Tricuspid chordal rupture following stab injury: a case of successful repair

We report a case of a 32-year-old male patient who sustained an isolated stab injury to the left chest wall. He was initially treated with emergency surgery for right ventricular free wall rupture, with an uneventful postoperative course. During follow-up, the patient complained of exercise intolerance and dyspnea on effort. Transthoracic echocardiography (TTE) demonstrated a previously undiagnosed severe tricuspid regurgitation due to flail of the anterior leaflet and a ruptured chorda. A redo operation was scheduled, and the valve was successfully repaired, with different techniques employed. This case highlights the importance of careful clinical evaluation of victims of chest penetrating trauma and how early diagnosis of hidden valvular lesions might increase the odds of valve repair. It also demonstrates the clover technique as a valuable technique in the correction of traumatic tricuspid regurgitation.

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Severe tricuspid regurgitation 14 years after diagnosis of “transient neonatal tricuspid regurgitation”

Heart ◽

10.1136/hrt.86.1.88 ◽

2001 ◽

Vol 86 (1) ◽

pp. 88-90

Author(s):

D Boshoff ◽

L Mertens ◽

M Gewillig

Keyword(s):

Tricuspid Regurgitation ◽

Neonatal Period ◽

Clinical Course ◽

Subsequent Evolution ◽

Severe Tricuspid Regurgitation ◽

Echocardiographic Examination ◽

Long Term Follow Up ◽

Transient Tricuspid Regurgitation

A 14 year old girl presented with severe tricuspid regurgitation after she was diagnosed with “transient tricuspid regurgitation of the newborn”. In the neonatal period she had presented with severe tricuspid regurgitation without an obvious underlying anatomical cause. This spontaneously regressed during the first months of life. She was dismissed from follow up at the age of 5 years after complete normalisation of the clinical and echocardiographic examination. The subsequent evolution and management of the patient, as well as the possible pathogenesis responsible for the unusual clinical course, is discussed. This case stresses the importance of long term follow up of patients with transient tricuspid regurgitation.

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5940Right ventricular reverse remodeling occurs early after transcatheter tricuspid valve repair for isolated severe tricuspid regurgitation and is associated with better outcome

European Heart Journal ◽

10.1093/eurheartj/ehz746.0090 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Orban ◽

L Stolz ◽

D Braun ◽

T Stocker ◽

K Stark ◽

...

Keyword(s):

Heart Failure ◽

Clinical Outcome ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Significant Trend ◽

Tricuspid Valve Repair ◽

Tricuspid Annulus ◽

Valve Repair ◽

Severe Tricuspid Regurgitation

Abstract Background Transcatheter edge-to-edge tricuspid valve repair (TTVR) is a novel treatment option in patients with severe tricuspid regurgitation (TR), right-sided heart failure and prohibitive surgical risk. Purpose We investigated whether RVRR can occur early after TTVR in patients with isolated TR and its potential association with clinical outcome. Method We measured right ventricular parameters by transthoracic echocardiography (TTE) at baseline (BL) in 44 consecutive patients undergoing TTVR for isolated severe TR. We obtained follow-up (FU) TTEs after 1 month. Results At BL, we observed dilated RVs with an RV end-diastolic area (RVEDA) of 28.0±8.3cm2, RV mid diameter of 40.7±7.3mm and tricuspid annulus of 47.5±8.1mm. The majority of patients (63%) showed RV systolic dysfunction with either a tricuspid annular plane excursion (TAPSE) <17mm or fractional area change (FAC) <35%. In 40 Patients (90%), a periprocedural TR reduction by at least 1 degree was achieved (p<0.01). During further clinical FU (272±183 days), 21 patients died (of whom 14 had prior hospitalizations for heart failure before death), 8 patients had hospitalizations for heart failure, 1 patient underwent heart transplantation and 1 patient was lost to clinical FU. We acquired a short-term echocardiographic follow-up (Echo-FU) after 30 days in 36 patients (82%). TR reduction was stable after 1 month with a TR grade ≤2+ in 26 of 36 patients (72%, p<0.01 vs BL). We detected RVRR in the majority of patients with 1-month Echo-FU: RVEDA decreased from 28.8±8.2 to 26.3±7.4cm2 (p<0.01), RV mid diameter from 41.2±7.3 to 38.5±7.7mm (p<0.01) and tricuspid annulus from 48.3±8.3 to 42.8±6.6mm (Figure, p<0.01). We observed a non-significant trend towards reduction of TAPSE (17.5mm to 16.1 mm, p=0.12) and FAC (37.8% to 35.5%, p=0.17), which could represent a normalization of systolic function of a previously hyperactive RV. Next, we evaluated whether RVRR is potentially associated with clinical outcome. We stratified patients into two groups with more or less than median change in RVEDA, RV mid diameter and TV annulus. Fewer combined clinical events (time to death or repeat intervention or first hospitalization for heart failure) were observed in patients with pronounced decrease of RV mid diameter (p=0.03) and TV annulus (Figure, p=0.02) at FU. A decrease of RVEDA showed a non-significant trend towards better outcome (p=0.06). Figure 1 Conclusions Our report demonstrates that RVRR occurs already 1 month after TTVR for isolated TR and is associated with less clinical endpoints.

