Percutaneous Inferior Vena Cava Valve Implantation May Improve Tricuspid Valve Regurgitation and Cardiac Output: Lessons Learned

2020 ◽  
Vol 15 (6) ◽  
pp. 577-580
Author(s):  
Seyed Hossein Aalaei-Andabili ◽  
Anthony A. Bavry ◽  
Calvin Choi ◽  
George Arnaoutakis ◽  
R. David Anderson ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Inferior Vena Cava ◽  
Tricuspid Valve ◽  
Inferior Vena ◽  
Vena Cava ◽  
Left Ventricular Ejection ◽  
Valve Regurgitation ◽  
Tricuspid Valve Regurgitation ◽  
Transcatheter Valve ◽  
Valve Implantation

Tricuspid valve regurgitation (TR) can be associated with poor prognosis. Transcatheter valve technology was adopted to treat the upstream effects of severe TR by placing a transcatheter valve in the inferior vena cava (IVC). In this study, we report off-label transcatheter valve implantation into the stented IVC in patients with severe TR for compassionate use. From September 2018 to February 2020, 6 inoperable patients with severe TR who failed medical treatment underwent percutaneous caval valve implantation (CAVI). Severity of TR was confirmed by intraoperative transesophageal echocardiography. Z-stents (Cook, Inc., Bloomington, IN, USA) were placed in the proximal IVC, and then a transcatheter valve was deployed in the suprahepatic cava without rapid pacing. Six patients, 2 females and 4 males, with a mean ± SD age of 74.7 ± 8.0 years were included. The procedure was successfully performed in all 6 patients (100%) employing a 29-mm SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) with supranominal volume. No procedural complication was detected. At 30 days, TR improved from severe to trace in 1 patient, to mild-moderate in 3 patients, and 2 patients remained with severe TR. Among patients with improved TR, left ventricular ejection fraction increased from 47.5% ± 18.5% to 55% ± 20.4% ( P = 0.014). No patient had readmission at 30 days. Four patients needed rehospitalization within 6 months. Percutaneous CAVI is feasible and can be considered as a short-term palliative measure in patients with severe TR. CAVI can improve TR and potentially improve cardiac output in selected patients.

scholarly journals Transcatheter valve implantation to inferior vena cava to control carcinoid symptoms

2017 ◽  
pp. bcr-2017-220888
Author(s):  
Vandana M Sagar ◽  
Richard P Steeds ◽  
Sagar N Doshi ◽  
Tahir Shah
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Transcatheter Valve ◽  
Valve Implantation

scholarly journals Do changes in pulse pressure variation and inferior vena cava distensibility during passive leg raising and tidal volume challenge detect preload responsiveness in case of low tidal volume ventilation?

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Temistocle Taccheri ◽  
Francesco Gavelli ◽  
Jean-Louis Teboul ◽  
Rui Shi ◽  
Xavier Monnet
Keyword(s):  
Cardiac Output ◽  
Inferior Vena Cava ◽  
Tidal Volume ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Inferior Vena ◽  
Vena Cava ◽  
Pressure Variation ◽  
Diagnostic Threshold ◽  
Preload Responsiveness

Abstract Background In patients ventilated with tidal volume (Vt) < 8 mL/kg, pulse pressure variation (PPV) and, likely, the variation of distensibility of the inferior vena cava diameter (IVCDV) are unable to detect preload responsiveness. In this condition, passive leg raising (PLR) could be used, but it requires a measurement of cardiac output. The tidal volume (Vt) challenge (PPV changes induced by a 1-min increase in Vt from 6 to 8 mL/kg) is another alternative, but it requires an arterial line. We tested whether, in case of Vt = 6 mL/kg, the effects of PLR could be assessed through changes in PPV (ΔPPVPLR) or in IVCDV (ΔIVCDVPLR) rather than changes in cardiac output, and whether the effects of the Vt challenge could be assessed by changes in IVCDV (ΔIVCDVVt) rather than changes in PPV (ΔPPVVt). Methods In 30 critically ill patients without spontaneous breathing and cardiac arrhythmias, ventilated with Vt = 6 mL/kg, we measured cardiac index (CI) (PiCCO2), IVCDV and PPV before/during a PLR test and before/during a Vt challenge. A PLR-induced increase in CI ≥ 10% defined preload responsiveness. Results At baseline, IVCDV was not different between preload responders (n = 15) and non-responders. Compared to non-responders, PPV and IVCDV decreased more during PLR (by − 38 ± 16% and − 26 ± 28%, respectively) and increased more during the Vt challenge (by 64 ± 42% and 91 ± 72%, respectively) in responders. ∆PPVPLR, expressed either as absolute or as percent relative changes, detected preload responsiveness (area under the receiver operating curve, AUROC: 0.98 ± 0.02 for both). ∆IVCDVPLR detected preload responsiveness only when expressed in absolute changes (AUROC: 0.76 ± 0.10), not in relative changes. ∆PPVVt, expressed as absolute or percent relative changes, detected preload responsiveness (AUROC: 0.98 ± 0.02 and 0.94 ± 0.04, respectively). This was also the case for ∆IVCDVVt, but the diagnostic threshold (1 point or 4%) was below the least significant change of IVCDV (9[3–18]%). Conclusions During mechanical ventilation with Vt = 6 mL/kg, the effects of PLR can be assessed by changes in PPV. If IVCDV is used, it should be expressed in percent and not absolute changes. The effects of the Vt challenge can be assessed on PPV, but not on IVCDV, since the diagnostic threshold is too small compared to the reproducibility of this variable. Trial registration: Agence Nationale de Sécurité du Médicament et des Produits de santé: ID-RCB: 2016-A00893-48.

