The various mechanisms of tricuspid regurgitation in patients with right ventricular leads: a case series.

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

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Right ventricular longitudinal strain predicts survival in patients with functional tricuspid regurgitation

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2021.01.006 ◽

2021 ◽

Author(s):

M. Bannehr ◽

U. Kahn ◽

J. Liebchen ◽

M. Okamoto ◽

V. Hähnel ◽

...

Keyword(s):

Right Ventricular ◽

Tricuspid Regurgitation ◽

Longitudinal Strain ◽

Functional Tricuspid Regurgitation

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Acute right ventricular failure in COVID-19 infection: A case series

Journal of Cardiology Cases ◽

10.1016/j.jccase.2021.01.001 ◽

2021 ◽

Author(s):

Edgar García-Cruz ◽

Daniel Manzur-Sandoval ◽

Luis Augusto Baeza-Herrera ◽

Arturo Díaz-Méndez ◽

Adán López-Zamora ◽

...

Keyword(s):

Right Ventricular ◽

Case Series ◽

Right Ventricular Failure ◽

Ventricular Failure ◽

Acute Right Ventricular Failure

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RIGHT VENTRICULAR SIZE MODIFIES THE EFFECT OF TRICUSPID REGURGITATION ON SURVIVAL IN OLDER AGED ADULTS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03058-8 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1702

Author(s):

Jordan B. Strom ◽

Ariane Fraiche ◽

Jiaman Xu ◽

Lawrence J. Markson ◽

Connie Tsao ◽

...

Keyword(s):

Right Ventricular ◽

Tricuspid Regurgitation ◽

Ventricular Size ◽

Right Ventricular Size

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Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

Clinical Research in Cardiology ◽

10.1007/s00392-021-01812-3 ◽

2021 ◽

Author(s):

Martin Riesenhuber ◽

Andreas Spannbauer ◽

Marianne Gwechenberger ◽

Thomas Pezawas ◽

Christoph Schukro ◽

...

Keyword(s):

Mitral Regurgitation ◽

Right Ventricular ◽

Tricuspid Regurgitation ◽

Pacemaker Implantation ◽

Ventricular Dilatation ◽

Pacemaker Lead ◽

Survival Analyses ◽

Before And After ◽

Right Ventricular Dilatation ◽

Survival Predictors

Abstract Background Transcatheter tricuspid valve intervention became an option for pacemaker lead-associated tricuspid regurgitation. This study investigated the progression of tricuspid regurgitation (TR) in patients with or without pre-existing right ventricular dilatation (RVD) undergoing pacemaker implantation. Methods Patients were included if they had implantation of transtricuspid pacemaker lead and completed echocardiography before and after implantation. The cohort was divided in patients with and without RVD (cut-off basal RV diameter ≥ 42 mm). TR was graded in none/mild, moderate, and severe. Worsening of one grade was defined as progression. Survival analyses were plotted for 10 years. Results In total, 990 patients were analyzed (24.5% with RVD). Progression of TR occurred in 46.1% of patients with RVD and in 25.6% of patients without RVD (P < 0.001). Predictors for TR progression were RV dilatation (OR 2.04; 95% CI 1.27–3.29; P = 0.003), pre-existing TR (OR 4.30; 95% CI 2.51–7.38; P < 0.001), female sex (OR 1.68; 95% CI 1.16–2.43; P = 0.006), single RV lead (OR 1.67; 95% CI 1.09–2.56; P = 0.018), mitral regurgitation (OR 2.08; 95% CI 1.42–3.05; P < 0.001), and enlarged left atrium (OR 1.98; 95% CI 1.07–3.67; P = 0.03). Survival-predictors were pacemaker lead-associated TR (HR 1.38; 95% CI 1.04–1.84; P = 0.028), mitral regurgitation (HR 1.34; 95% CI 1.02–1.77; P = 0.034), heart failure (HR 1.75; 95% CI 1.31–2.33; P < 0.001), kidney disease (HR 1.62; 95% CI 1.25–2.11; P < 0.001), and age ≥ 80 years (HR 2.84; 95% CI 2.17–3.71; P < 0.001). Conclusions Patients with RVD receiving pacemaker suffered from increased TR progression, leading to decreased survival. Graphic abstract

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Emergency sandwich patch repair via right ventricular incision for postinfarction ventricular septal defects: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab141 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Yusuke Shimahara ◽

Satsuki Fukushima ◽

Shin Yajima ◽

Naoki Tadokoro ◽

Takashi Kakuta ◽

...