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Myocarditis, flail tricuspid valve, and normal rhythm: an exceptional form of neonatal cardiac lupus

Cardiology in the Young ◽

10.1017/s1047951117000543 ◽

2017 ◽

Vol 27 (7) ◽

pp. 1419-1422

Author(s):

María-Teresa González-López ◽

Ramón Pérez-Caballero-Martínez ◽

Juan-Miguel Gil-Jaurena

Keyword(s):

Autoimmune Disease ◽

Surgical Management ◽

Papillary Muscle ◽

Tricuspid Regurgitation ◽

Papillary Muscle Rupture ◽

Severe Tricuspid Regurgitation ◽

Conduction Disturbances ◽

Muscle Rupture ◽

Tricuspid Repair

AbstractNeonatal cardiac lupus is a rare, passively acquired autoimmune disease. We report a case of in utero myocarditis, confirmed postnatally, with papillary muscle rupture and severe tricuspid regurgitation after birth in the absence of conduction disturbances. Tricuspid repair was successfully performed with polytetrafluoroethylene neochordae. In this article, we discuss the pathophysiology, medical and surgical management, and implications at follow-up in this unique scenario.

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Outcomes of Tricuspid Regurgitation after Percutaneous Mitral Commissurotomy

ASEAN Heart Journal ◽

10.31762/ahj2130.0203 ◽

2021 ◽

Vol 30 (2) ◽

pp. 9-19

Author(s):

Bryan Rene F. Toledano ◽

Maria Johanna Jaluage-Villanueva ◽

Sharon Marisse Lacson

Keyword(s):

Tricuspid Regurgitation ◽

Numerical Data ◽

Functional Class ◽

Test Results ◽

Chi Square ◽

Severe Tricuspid Regurgitation ◽

Chi Square Test ◽

Echocardiographic Parameters ◽

Mitral Commissurotomy

PURPOSE The gap in evidence in the management of multivalvular lesions can be addressed by providing more data on clinical and echocardiographic outcomes after Percutaneous Mitral commissurotomy (PMC). METHODS Participants were Filipinos aged >/= 19 years old, admitted due to severe mitral stenosis with moderate to severe tricuspid regurgitation (TR). The outcome of PMC was divided into 2 groups: Significant TR which included the progression of moderate to severe TR or persistence of severe TR and Insignificant TR group which included those with mild TR, regression to moderate to mild TR, severe to moderate, or persistence of moderate TR. These groups were compared from baseline, 24th hour, 1st month, and 6th month using the same echocardiographic parameters. The numerical data between significant and nonsignificant tricuspid regurgitation were compared using non-parametric Mann Whitney U test and categorical data using the Chi-Square test. RESULTS A total of 38 participants were analyzed. On the 24th-hour post- PTMC, the Significant TR group had significantly higher RAVI (42.3 vs 26.1, p=.004), RVD mid (3.81 vs 2.92, p=.001), SPAP (60.5 vs 38.5, p=.003), and RVOT (2.8 vs 2.2, p=.001) and lower MV planimetry (1.25 vs 1.58, p=.009); On the 1st-month RVD mid (3.4 vs 2.8, p=.02) and TV annulus (3.35 vs 2.76, p=0.10) were significantly higher in the Significant TR group; On the 6th month RAVI (59 vs 24.7, p=.001), RVD mid (4 vs 2.73, p=.006), and TV annulus (4.5 vs 2.67 p=.001) were significantly higher in the Significant TR group when compared to Insignificant TR group. CONCLUSION PMC improved baseline parameters of SPAP, MV planimetry, MV gradient, and functional class on short-term follow-up on both groups of TR. Majority of outcomes after the procedure had insignificant TR. However, those with significant TR had higher RVD mid and TV annulus from the 24th hour to 6 months when compared to the insignificant TR group.

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Outcomes of Isolated Tricuspid Valve Surgery

The Heart Surgery Forum ◽

10.1532/hsf.3093 ◽

2020 ◽

Vol 23 (6) ◽

pp. E763-E769

Author(s):

Gemma Sánchez-Espín ◽

Jorge Rodríguez-Capitán ◽

Juan José Otero Forero ◽

Víctor Manuel Becerra Muñoz ◽

Emiliano Andrés Rodríguez Caulo ◽

...

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Functional Class ◽

Valve Surgery ◽

Perioperative Mortality ◽

Severe Tricuspid Regurgitation ◽

Tricuspid Valve Surgery ◽

Long Term Mortality

Background: Isolated tricuspid valve surgery is a rarely performed procedure and traditionally is associated with a bad prognosis, although its clinical outcomes still are little known. The aim of this study was to assess the short- and long-term clinical outcomes obtained at our center after isolated tricuspid valve surgery as treatment for severe tricuspid regurgitation. Methods: This retrospective study included 71 consecutive patients with severe tricuspid regurgitation who underwent isolated tricuspid valve surgery between December 1996 and December 2017. Perioperative and long-term mortality, tricuspid valve reoperation, and functional class were analyzed after follow up. Results: Regarding surgery, 7% of patients received a De Vega annuloplasty, 14.1% an annuloplasty ring, 11.3% a mechanical prosthesis, and 67.6% a biological prosthesis. Perioperative mortality was 12.7% and no variable was shown to be predictive of this event. After a median follow up of 45.5 months, long-term mortality was 36.6%, and the multivariate analysis identified atrial fibrillation as the only predictor (Hazard Ratio 3.014, 95% confidence interval 1.06-8.566; P = 0.038). At the end of follow up, 63.6% of survivors had functional class I. Conclusions: Isolated tricuspid valve surgery was infrequent in our center. