Tricuspid Insufficiency Associated With Aneurysm of the Ventricular Septum

PEDIATRICS ◽  
1978 ◽  
Vol 61 (4) ◽  
pp. 586-592
Author(s):  
Eshagh Eshaghpour ◽  
Nobuyoshi Kawai ◽  
Joseph W. Linhart
Keyword(s):  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Septal Defect ◽  
Venous Return ◽  
Systolic Murmur ◽  
Ventricular Septum ◽  
Systemic Resistance ◽  
Tricuspid Insufficiency ◽  
Amyl Nitrite ◽  
Systemic Venous Return

Because of the anatomic relation of an aneurysm of the membranous ventricular septum (AMVS) to the tricuspid septal leaflet or because of the tricuspid septal leaflet involvement in the aneurysm formation, dysfunction of the tricuspid valve is likely to occur in patients with AMVS. The auscultatory manifestations of the resultant tricuspid insufficiency (TI) could be masked by the systolic murmur of the ventricular septal defect (VSD), which is often present in these patients. The presence of TI is suggested by phonocardiographic findings in five patients with AMVS and is further supported by intracardiac phonocardiography and angiocardiography. After inhalation of amyl nitrite, a pansystolic murmur appeared in three patients, and the intensity of the pansystolic murmur increased significantly in two patients. Inhalation of amyl nitrite reduces the systemic resistance, resulting in decreased systemic pressure and diminished intensity of the murmur of a small VSD. Augmentation of the systemic venous return is reponsible for increased intensity of TI murmur.

The atypical systolic murmur of minute ventricular septal defect and its recognition by amyl nitrite and phenylephrine

1961 ◽  
Vol 62 (1) ◽  
pp. 101-118 ◽  
Author(s):  
L. Vogelpoel ◽  
V. Schrire ◽  
W. Beck ◽  
M. Nellen ◽  
A. Swanepoel
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Systolic Murmur ◽  
Amyl Nitrite

scholarly journals P1730 Multimodality assessment of complex ventricular septal defect

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M L Morrison ◽  
S Kabir ◽  
C Salih ◽  
I Valverde ◽  
A Tometzki ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Tricuspid Valve ◽  
Cardiac Mri ◽  
Septal Defect ◽  
Systolic Function ◽  
Multimodality Imaging ◽  
Ventricular Septum ◽  
Complex Congenital Heart Disease ◽  
Pulmonary Artery Band

Abstract Case Summary A 16 month old, 8.2 kg patient came forward for evaluation of complex cardiac anatomy with multimodality imaging assessment to ascertain suitability for biventricular repair. A large ventricular septal defect was diagnosed before birth but possible straddling of the tricuspid valve identified postnatally. The patient developed symptoms of congestive cardiac failure and was palliated with a pulmonary artery band. In view of the difficult nature of the defect they were reviewed with 3D-transthoracic echo, transoesophageal echo and cardiac MRI. Their transthoracic echo confirmed situs solitus with levocardia, atrioventricular and ventriculoarterial concordance. There was a well placed pulmonary artery band with peak velocity of 5 m/s. Biventricular systolic function appeared good. There was a large ventricular septal defect at the inlet extending to the muscular septum. There were 2 prominent muscle bundles arising from the ventricular apex and it was difficult to distinguish on echocardiography which of these formed the true ventricular septum (Figures A & B). Although the tricuspid valve opened normally, there were multiple chords extending to overlie the right ventricular aspect of the ventricular septal defect (Figure C), some of which appeared to cross the through defect (*) and attach to the more leftward of the apical trabeculations (Figure D white dotted line illustrates the true plane of ventricular septum which overlies the attachments. Red dotted line represents the plane followed by the leftward apical trabeculation). Cardiac MRI showed that the trabeculation positioned to the left was the true ventricular septum, as it seemed to be in line with the plane of the atrial septum at the crux of the heart (Figure E & F). At surgery her heart was found to be unseptatable due to multiple straddling chords from the tricuspid valve inserting into multiple papillary muscle heads with the left ventricle. Conclusions The key issue in this case is which of the muscular structures positioned at the ventricular apex is considered to be the true ventricular septum as this determines whether on not there is straddle of the tricuspid valve. In addition the complex and multiple nature of the chordal attachments below the valve made accessing and closing the defect not feasible. Even in the present era with wide availability of advanced, multimodality imaging techniques demonstrating anatomy can still prove challenging in planning surgical repair, especially within the setting of complex congenital heart disease. Many aspects of such cases still only become apparent at the time of surgery and this remains a key issue when counselling parents. Abstract P1730 Figure.

Aneurysm of the membranous ventricular septum with ventricular septal defect, mitral and tricuspid insufficiency

1998 ◽  
Vol 46 (10) ◽  
pp. 1009-1013
Author(s):  
Ko Tanaka ◽  
Hiroshi Yasunaga ◽  
Aritomo Egashira ◽  
Munetaka Kumate ◽  
Takemi Kawara ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Ventricular Septum ◽  
Tricuspid Insufficiency

scholarly journals Straddling tricuspid valve without a ventricular septal defect.

Heart ◽  
1989 ◽  
Vol 62 (3) ◽  
pp. 222-224 ◽  
Author(s):  
Y Isomatsu ◽  
H Kurosawa ◽  
Y Imai
Keyword(s):  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Septal Defect

Tricuspid valve endocarditis in a horse with a ventricular septal defect

2010 ◽  
Vol 18 (4) ◽  
pp. 172-176 ◽  
Author(s):  
W. F. Roehlich ◽  
S. Wlaschitz ◽  
K. Riedelberger ◽  
V. B. Reef
Keyword(s):  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Septal Defect ◽  
Tricuspid Valve Endocarditis

scholarly journals Does tricuspid valve detachment improve outcomes compared with the non-tricuspid valve detachment approach in ventricular septal defect closure?

2020 ◽  
Author(s):  
Yunfei Ling ◽  
Xiaohui Bian ◽  
Yue Wang ◽  
Yongjun Qian
Keyword(s):  
Cardiopulmonary Bypass ◽  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
The Other ◽  
Cardiopulmonary Bypass Time ◽  
Significant Difference ◽  
Ventricular Septal Defect Closure ◽  
Valve Detachment

Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the tricuspid valve detachment (TVD) approach to ventricular septal defect repair provides superior outcomes compared with the non-TVD approach. Altogether more than 54 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A total of 2059 participants were enrolled in the 10 studies, including 2 prospective studies and 8 retrospective studies. Six studies demonstrated a longer cardiopulmonary bypass time or aortic clamp time in the TVD group, whereas 4 studies showed no difference. Only 1 study reported a lower incidence of trivial tricuspid regurgitation in the TVD group, whereas the other 9 studies showed no significant difference. One study showed that a higher incidence of residual shunting occurred in those patients who had indications for TVD but did not perform detachment during surgery. No difference in postoperative residual shunting was demonstrated in the other 9 studies. We conclude that surgeons should be reassured that if TVD is required to repair the ventricular septal defect, although it may lead to longer cardiopulmonary bypass time and cross-clamp times, outcomes are equivalent in terms of the degree of tricuspid regurgitation and incidence of the residual ventricular septal defect.

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