Keyword(s):

Hospital Mortality ◽

Right Ventricular ◽

Artery Bypass ◽

Case Series ◽

The Other ◽

Patch Repair ◽

Right Atrial ◽

Residual Shunt ◽

Low Cardiac Output Syndrome ◽

St Segment Elevation

Abstract Background The surgical treatment for postinfarction ventricular septal defect (VSD) remains challenging, especially in emergency cases. Several authors have reported the efficacy of a sandwich patch VSD repair via a right ventricular (RV) incision. However, this procedure remains uncommon, and its efficacy is still unknown, especially when performed under an emergency. Case summary We were able to perform sandwich patch VSD repair via an RV incision on seven consecutive patients with VSD following an ST-segment elevation myocardial infarction (STEMI) from March 2017 to December 2019. Bovine pericardial patches were used for sandwich patches. Two patients developed inferior STEMI, and the other patients developed anterior STEMI. Six patients received intra-aortic balloon pump prior to surgery, and the other received extracorporeal membrane oxygenation with Impella. The interval between the diagnosis of VSD and surgery was within 1 day in all patients except one (5 days). All seven patients underwent VSD repair in the emergency status. Four patients underwent concomitant coronary artery bypass grafting. The hospital mortality rate was 14.3% (1/7). Early postoperative transthoracic echocardiography revealed that only one patient developed more than trace residual shunt. The postoperative right atrial pressure was not significantly elevated at ≤12 mmHg in all patients. No patient developed early postoperative prolonged low cardiac output syndrome. Discussion In patients with postinfarction VSD, a sandwich patch VSD repair via an RV incision is a promising procedure with a low incidence of residual shunt development and hospital mortality, even in emergency cases.

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Heterotopic caval valve implantation for the management of severe tricuspid regurgitation: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa428 ◽

2020 ◽

Author(s):

Aidan Sharkey ◽

Ronny Munoz Acuna ◽

Kiran Belani ◽

Ravi K Sharma ◽

Omar Chaudhary ◽

...

Keyword(s):

Medical Therapy ◽

Tricuspid Regurgitation ◽

Surgical Intervention ◽

Symptom Relief ◽

Vena Cava ◽

Case Series ◽

High Morbidity ◽

Severe Tricuspid Regurgitation ◽

Maximal Medical Therapy ◽

Valve Implantation

Abstract Background Severe tricuspid regurgitation (TR) is a complex condition that can be difficult to treat medically, and often surgical intervention is prohibited due to the high morbidity and mortality associated with this intervention. In patients who have failed maximal medical therapy and have progressive symptoms related to their severe TR, heterotopic caval valve implantation (CAVI) offers potential for symptom relief for these patients. Case summary We present two cases of patients with severe TR with symptoms of heart failure that were refractory to medical therapy. Due to extensive comorbidities in these patient’s surgical intervention was deemed unsuitable and the decision was made to proceed with heterotopic CAVI in order to try and control their symptoms. Both patients successfully underwent the procedure and had an Edwards SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) implanted in the inferior vena cava/right atrium junction. In both patients, there was improvement in the postoperative haemodynamics as measured by invasive and non-invasive methods. Successful discharge was achieved in both patients with improvement in their symptoms. Discussion Selective use of heterotopic CAVI to treat symptomatic severe TR that is refractory to medical therapy may be a viable option to improve symptoms in those patients that are unsuitable for surgical intervention.

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Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

Journal of Clinical Medicine ◽

10.3390/jcm10112266 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2266

Author(s):

Matthias Schneider ◽

Varius Dannenberg ◽

Andreas König ◽

Welf Geller ◽

Thomas Binder ◽

...

Keyword(s):

Right Ventricular ◽

Ventricular Function ◽

Tricuspid Regurgitation ◽

Right Ventricular Function ◽

Prognostic Value ◽

Large Scale ◽

Systolic Function ◽

Left Ventricular ◽

Severe Tricuspid Regurgitation ◽

Vena Contracta

Background: Presence of severe tricuspid regurgitation (TR) has a significant impact on assessment of right ventricular function (RVF) in transthoracic echocardiography (TTE). High trans-valvular pendulous volume leads to backward-unloading of the right ventricle. Consequently, established cut-offs for normal systolic performance may overestimate true systolic RVF. Methods: A retrospective analysis was performed entailing all patients who underwent TTE at our institution between 1 January 2013 and 31 December 2016. Only patients with normal left ventricular systolic function and with no other valvular lesion were included. All recorded loops were re-read by one experienced examiner. Patients without severe TR (defined as vena contracta width ≥7 mm) were excluded. All-cause 2-year mortality was chosen as the end-point. The prognostic value of several RVF parameters was tested. Results: The final cohort consisted of 220 patients, 88/220 (40%) were male. Median age was 69 years (IQR 52–79), all-cause two-year mortality was 29%, median TAPSE was 19 mm (15–22) and median FAC was 42% (30–52). In multivariate analysis, TAPSE with the cutoff 17 mm and FAC with the cutoff 35% revealed non-significant hazard ratios (HR) of 0.75 (95%CI 0.396–1.421, p = 0.38) and 0.845 (95%CI 0.383–1.867, p = 0.68), respectively. TAPSE with the cutoff 19 mm and visual eyeballing significantly predicted survival with HRs of 0.512 (95%CI 0.296–0.886, p = 0.017) and 1.631 (95%CI 1.101–2.416, p = 0.015), respectively. Conclusions: This large-scale all-comer study confirms that RVF is one of the main drivers of mortality in patients with severe isolated TR. However, the current cut-offs for established echocardiographic parameters did not predict survival. Further studies should investigate the prognostic value of higher thresholds for RVF parameters in these patients.

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