Notch of the Anterior Leaflet of the Tricuspid Valve with Severe Tricuspid Regurgitation

Background. Pacemaker or implantable cardiovascular-defibrillator (ICD) leads may be a primary cause of symptomatic tricuspid regurgitation (TR). The aim of this study was to evaluate the utility of 3-dimensional echocardiography (3-DE) in identifying intracardiac routes of pacemaker or ICD leads in relation to TR. Methods. 3-DE examinations were performed to evaluate intracardiac lead routes from right atrium to ventricle and positions at the tricuspid valve in 73 patients: 53 patients with pacemaker and 20 patients with ICD. TR severity was assessed by 2-dimensional echocardiography and classified as mild, moderate, or severe based on the ratio of TR area to right atrium area. Results 3-DE identified the lead route and position at the tricuspid valve in 68 patients (93.1%). In the remaining 5 patients, an appropriate image could not be obtained due to artifacts caused by the lead. TR severity was classified as mild in 47 patients, moderate in 18 patients, and severe in 8 patients. In 7 of the 8 patients with severe TR, obstruction to tricuspid valve closing caused by the lead was identified (Figure ): obstruction of septal leaflet in 3 patients, posterior leaflet in 3 patients, and anterior leaflet in 1 patient. However, in all patients with mild to moderate TR, the lead was positioned at the annulus side between leaflets, and no closing obstruction was identified. Conclusion. 3DE can identify pacemaker or ICD lead route and position at the tricuspid valve and the obstruction to closing caused by the lead in patients with severe TR. Therefore, 3DE may be useful to evaluate the cause of severe TR in patients receiving a pacemaker or ICD.

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Tricuspid Valve Anterior Leaflet Strains in Ovine Functional Tricuspid Regurgitation

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2020.09.012 ◽

2020 ◽

Cited By ~ 2

Author(s):

Tomasz Jazwiec ◽

Marcin J. Malinowski ◽

Haley Ferguson ◽

Jessica Parker ◽

Mrudang Mathur ◽

...

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Anterior Leaflet ◽

Functional Tricuspid Regurgitation

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Faculty Opinions recommendation of Long-Term Outcomes of the FORMA Transcatheter Tricuspid Valve Repair System for the Treatment of Severe Tricuspid Regurgitation: Insights From the First-in-Human Experience.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736343783.793580323 ◽

2020 ◽

Author(s):

Michele De Bonis ◽

Benedetto Del Forno

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Human Experience ◽

Tricuspid Valve Repair ◽

Repair System ◽

Valve Repair ◽

Long Term Outcomes ◽

Severe Tricuspid Regurgitation

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Transesophageal echocardiographic diagnosis of isolated tricuspid valve prolapse with severe tricuspid regurgitation

American Heart Journal ◽

10.1016/0002-8703(92)90775-q ◽

1992 ◽

Vol 123 (1) ◽

pp. 230-232 ◽

Cited By ~ 1

Author(s):

Norman E. Liddell ◽

Marcus F. Stoddard ◽

J.David Talley ◽

Vincent L. Guinn ◽

Joel Kupersmith

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Severe Tricuspid Regurgitation

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Abstract 16979: Hemodynamic Comparison of Tricuspid Ring Annuloplasty vs. Hetzer Annuloplasty Technique to Repair Functional Tricuspid Regurgitation

Circulation ◽

10.1161/circ.142.suppl_3.16979 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Alan Amedi ◽

Daisuke Onohara ◽

Muralidhar Padala

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Ex Vivo ◽

Working Fluid ◽

Posterior Leaflet ◽

Anterior Leaflet ◽

Ex Vivo Model ◽

Functional Tricuspid Regurgitation ◽

Ring Annuloplasty ◽

Valve Function

Introduction: Surgical repair of functional tricuspid regurgitation (FTR) is increasingly performed, and the techniques are evolving. Annuloplasty is currently the technique of choice, with different techniques yielding varied results, and thus require optimization. Objective: In this study, we sought to compare tricuspid valve function and kinematics after ring annuloplasty and Hetzer’s double orifice repair in an ex vivo model of FTR. Methods: Ten pig hearts were mounted into a right heart simulator, and studied at 70 bpm while maintaining the total volume of working fluid. FTR was created by increasing afterload, which caused acute right ventricular dilation and TV tethering. Tricuspid valve annuloplasty (TVA) was performed with a 26mm MC 3 ring. Hetzer procedure was performed with pledgeted sutures that approximated the anteroposterior and septal annular segments. Flow probes were used to measure FTR, and leaflet kinematics with echocardiography. Results: FTR of 17.7±9.2mL(p<0.0001) after RV dilation. Repair with TVA and Hetzer reduced FTR to 8.8±6.8ml(p=0.7142) and 7.8±6.9ml(p=0.0919), respectively, but did not eliminate it. Septal leaflet excursion angle decreased by 48.1% with FTR (p=0.04 vs. baseline ) . Repair with TVA and Hetzer increased the angle to 17.3±6.7°(p=0.0312) and 21.5±8.3°(vs FTR, p=0.0034), respectively. The Hetzer improved septal leaflet mobility better than TVA (p=0.0145). The posterior leaflet excursion angle decreased by 49.2% compared to baseline to 18.4±10.5° (p=0.0060) and both TVA and Hetzer significantly improved mobility to 33.6±8.4° (p=0.0081) and 31.6±15.6° (p=0.0256), respectively. Anterior leaflet mobility decreased after FTR by 60.7% to 18.1±8.2°. The effect of these repairs on the sub-valvular apparatus was negligible. Conclusion: TVA and Hetzer both reduced regurgitation but did not eliminate it. Septal and posterior leaflet mobility was improved, while the anterior leaflet remained tethered.

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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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