Surgical repair of massive dilatation of the right atrium with tricuspid regurgitation

Abstract Background Partial anomalous pulmonary venous connection draining into the right atrium with an intact atrial septum is a very rare clinical entity in the adult population. Partial anomalous pulmonary venous connection must be suspected as a differential diagnosis when the cause of right heart enlargement and pulmonary artery hypertension is unknown. Case presentation This study describes the surgical case of an isolated right partial anomalous pulmonary venous connection to the right atrium in a 68-year-old woman, who underwent tricuspid ring annuloplasty and right-sided maze procedure simultaneously. She had complaints of gradually progressing dyspnea on exertion. However, a diagnosis could not be established despite consultations at multiple hospitals for over a year. Right heart catheterization revealed severe pulmonary artery hypertension with a mean pulmonary artery pressure of 46 mmHg, step-up phenomenon of oxygen saturation at the mid-level of the right atrium with a pulmonary-to-systemic blood flow ratio of 2.4, and a pulmonary vascular resistance of 3.1 Wood Units. As medical treatment with pulmonary artery vasodilator therapy did not improve her symptoms, she underwent surgical repair. An atrial septal defect was created surgically with a curvilinear tongue-shaped cut. The right anomalous pulmonary veins were rerouted through the surgically created atrial septal defect into the left atrium with a baffle comprised of the interatrial septum flap, kept in continuity with the anterior margin and sutured while mobilizing the enlarged right atrium. The patient had an uneventful postoperative course and remains asymptomatic. Conclusions The described surgical technique could be considered an effective alternative for patients undergoing surgical repair for a partial anomalous pulmonary venous connection isolated to the right atrium. The indication for surgery must be judged on a case-by-case basis in these patients with prevalent systemic-to-pulmonary shunting.

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P189 Duplication of the tricuspid valve (DOTV): case report of a rare congenital anomaly

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.059 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Cited By ~ 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.

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Diagnosing tricuspid regurgitation by direct imaging of the regurgitant flow in the right atrium using contrast echocardiography

The American Journal of Cardiology ◽

10.1016/0002-9149(83)90530-1 ◽

1983 ◽

Vol 52 (8) ◽

pp. 1050-1053 ◽

Cited By ~ 7

Author(s):

Richard S. Meltzer ◽

Zvi Vered ◽

Patricia Benjamin ◽

Julius Hegesh ◽

Cees A. Visser ◽

...

Keyword(s):

Tricuspid Regurgitation ◽

Right Atrium ◽

Contrast Echocardiography ◽

Direct Imaging ◽

Regurgitant Flow ◽

The Right

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Repair of an Isolated Right Partial Anomalous Pulmonary Venous Connection by Rerouting Blood Flow Through an Interatrial Septum Flap in a 68-Year-Old-Woman: A Case Report

10.21203/rs.3.rs-39603/v1 ◽

2020 ◽

Author(s):

Atsushi Morishtia ◽

Ikuo Hagino ◽

Hideyuki Tomioka ◽

Seiichiro Katahira ◽

Takeshi Hoshino ◽

...

Keyword(s):

Blood Flow ◽

Pulmonary Artery ◽

Right Atrium ◽

Septal Defect ◽

Surgical Repair ◽

Interatrial Septum ◽

Pulmonary Artery Hypertension ◽

Right Heart ◽

The Right ◽

Anomalous Pulmonary Venous Connection

Abstract Background: Partial anomalous pulmonary venous connection draining into the right atrium with an intact atrial septum is a very rare clinical entity in the adult population. Partial anomalous pulmonary venous connection must be suspected as a differential diagnosis when the cause of right heart enlargement and pulmonary artery hypertension is unknown.Case presentation: This study describes the surgical case of an isolated right partial anomalous pulmonary venous connection to the right atrium in a 68-year-old woman, who underwent tricuspid ring annuloplasty and right-sided maze procedure simultaneously. She had complaints of gradually progressing dyspnea on exertion. However, a diagnosis could not be established despite consultations at multiple hospitals for over a year. Right heart catheterization revealed severe pulmonary artery hypertension with a mean pulmonary artery pressure of 46 mmHg, step-up phenomenon of oxygen saturation at the mid-level of the right atrium with a pulmonary-to-systemic blood flow ratio of 2.4, and a pulmonary vascular resistance of 3.1 Wood Units. In addition, it was mandatory to comprehensively utilize valuable imaging modalities, such as transthoracic echocardiography, transesophageal echocardiography, and multidetector computed tomography angiography for the accurate diagnosis and efficient surgical planning of this partial anomalous pulmonary venous connection. As medical treatment with pulmonary artery vasodilator therapy did not improve her symptoms, she underwent surgical repair. An atrial septal defect was created surgically with a curvilinear tongue-shaped cut. The right anomalous pulmonary veins were rerouted through the surgically created atrial septal defect into the left atrium with a baffle comprised of the interatrial septum flap, kept in continuity with the anterior margin and sutured while mobilizing the enlarged right atrium. The patient had an uneventful postoperative course and remains asymptomatic. Conclusions: The described surgical technique could be considered an effective alternative for patients undergoing surgical repair for a partial anomalous pulmonary venous connection isolated to the right atrium. The indication for surgery must be judged on a case-by-case basis in these patients with prevalent systemic-to-pulmonary shunting.

