scholarly journals Management of Tricuspid Regurgitation: The Role of Transcatheter Therapies

2017 ◽  
Vol 12 (01) ◽  
pp. 51 ◽  
Author(s):  
Maurizio Taramasso ◽  
Christelle Calen ◽  
Andrea Guidotti ◽  
Shingo Kuwata ◽  
Hector Rodriguez Cetina Biefer ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Standard Treatment ◽  
Attractive Alternative ◽  
Efficacy And Safety ◽  
New Techniques ◽  
Future Studies ◽  
Percutaneous Procedures ◽  
Functional Tricuspid Regurgitation ◽  
Transcatheter Devices

Surgical treatment is the gold standard treatment of functional tricuspid regurgitation (FTR) but this carries high risks of morbidity and mortality. Percutaneous procedures are an attractive alternative to surgery for selected patients deemed to be high-risk surgical candidates. A number of tricuspid transcatheter devices have been developed to treat FTR, but at present, evidence of their efficacy and safety is scarce. Preliminary data have shown promising results, but ongoing and future studies will provide a clearer picture of the benefits of these new techniques.

OC28 FAILURE OF TRICUSPID ANNULOPLASTY FOR FUNCTIONAL TRICUSPID REGURGITATION. THE ROLE OF PREOPERATIVE TRICUSPID VALVE APPARATUS REMODELING

2018 ◽  
Vol 19 ◽  
pp. e4
Author(s):  
M. Foschi ◽  
M. Di Mauro ◽  
A. Iacò ◽  
H. Kheirallah ◽  
M. Alsaied ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Tricuspid Annuloplasty ◽  
Functional Tricuspid Regurgitation

scholarly journals The role of left atrial strain in patients with functional tricuspid regurgitation before and after annuloplasty: a long-term follow-up study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Qing-long Meng ◽  
Hong Meng ◽  
Jia Tao ◽  
Shu Yang ◽  
Hao Wang
Keyword(s):  
Tricuspid Regurgitation ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Pearson Correlation ◽  
Characteristic Curve ◽  
Control Group ◽  
Rheumatic Mitral Stenosis ◽  
Functional Tricuspid Regurgitation

Abstract Background Functional tricuspid regurgitation (TR) is common among patients with left heart disease and may recur during the follow-up period after selective tricuspid valve annuloplasty (TVA). This study aims to analyse the relationship between left atrial (LA) strain and the degree of preoperative functional TR and to explore the role of LA strain in predicting TR recurrence. Methods This study included 63 patients with rheumatic mitral stenosis who underwent mitral valve replacement and concomitant TVA. Additionally, 20 healthy controls were enrolled. Preoperative conventional LA echocardiographic parameters and LA strain were measured. The association between LA strain and preoperative functional TR severity was analysed by Pearson correlation. Predictors of recurrent TR were determined by multivariate logistic regression analyses. Results Compared with the control group, the mitral stenosis group developed a significant impairment in terms of LA strain. The degree of preoperative functional TR exhibited moderate correlations with LA reservoir strain (r = − 0.57) and LA conduit strain (r = 0.48). During a median follow-up period of 66.4 ± 36.4 months, TR recurred in 18 patients. Preoperative LA reservoir strain and the mean transmitral gradient were predictors of postoperative TR recurrence. When the two indexes were combined to establish a prediction, the sensitivity and specificity of prediction increased. The area under the receiver operating characteristic curve of the combined indicator was higher than those of the single indicators (0.90 vs. 0.70 and 0.72). Conclusions LA strain correlates with preoperative functional TR severity in patients with rheumatic mitral stenosis. The LA reservoir strain and preoperative mean transmitral gradient are independent predictive factors for recurrent TR after TVA.

scholarly journals Role of concomitant tricuspid surgery in moderate functional tricuspid regurgitation in patients undergoing left heart valve surgery

2012 ◽  
Vol 43 (1) ◽  
pp. 2-8 ◽  
Author(s):  
Balakrishnan Mahesh ◽  
Francis Wells ◽  
Samer Nashef ◽  
Sukumaran Nair
Keyword(s):  
Heart Valve ◽  
Tricuspid Regurgitation ◽  
Valve Surgery ◽  
Heart Valve Surgery ◽  
Left Heart ◽  
Functional Tricuspid Regurgitation

scholarly journals 145 Prognostic value of three-dimensional echocardiographic assessment of tricuspid valve geometry in atrial and ventricular functional tricuspid regurgitation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesca Heilbron ◽  
Mara Gavazzoni ◽  
Diana Florescu ◽  
Roberto Ochoa ◽  
Michele Tomaselli ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Major Axis ◽  
Right Atrial ◽  
Vena Contracta ◽  
Functional Tricuspid Regurgitation ◽  
Significant Difference ◽  
History Of ◽  
The Difference