Increased pulmonary vascular resistance and reduced stroke volume in association with CO2retention and inferior vena cava dilatation

2006 ◽  
Vol 101 (3) ◽  
pp. 866-872 ◽  
Author(s):  
Darija Baković ◽  
Davor Eterović ◽  
Zoran Valic ◽  
Žana Saratlija-Novaković ◽  
Ivan Palada ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Inferior Vena Cava ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Inferior Vena ◽  
Vena Cava ◽  
Arterial Oxygen ◽  
Breath Holding ◽  
Oxygen Saturation Level ◽  
The Impact

Changes in cardiovascular parameters elicited during a maximal breath hold are well described. However, the impact of consecutive maximal breath holds on central hemodynamics in the postapneic period is unknown. Eight trained apnea divers and eight control subjects performed five successive maximal apneas, separated by a 2-min resting interval, with face immersion in cold water. Ultrasound examinations of inferior vena cava (IVC) and the heart were carried out at times 0, 10, 20, 40, and 60 min after the last apnea. The arterial oxygen saturation level and blood pressure, heart rate, and transcutaneous partial pressures of CO2and O2were monitored continuously. At 20 min after breath holds, IVC diameter increased (27.6 and 16.8% for apnea divers and controls, respectively). Subsequently, pulmonary vascular resistance increased and cardiac output decreased both in apnea divers (62.8 and 21.4%, respectively) and the control group (74.6 and 17.8%, respectively). Cardiac output decrements were due to reductions in stroke volumes in the presence of reduced end-diastolic ventricular volumes. Transcutaneous partial pressure of CO2increased in all participants during breath holding, returned to baseline between apneas, but remained slightly elevated during the postdive observation period (∼4.5%). Thus increased right ventricular afterload and decreased cardiac output were associated with CO2retention and signs of peripheralization of blood volume. These results indicate that repeated apneas may cause prolonged hemodynamic changes after resumption of normal breathing, which may suggest what happens in sleep apnea syndrome.

scholarly journals Atresia of the inferior vena cava in a patient undergoing mitral and tricuspid valve surgery

2018 ◽  
Vol 28 (2) ◽  
pp. 324-326
Author(s):  
Ayse Cetinkaya ◽  
Peter Bramlage ◽  
Markus Schönburg ◽  
Manfred Richter
Keyword(s):  
Inferior Vena Cava ◽  
Tricuspid Valve ◽  
Inferior Vena ◽  
Vena Cava ◽  
Valve Surgery ◽  
Tricuspid Valve Surgery

scholarly journals Respiratory Variations in Electrocardiographic R-Wave Amplitude during Acute Hypovolemia Induced by Inferior Vena Cava Clamping in Patients Undergoing Liver Transplantation

2019 ◽  
Vol 8 (5) ◽  
pp. 717
Author(s):  
Hee-Sun Park ◽  
Sung-Hoon Kim ◽  
Yong-Seok Park ◽  
Robert H. Thiele ◽  
Won-Jung Shin ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Cardiac Output ◽  
Inferior Vena Cava ◽  
Wave Amplitude ◽  
Inferior Vena ◽  
Vena Cava ◽  
Area Under The Curve ◽  
Dynamic Parameter ◽  
Cutoff Value ◽  
R Wave Amplitude

The aim of this study was to analyze whether the respiratory variation in electrocardiogram (ECG) standard lead II R-wave amplitude (ΔRDII) could be used to assess intravascular volume status following inferior vena cava (IVC) clamping. This clamping causes an acute decrease in cardiac output during liver transplantation (LT). We retrospectively compared ΔRDII and related variables before and after IVC clamping in 34 recipients. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to derive a cutoff value of ΔRDII for predicting pulse pressure variation (PPV). After IVC clamping, cardiac output significantly decreased while ΔRDII significantly increased (p = 0.002). The cutoff value of ΔRDII for predicting a PPV >13% was 16.9% (AUC: 0.685) with a sensitivity of 57.9% and specificity of 77.6% (95% confidence interval 0.561 – 0.793, p = 0.015). Frequency analysis of ECG also significantly increased in the respiratory frequency band (p = 0.016). Although significant changes in ΔRDII during vena cava clamping were found at norepinephrine doses <0.1 µg/kg/min (p = 0.032), such changes were not significant at norepinephrine doses >0.1 µg/kg/min (p = 0.093). ΔRDII could be a noninvasive dynamic parameter in LT recipients presenting with hemodynamic fluctuation. Based on our data, we recommended cautious interpretation of ΔRDII may be requisite according to vasopressor administration status.

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