated with isolated TV surgery. Although the anatomy and the imaging of the TV are very challenging, the edge-to-edge repair with the TriClip (Abbott Vascular, Santa Clara, CA) showed promising results. We report preliminary results of our experience with the TriClip System in a cohort of ‘real life’ patients with functional tricuspid regurgitation (TR). Methods and results From January to September 2021, 30 consecutive patients with severe TR has been screened, 8 underwent transcatheter TriClip repair. The anatomical feasibility was established according to a complete transesophageal echocardiogram (TEE) and a dedicated CT scan for the right cardiac chambers. All the echocardiographic projections focused on right ventricle were used during the procedure, with the aim of optimizing the visualization of the catheters and device with respect to the anatomical structures of the tricuspid valve complex. The procedure was conducted under general anesthesia, guided by TEE and fluoroscopy. In-hospital and 30-day clinical and echocardiographic outcomes were recorded. The annulus septo-lateral diameter was enlarged in all cases, and functional TR was present in all patients. In two patients, the pacemaker lead interfered with leaflets coaptation. TR jet was predominantly central. The implant and procedural success were achieved in all cases, implanting one device in five patients and two in three patients. The final TR grade was 2+ in four patients and and 1+ in the others. All patients were extubated in the catheterization laboratory. There were no procedural or in-hospital adverse events. At 30-day follow-up, we observed significant improvement in clinical and echocardiographic outcomes. Conclusions In our experience, 26% of screened patients were selected for the procedure. Favourable anatomical findings for the TV edge-to-edge repair were the following: moderate leaflet tethering (coaptation depth <10 mm); large annulus but with small coaptation gap (<7 mm); antero-septal or postero-septal jet location; commissural jet; small right ventricular dimensions; pacemaker lead with no leaflet tethering. The best transcatheter approach consists of obliterating the antero-septal coaptation rim for a more favourable angle between the inferior vena cava and valvular plane. High-quality TEE imaging during the procedure is required for obtaining procedural success. Patient selection and tricuspid valve anatomy characterization with TEE and cardiac CT scan is critical for procedural success and clinical improvements.

Perimeter of The Tricuspid Valve: A Cadaveric Human Heart Study

2020 ◽  
Vol 11 (3) ◽  
pp. 3424-3428
Author(s):  
Kirti Chaudhary ◽  
Amey Dhatrak ◽  
Brij Raj Singh ◽  
Ujwal Gajbe
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Right Ventricular Dysfunction ◽  
Mean Value ◽  
Female Population ◽  
Functional Tricuspid Regurgitation ◽  
Lv Dysfunction ◽  
Heart Study ◽  
Males And Females ◽  
The Right

Historically, the research on the right ventricle (RV) has been neglected by his left equivalent because of the complexity of left ventricle (LV) dysfunction. Tricuspid regurgitation (TR) can be classified as linked to primary valve disease or functional in nature, but most are functional. Although it was historically assumed that such functional Tricuspid regurgitation, i.e. arising from leftsided disease, and it can be resolved after corrective surgery, but after successful surgery, on the aortic or mitral valve annular dilatation, the Tricuspid regurgitation and right ventricular dysfunction may persist.To study the circumference of tricuspid orifice and it’s the diameter in two perpendicular planes and its comparison among the male and female population. The material for the present study comprised of 50 formalin fixed human hearts (35 males and 15 females) which were obtained from the department of anatomy. In this study, it is observed that: The mean value of circumference of a tricuspid orifice is 11.01+/-0.63 cm. The diameter of tricuspid orifice along the frontal dimension is 3.06+/-0.38 cm, and the diameter along the sagittal dimension is 2.26+/-0.23 cm. The measurements of the circumference of tricuspid orifice reported for males and females in western countries were higher than the present study and the diameter along the frontal dimension is greater than the diameter along the sagittal dimension. The tricuspid valve diameter along the frontal dimension was more than the diameter along the sagittal dimension in both males and females.