Abstract Aims Atrial and ventricular functional tricuspid regurgitation (A-FTR and V-FTR) have recently emerged as different phenotypes of FTR. Given the difference in mechanisms that are postulated to be underlying these two entities, a different remodelling of tricuspid valve (TV) apparatus can occur and therefore also a specific quantitative approach could be deemed. Moreover, considered the known limitation of the two-dimensional flow convergence method (2D-PISA) for quantifying FTR in advanced valve apparatus remodelling with irregular effective valve orifice (ERO) morphology, it would be expected that also the parameters of severity of FTR can be different in these two types of FTR. The aim of this study was to investigate the TV apparatus remodelling in the two different phenotypes of FTR: ventricular (V-FTR) and atrial (A-FTR) and the role of echocardiographic parameters of TV remodelling and TR severity to predict clinical outcomes. Methods and results The present retrospective study included consecutive patients with moderate to severe functional tricuspid regurgitation (FTR) referred for echocardiography in two Italian centres. The composite endpoint of death for any cause and heart failure (HF) hospitalization was used as primary outcome of this analysis. According to more recent guidelines, patients were considered having A-FTR if having history of long-standing atrial fibrillation, without history of pulmonary hypertension and left side heart disease. A total of 180 patients were included. Despite the right atrial volume (RAV) was not different in the two groups, in A-FTR tethering height was significantly lower (11.7 ± 4.8 mm vs. 15.0 ± 5.5 in V-FTR. P < 0.01) and the 3D-derived tricuspid annulus (TA) diameters were larger both in end-diastolic and mid-systolic phase (3D-TA-End diastolic-major axis: 45.2 ± 6.2 mm in A-FTR vs. 42.8 ± 5.4 in V-FTR. P = 0.04; 3D-TA mid systolic major axis: 41.7 ± 6.4 mm in A-FTR vs. 37.9 ± 5.1 in V-FTR, P < 0.01). 3D-TA-End diastolic-minor axis: 39.7 ± 6.8 vs. 37.1 ± 5.2. P = 0.03. Regarding the parameters of severity of FTR, patients with V-FTR had larger vena contracta (VC), either when 2D estimated or 3D (2D-VC-average: 5.3 ± 2.8 mm in A-FTR vs. 6.6 ± 3.7 in V-FTR. P = 0.02; 3D-VCA: 0.9 ± 0.4 cm2 vs. 1.3 ± 1.1 cm2, P = 0.02); conversely the value of 2D-ERO and regurgitant volume estimated with 2D-PISA method did not show significant difference between the two groups. After a median follow-up of 24 months (IQR: 2–48) 72 patients (40%) reached the primary endpoint and 64 (36%) hospitalized for HF. Different predictors of combined endpoint were found in the two groups: tenting height. 2D-VC. 3D-VCA and regurgitant fraction were prognostic correlates in V-FTR; TA dimensions as well as all the parameters of severe TR, including EROA with PISA method were related to the prognosis in A-FTR. Conclusions Different TV remodelling occurs in patients with A- and V-FTR, having the second more pronounce tethering of TV leaflets; the prognostic role of quantitative parameters of FTR in these two groups is different, thus reaffirming: (1) the limitation of PISA method without correction in case of more pronounced tenting of leaflets; (2) the difference in underlying pathogenic mechanisms; and (3) the needing for a more specific diagnostic approach and prognostic stratification in these two FTR phenotypes.

scholarly journals Use of antipsychotic drugs and lithium in mania

2001 ◽  
Vol 178 (S41) ◽  
pp. s148-s156 ◽  
Author(s):  
John Cookson
Keyword(s):  
Bipolar Disorder ◽  
Antipsychotic Drugs ◽  
Antipsychotic Agents ◽  
Routine Practice ◽  
Efficacy And Safety ◽  
First Line ◽  
Future Studies ◽  
Atypical Antipsychotic Agents

BackgroundStudies highlighting the difficulties associated with lithium suggest that the role of antipsychotic drugs and mood stabilisers in bipolar disorder should be reconsidered.AimsTo review the efficacy and mode of action of antipsychotic drugs in mania, and to consider the differences between official guidelines and routine clinical practice in the use of these agents for mania.MethodReview of research, guideline- and practice-based literature.ResultsGuidelines recommend lithium or valproate as first-line treatments for mania, and antipsychotic agents only as ‘adjuncts’ for agitation, dangerous behaviour or psychosis. However, in routine practice, antipsychotic drugs are often prescribed. The effectiveness of these agents in mania has been established by several studies; newer atypical compounds demonstrate antimanic efficacy with a reduced incidence of neurological side-effects.ConclusionAntipsychotic drugs are important in the treatment of bipolar disorder and mania. Future studies should evaluate the long-term efficacy and safety of newer atypical antipsychotic agents, and the place of anticonvulsants in combination with antipsychotics in bipolar disorder.

scholarly journals Transcatheter Edge-to-edge Repair of Severe Tricuspid Regurgitation

2019 ◽  
Vol 13 (1) ◽  
pp. 35-40
Author(s):  
Shu-I Lin ◽  
Mizuki Miura ◽  
Francesco Maisano ◽  
Michel Zuber ◽  
Mara Gavazzoni ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Clinical Results ◽  
Long Term Results ◽  
Current Evidence ◽  
Attractive Alternative ◽  
Adverse Consequence ◽  
Clinical Experiences ◽  
Severe Tricuspid Regurgitation ◽  
Percutaneous Procedures

Despite the increasing knowledge of the long-term adverse consequence of severe tricuspid regurgitation (TR), most patients with moderate- to-severe TR are still treated conservatively because of the high risk of surgery. Percutaneous procedures have emerged as an attractive alternative treatment. Transcatheter edge-to-edge repair is a validated technique to treat mitral regurgitation. In recent years, the same concept has been applied to patients with TR and prohibitive operative risk. Early trials have shown feasibility and safety. More clinical experiences and long-term results are still being gathered. In this article, we provide an overview of transcatheter edge-to-edge repair and look at the current evidence and clinical results regarding procedure.

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