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.

scholarly journals Haemodynamic determinants of improved aerobic capacity after tricuspid valve surgery in Ebstein anomaly

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317756
Author(s):  
Alexander Egbe ◽  
William Miranda ◽  
Heidi Connolly ◽  
Joseph Dearani
Keyword(s):  
Relative Risk ◽  
Tricuspid Valve ◽  
Aerobic Capacity ◽  
Tricuspid Regurgitation ◽  
Valve Surgery ◽  
Ebstein Anomaly ◽  
Severe Tricuspid Regurgitation ◽  
Tricuspid Valve Surgery ◽  
Postoperative Improvement

BackgroundAlthough tricuspid valve surgery improves functional capacity in patients with Ebstein anomaly, it is not always associated with improvement in aerobic capacity. The purpose of this study was to identify the determinants of improved aerobic capacity after tricuspid valve surgery in adults with Ebstein anomaly with severe tricuspid regurgitation.MethodsRetrospective study of patients with severe tricuspid regurgitation due to Ebstein anomaly that had tricuspid valve surgery at Mayo Clinic Rochester (2000–2019) and had preoperative and postoperative cardiopulmonary exercise tests and echocardiograms. The patients were divided into aerobic capacity(+) and aerobic capacity(-) groups depending on whether they had postoperative improvement in %-predicted peak oxygen consumption (VO2).ResultsOf 76 patients with severe tricuspid regurgitation due to Ebstein anomaly, 28 (37%) and 48 (63%) were in aerobic capacity(+) and aerobic capacity(-) groups, respectively. The average improvement in peak VO2 was 2.1±1.4 mL/kg/min and −0.9±0.4 mL/kg/min in the in aerobic capacity(+) and aerobic capacity(-) groups, respectively. Although both groups had similar severity of residual tricuspid regurgitation, the aerobic capacity(+) group had more postoperative improvement in right atrial (RA) function, left atrial (LA) function and left ventricular preload and stroke volume. Of the preoperative variables analysed, RA reservoir strain (relative risk 1.12; 95% CI 1.06 to 1.18); LA reservoir strain (relative risk 1.09; 95% CI 1.04 to 1.14) and LV stroke volume index (OR 1.04; 95% CI 1.01 to 1.07) were predictors of postoperative improvement in peak VO2.ConclusionsOne-third of patients with severe tricuspid regurgitation due to Ebstein anomaly had postoperative improvement in aerobic capacity, and atrial function indices were the best predictors of postoperative improvement in aerobic capacity. These data provide new insight into the haemodynamic determinants of exercise capacity and lay the foundation for further studies to determine whether postoperative improvement in aerobic capacity translates to improved long-term survival, and whether timing of tricuspid valve surgery based on these echocardiographic indices will improve long-term outcomes.

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 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 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.

scholarly journals P288 Prognostic role of hemoglobin levels in patients with severe tricuspid regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Garcia Martin ◽  
R Hinojar ◽  
A Gonzalez Gomez ◽  
M Plaza Martin ◽  
M Pascual Izco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Ejection Fraction ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Valve Surgery ◽  
Therapeutic Options ◽  
Severe Tricuspid Regurgitation ◽  
End Point ◽  
Tricuspid Valve Surgery

Abstract Background Patients with severe tricuspid regurgitation (TR) frequently develop heart failure (HF) and their surgical therapeutic options are limited because of very high or prohibitive risk. According to the 2016 ESC guidelines for HF, anaemia and iron deficiency are associated with worse prognosis and intravenous iron therapy should be considered in symptomatic patients with HF reduced ejection fraction (HFrEF) in order to alleviate symptoms, improve exercise capacity and quality of life. The effect of treating iron deficiency in HF preserved ejection fraction (HFpEF) is unknown. The purpose of this study was to analyze the correlation between levels of hemoglobin (Hb) and the prognosis in patients with severe TR and preserve EF. Methods Consecutive patients with significant TR (moderate to severe or severe by echocardiography) evaluated in the Heart Valve Clinic between 2015-2018 were included. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure. Results A total of 70 patients were included (mean age was 74± 8 years, 71% females). According to aetiology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). Mean left ventricular ejection fraction was 56,5% ±6,7%. During a median follow up of 18 months [IQR: 4-28], 35% of the patients reached the combined end-point (n = 16 developed right HF, n = 17 underwent tricuspid valve surgery, and n = 3 died). Patients with events showed lower Hb values (p = 0.04). The level of anaemia was a prognostic factor of the combined endpoint (per gr/dl, HR 0.77 [0-61-0.98], p = 0.036). Conclusion Hemoglobin is predictive of poor outcomes in patients with significant TR. According to these preliminary results, iron deficiency could be a therapeutic target in this subgroup of patients with limited therapeutic options.

scholarly journals Stepwise Progression of Right-to-Left Atrial Shunting through a Combination of Patent Foramen Ovale and Tricuspid Regurgitation

2016 ◽  
Vol 43 (2) ◽  
pp. 171-174
Author(s):  
Evan P. Kransdorf ◽  
Lisa N. Kransdorf ◽  
F. David Fortuin ◽  
John P. Sweeney ◽  
Susan Wilansky
Keyword(s):  
Tricuspid Regurgitation ◽  
Left Atrial ◽  
Patent Foramen Ovale ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Severe Tricuspid Regurgitation ◽  
Occluder Device ◽  
Clinically Significant ◽  
Ischemic Attack ◽  
Common Clinical Finding

Patent foramen ovale is a common clinical finding that generally becomes a concern in the presence of transient ischemic attack or stroke. Rarely, patent foramen ovale is associated with hypoxemia in the presence of substantial right-to-left atrial shunting. We present the case of an 86-year-old woman with a pacemaker, who was initially asymptomatic notwithstanding a patent foramen ovale. Over 1.5 years, her symptoms progressed in a stepwise fashion, in the setting of progressive pacemaker-associated tricuspid regurgitation. Ultimately, the patient's symptoms and her hypoxemia resolved after percutaneous closure of her patent foramen ovale with use of a 25-mm “Cribriform” occluder device. This case highlights the fact that clinically significant right-to-left shunting requires an anatomic lesion, such as patent foramen ovale, together with elevated right atrial pressure, which in this case was contributed by severe tricuspid regurgitation.

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