Morphometric Characterization and Finite Element Modeling of the Physiological Tricuspid Valve

2009 ◽  
Author(s):  
Marco Stevanella ◽  
Emiliano Votta ◽  
Massimo Lemma ◽  
Carlo Antona ◽  
Alberto Redaelli
Keyword(s):  
Finite Element ◽  
Tricuspid Valve ◽  
Heart Valves ◽  
Heart Surgery ◽  
Biomechanical Analysis ◽  
Left Heart ◽  
Mortality And Morbidity ◽  
Functional Tricuspid Regurgitation ◽  
Underlying Mechanisms ◽  
The Right

The tricuspid valve (TV) is the right atrio-ventricular valve. The most common TV disease is secondary or functional tricuspid regurgitation (FTR), an important complication of left-sided valvular heart lesions, which frequently persists after mitral and aortic valve operations. FTR is associated with high mortality and morbidity and requires surgical intervention, the preferential solution being TV repair through techniques such as annuloplasty performed during left heart surgery. However, significant residual regurgitation persists or recurs in 10% to 20% after annuloplasty, thus highlighting the incomplete understanding of the underlying mechanisms and the need for deeper insight into TV pathophysiology. At this purpose finite element models (FEMs) could be adopted, as suggested by their effective application to the biomechanical analysis of left heart valves. However, while for those several data are available regarding morphology and tissue mechanical properties, such information is missing for the TV, making it difficult to implement a FEM of the TV.

Heart valve disease: tricuspid valve disease

2016 ◽  
Author(s):  
Denisa Muraru ◽  
Ashraf M. Anwar ◽  
Jae-Kwan Song
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Imaging Modality ◽  
Three Dimensional ◽  
Valve Disease ◽  
Heart Valve Disease ◽  
Functional Tricuspid Regurgitation ◽  
Valve Pathology ◽  
Three Dimensional Echocardiography ◽  
The Right

The tricuspid valve is currently the subject of much interest from echocardiographers and surgeons. Functional tricuspid regurgitation is the most frequent aetiology of tricuspid valve pathology, is characterized by structurally normal leaflets, and is due to annular dilation and/or leaflet tethering. A primary cause of tricuspid regurgitation with/without stenosis can be identified only in a minority of cases. Echocardiography is the imaging modality of choice for assessing tricuspid valve diseases. It enables the cause to be identified, assesses the severity of valve dysfunction, monitors the right heart remodelling and haemodynamics, and helps decide the timing for surgery. The severity assessment requires the integration of multiple qualitative and quantitative parameters. The recent insights from three-dimensional echocardiography have greatly increased our understanding about the tricuspid valve and its peculiarities with respect to the mitral valve, showing promise to solve many of the current problems of conventional two-dimensional imaging. This chapter provides an overview of the current state-of-the-art assessment of tricuspid valve pathology by echocardiography, including the specific indications, strengths, and limitations of each method for diagnosis and therapeutic planning.

scholarly journals 757 Cardio-TC role in patients selection for transcatheter edge to edge tricuspid repair

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Edoardo Nobile ◽  
Valeria Cammalleri ◽  
Domenico De Stefano ◽  
Luka Vitez ◽  
Aurelio De Filippis ◽  
...  
Keyword(s):  
Spatial Resolution ◽  
Tricuspid Valve ◽  
High Spatial Resolution ◽  
Three Dimensional ◽  
Vena Cava ◽  
Endocardial Border ◽  
Centroid Distance ◽  
Study Population ◽  
Regurgitant Orifice Area ◽  
The Right

Abstract Aims Anatomic knowledge of the tricuspid valve (TV) is the first step in the management of patients with tricuspid regurgitation (TR) who are candidates for transcatheter tricuspid valve intervention (TTVI). Echocardiography is undoubtedly the first approach in assessing the aetiology and severity of TR and the size and function of the right chambers. Computed tomography (CT) provides a detailed morphological visualization of the cardiac structures owing to acquisition of 3D data with high spatial resolution. These findings may undoubtedly help in decision-making progress for novel transcatheter therapies. The purpose of the present study was to assess the geometrical changes of the TV complex using CT images, in patients suffering from functional TR and lead-induced TR. Methods The study population consisted of 21 consecutive patients with symptomatic severe TR referred to Policlinico Universitario Campus Biomedico between November 2020 and October 2021. Patients were prospectively included in the study only if they presented severe TR, diagnosed by echocardiography and underwent cardiac CT study dedicated to the right-chambers. The reconstructions were transferred to an external workstation for off-line image analysis. The following measurements were reported: tricuspid annulus area, perimeter, septal–lateral and antero-posterior diameters. Commissures were identified as antero-septal (AS), postero-septal (PS) and anteroposterior (AP). Were measured the inferior vena cava ostium to tricuspid valve centroid distance, anatomic regurgitant orifice area (AROA) and its position respect to the centroid, and the right chambers. Results All 21 patients underwent CT scan using Siemens SOMATOM Definition AS 128 Slice CT Machine. The measurements were calculated off-line using the 3mensio workstation. In our study population, the annulus resulted enlarged in the annulus area, perimeter, septal-lateral and anterior-posterior dimensions. Measurements did not differ significantly, except for the septal-lateral diameter that was smaller in systole (52.80 ± 7.28 mm vs. 47.83 ± 6.83 mm (P=0.027). Also, distances between the commissures were similar except for the AP-AS distance that was shorter in systole (45.26 ± 3.48 mm vs. 42.13 ± 3.73, P=0.007). The AROA resulted to be central in 7 patients, the IVC ostium to TV centroid distance was 23±3 mm. Right chambers and IVC resulted very enlarged in all patients. Conclusions CT provides a complete morphologic imaging of the heart structures, thanks to a high spatial resolution with excellent capacity to define the endocardial border and allows acquisition of three-dimensional data with high spatial resolution of the TV and provides valuable information about the geometric variations of the tricuspid complex in patients with TR. Image quality for analysis should be optimized with specific CT acquisition protocols that focus on the right ventricles.

scholarly journals Incidental Gossypiboma Discovered during Tricuspid Valve Re-Repair 11 Years after Ebstein Anomaly Repair

2013 ◽  
Vol 16 (4) ◽  
pp. 216 ◽  
Author(s):  
Tornike Sologashvili ◽  
Afksendiyos Kalangos ◽  
C�cile Tissot ◽  
Patrick O. Myers
Keyword(s):  
Cardiac Surgery ◽  
Tricuspid Valve ◽  
Superior Vena ◽  
Vena Cava ◽  
Granulomatous Reaction ◽  
Ebstein Anomaly ◽  
Surgical Sponge ◽  
Severe Tricuspid Regurgitation ◽  
Retained Surgical Sponge ◽  
The Right

<p><b>Background:</b> A retained surgical sponge, an extremely rare occurrence after cardiac surgery, can trigger a granulomatous reaction and form a sizeable mass or gossypiboma. We report the incidental operative finding of a gossypiboma 11 years after repair of Ebstein anomaly.</p><p><b>Case Report:</b> A 24-year-old man, who had previously undergone tricuspid annuloplasty for Ebstein anomaly 11 years earlier at another institution, was referred for recurrent severe tricuspid regurgitation. During the dissection along the superior vena cava and the right atrium, we entered 2 cystic cavities that exuded a pus-like material, which was sent for culture. Mesh from a retained surgical sponge (gossypiboma) was identified. After complete debridement and administration of vancomycin, the tricuspid valve was repaired. Antibiotics were continued until culture results were confirmed to be negative. The patient's postoperative course was uneventful, and he presented no signs of infection.</p><p><b>Conclusions:</b> We report a rare case of incidentally found gossypiboma after cardiac surgery.</p>

scholarly journals P1484 Unusual manifestation of constrictive pericarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Golinska Grzybala ◽  
A Gackowski
Keyword(s):  
Right Ventricle ◽  
Ct Scan ◽  
Constrictive Pericarditis ◽  
Vena Cava ◽  
Thick Layer ◽  
Lv Function ◽  
Hepatic Veins ◽  
Heart Team ◽  
Fatty Tissue ◽  
The Right