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Surgical Repair of a Sinus of Valsalva Aneurysm Ruptured into the Right Atrium Diagnosed After a Non-Penetrating Chest Trauma

Emergency Medicine Trauma & Surgical Care ◽

10.24966/ets-8798/100012 ◽

2016 ◽

Vol 3 (1) ◽

pp. 1-2

Author(s):

Ben Jmaà Hèla ◽

Keyword(s):

Right Atrium ◽

Chest Trauma ◽

Surgical Repair ◽

Sinus Of Valsalva ◽

Sinus Of Valsalva Aneurysm ◽

Penetrating Chest Trauma ◽

The Right

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Novel technique of repairing right partial anomalous pulmonary venous connection with intact atrial septum using in situ interatrial septum as a flap in a 68-year-old-woman: a case report

10.21203/rs.3.rs-39603/v2 ◽

2020 ◽

Author(s):

Atsushi Morishita ◽

Ikuo Hagino ◽

Hideyuki Tomioka ◽

Seiichiro Katahira ◽

Takeshi Hoshino ◽

...

Keyword(s):

Pulmonary Artery ◽

Right Atrium ◽

Septal Defect ◽

Surgical Repair ◽

Interatrial Septum ◽

Pulmonary Artery Hypertension ◽

Right Heart ◽

Intact Atrial Septum ◽

The Right ◽

Anomalous Pulmonary Venous Connection

Abstract Background: Partial anomalous pulmonary venous connection draining into the right atrium with an intact atrial septum is a very rare clinical entity in the adult population. Partial anomalous pulmonary venous connection must be suspected as a differential diagnosis when the cause of right heart enlargement and pulmonary artery hypertension is unknown.Case presentation: This study describes the surgical case of an isolated right partial anomalous pulmonary venous connection to the right atrium in a 68-year-old woman, who underwent tricuspid ring annuloplasty and right-sided maze procedure simultaneously. She had complaints of gradually progressing dyspnea on exertion. However, a diagnosis could not be established despite consultations at multiple hospitals for over a year. Right heart catheterization revealed severe pulmonary artery hypertension with a mean pulmonary artery pressure of 46 mmHg, step-up phenomenon of oxygen saturation at the mid-level of the right atrium with a pulmonary-to-systemic blood flow ratio of 2.4, and a pulmonary vascular resistance of 3.1 Wood Units. As medical treatment with pulmonary artery vasodilator therapy did not improve her symptoms, she underwent surgical repair. An atrial septal defect was created surgically with a curvilinear tongue-shaped cut. The right anomalous pulmonary veins were rerouted through the surgically created atrial septal defect into the left atrium with a baffle comprised of the interatrial septum flap, kept in continuity with the anterior margin and sutured while mobilizing the enlarged right atrium. The patient had an uneventful postoperative course and remains asymptomatic.Conclusions: The described surgical technique could be considered an effective alternative for patients undergoing surgical repair for a partial anomalous pulmonary venous connection isolated to the right atrium. The indication for surgery must be judged on a case-by-case basis in these patients with prevalent systemic-to-pulmonary shunting.

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The right atrium and tricuspid annulus are cardinal structures in tricuspid regurgitation with or without pulmonary hypertension

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.11.075 ◽

2017 ◽

Vol 230 ◽

pp. 171-174 ◽

Cited By ~ 3

Author(s):

Naohiko Nemoto ◽

Jonathan G. Schwartz ◽

John R. Lesser ◽

Wesley D. Pedersen ◽

Paul Sorajja ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Tricuspid Regurgitation ◽

Right Atrium ◽

Tricuspid Annulus ◽

The Right

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A Rare Cause of Dyspnea: Sudden Rupture of Aortic Valsalva Sinus Aneurysm

Case Reports in Medicine ◽

10.1155/2013/909302 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Erdinç Arıkan ◽

Arif Karagöz ◽

Serdar Bayata ◽

Levent Yilik ◽

Erden Erol Ünlüer

Keyword(s):

Heart Failure ◽

Right Atrium ◽

Surgical Repair ◽

Ruptured Aneurysm ◽

Cardiac Abnormality ◽

Common Complication ◽

Sinus Of Valsalva ◽

Right Heart ◽

The Right

Aneurysm of the sinus of Valsalva is an uncommon cardiac abnormality; however, the most common complication is rupture into the right heart chambers or rarely towards the left chambers. A ruptured aneurysm typically leads to an aortocardiac shunt and progressively worsening heart failure. We report a case of a 21-year-old male who suffered an aneurysm of the sinus of Valsalva rupture into the right atrium who underwent successful surgical repair.

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