Abstract Introduction The objective of this case report is to highlight the difficulties in establishing the proper management in some patients with chronic constrictive pericarditis (CCP). Case Description A 67 year-old-man with a long history of COPD (stage D), coronary heart disease, diabetes mellitus type 2, prostate cancer treated with local radiotherapy and hormonotherapy, was admitted due to progressive fatigue and dyspnoea on exertion,. Three months before he was hospitalised in pulmonary ward because of sudden onset of severe dyspnoea with mild leg oedema, and unusually weak response for typical COPD treatment was observed. At this time local lab test revealed moderately elevated CRP (43.6 mg/l), ESR (36 mm) and NT-proBNP (483 pg/ml). CT scan was performed to exclude pulmonary embolism. No pericardial calcifications were noted. Physical examination showed obesity (33 kg/m2), heato-jugular reflux and mild ankle oedema. Chest auscultation revealed normal lungs sounds and muffled heart sounds. Pleural effusion was excluded and no ascites nor hepatomegaly was found. Echocardiography revealed typical changes for CCP prominent septal bounce during inspiration, annulus reversus (TDI e` lat 16 cm/sek; e` med 18 cm/sek), annulus paradoxus (E/e` 8), normal LV function, dilated vena cava inferior (VCI). MRI showed thickened pericardium (5mm) particularly near the right ventricle (RV) and thick layer of fatty tissue (15 mm) localised in pericardium, next to the RV free wall. RV was compressed (fig.1). LVEF was 63%, EDV 117 ml, SV 74 ml, SVi 33 ml/m2, LV mass 78 g; RV EF 71%, EDV 72 ml/m2, right atrium enlargement was found (38 cm2), while left atrium was of normal size (22 cm2). VCI and hepatic veins were dilated (29 mm and 13mm respectively. Fig 1. MRI – thickened pericardium containing thick fatty tissue causin with RV compression After diuretic uptitration, the dyspnoea improved to NYHA I/II. Due to clinical improvement heart team decided to continue medical treatment. Due to comorbidities (DM, COPD, obesity), the risk of pericardiectomy was considered high. Three month later the patient was hospitalized due to sudden dyspnoea and subsequent cardiac arrest. Despite cardiopulmonary resuscitation the patient died in ICU. CCP was confirmed in autopsy. Discussion The diagnosis of CCP remains challenging. In this case the presentation was not fully typical. There was no clear precipitating factor, the history was relatively short and the symptoms and signs mild. CT scan did not show pericardial calcifications. Although TTE revealed typical features of CCP and MRI confirmed compression of the right ventricle, the heart team did not confirm the need for pericardiectomy, which is treatment of choice in progressive CCP. Abstract P1484 Figure. Fig.1

scholarly journals Imaging in Circulatory Arrest: Lessons to be Learned

2019 ◽  
Vol 9 ◽  
pp. 44
Author(s):  
Anindita Sinha ◽  
Vikas Bhatia ◽  
Uma Debi ◽  
Lokesh Singh ◽  
Ashish Bhalla ◽  
...  
Keyword(s):  
Circulatory Arrest ◽  
Superior Vena ◽  
Vena Cava ◽  
Arterial System ◽  
Hepatic Veins ◽  
Dismal Prognosis ◽  
The Right ◽  
Imaging Signs ◽  
Age Range ◽  
Systemic Arteries

Objective: This study describes the computed tomography (CT) features in patients with cardiac or circulatory arrest. Methods: We retrospectively reviewed the CT of 5 patients (age range – 6–50 years) who had circulatory arrest while undergoing imaging, within a 12 month period in our Trauma and Emergency Centre. The presence or absence of contrast in the right and left chambers of heart, venous and arterial system, contrast density, and layering were assessed. Results: Contrast pooling and layering in superior vena cava, inferior vena cava, and right heart chambers were common (5/5 patients). Left heart chambers and systemic arteries were non-opacified. Reflux of contrast was seen in hepatic veins (4/5), portal vein, and renal veins (2/5 patients). Three patients showed pooling in lumbar and posterior external venous plexus. One patient showed contrast in splenic and superior mesenteric vein and two patients had dense opacification of pelvic veins. All patients had a dismal prognosis and died within 24 h. Conclusion: The absence of left-sided chamber opacification and layering and pooling of dense contrast in the venous system is specific imaging signs of circulatory arrest. These features need to be recognized immediately, scanning terminated, and resuscitation initiated.

Familial cardiomyopathies

2016 ◽  
Author(s):  
Fausto Rigo ◽  
Covadonga Fernández-Golfín ◽  
Bruno Pinamonti
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Imaging Modality ◽  
Three Dimensional ◽  
Functional Tricuspid Regurgitation ◽  
Dimensional Echocardiography ◽  
Valve Pathology ◽  
Three Dimensional Echocardiography ◽  
The Right ◽  
Valve Diseases

The tricuspid valve is currently the subject of much interest from echocardiographers and surgeons. Functional tricuspid regurgitation is the most frequent aetiology of tricuspid valve pathology, is characterized by structurally normal leaflets, and is due to annular dilation and/or leaflet tethering. A primary cause of tricuspid regurgitation with/without stenosis can be identified only in a minority of cases. Echocardiography is the imaging modality of choice for assessing tricuspid valve diseases. It enables the cause to be identified, assesses the severity of valve dysfunction, monitors the right heart remodelling and haemodynamics, and helps decide the timing for surgery. The severity assessment requires the integration of multiple qualitative and quantitative parameters. The recent insights from three-dimensional echocardiography have greatly increased our understanding about the tricuspid valve and its peculiarities with respect to the mitral valve, showing promise to solve many of the current problems of conventional two-dimensional imaging. This chapter provides an overview of the current state-of-the-art assessment of tricuspid valve pathology by echocardiography, including the specific indications, strengths, and limitations of each method for diagnosis and therapeutic planning.

scholarly journals Neonatal intra-atrial baffle repair for isolated ventricular inversion with left isomerism: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Yuta Kuwahara ◽  
Yukihiro Takahashi ◽  
Yuya Komori ◽  
Naohiro Kabuto ◽  
Naoki Wada
Keyword(s):  
Tricuspid Valve ◽  
Ductus Arteriosus ◽  
Median Sternotomy ◽  
Vena Cava ◽  
Corrective Surgery ◽  
Atrial Switch ◽  
Atrial Septostomy ◽  
Situs Ambiguous ◽  
The Right ◽  
Isolated Ventricular Inversion

Abstract Background Discordant atrioventricular connection with concordant ventriculoarterial connection, otherwise known as isolated ventricular inversion (IVI), is an extremely rare congenital cardiac malformation. Reports on the corrective surgery for this anomaly in neonates are few, and the procedure is difficult and complicated. Herein, we report our use of atrial septostomy as a palliative procedure followed by corrective surgery for the repair of neonatal IVI with situs ambiguous(inversus) morphology. Case presentation A 2-day-old girl weighing 3.5 kg was admitted to our hospital with a low oxygen saturation (SpO2) of 70% She was diagnosed with IVI [situs ambiguous(inversus), D-loop, and D-Spiral], atrial septal defect, patent ductus arteriosus (PDA), interrupted inferior vena cava with azygos continuation to the left superior vena cava (SVC), and polysplenia by transthoracic echocardiography and cardiac computed tomography. We planned to perform corrective surgery and decided to first increase interatrial mixing by performing surgical atrial septostomy and PDA ligation 7 days after birth. However, despite the surgical septostomy, pulmonary venous blood flowed toward the right ventricle via the tricuspid valve rather than toward the left-sided atrium and hypoxemia persisted. We decided to perform the intra-atrial switch procedure at the age of 17 days via a re-median sternotomy. The cardiopulmonary bypass (CPB) circuit was established with ascending aorta and venous drainage through the SVC and hepatic veins. Utilizing a left-sided atrium(l-A) approach, a bovine pericardial patch was used for the intra-atrial baffle, which was trimmed into a trouser-shaped patch. Continuous suture using the patch was lying from the front of the right-sided upper pulmonary vein and rerouted SVC, hepatic vein, and coronary sinus to the tricuspid valve. Overall, CPB weaning proceeded smoothly; however, direct current cardioversion was performed for junctional ectopic tachycardia. The postoperative course was uneventful. Her postoperative SpO2 improved (approximately 99–100%); overall, the patient showed clinical improvement. Discharge echocardiography showed normal biventricular function and an intact atrial baffle with no venoatrial or atrioventricular obstruction. Conclusion We successfully performed an intra-atrial switch procedure for isolated ventricular inversion in a neonate. Long-term follow-up will be necessary to ensure the maintenance of optimal cardiac function.

scholarly journals Non Surgical Management of Mini Guide Wire Embolism with Self Made Guide Wire Snare

2016 ◽  
Vol 9 (3) ◽  
Author(s):  
Shabbir H Sheikh ◽  
Muhammad Ashfaq ◽  
Abdul Rauf Sheikh ◽  
Muhammad Zubair
Keyword(s):  
Guide Wire ◽  
Superior Vena ◽  
Vena Cava ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Inferior Wall ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Temporary Pacing ◽  
The Right

A 5 3 years old male presented in emergency department of local hospital with acute inferior wall myocardial infarction During his initial course of treatment he dev eloped symptomatic bradycardia and 2:1 artioventricular block, for which he was tried for implantation of temporary pacing lead through right subclavian vein with 6 F venous sheath. During the procedure the operator embolized the J-tip mini guide wire in the heart, for which the patient was shifted to our hospital for the management of the embolised guide wire and coronary angiography. The patient was immediately brought to cardiac catheterization laboratory and the position of mini guide wire was located under fluoroscopy. Its upper end was lying near the junction of superior vena cava with right atrium and the lower end was in the right common iliac vein. Continued 

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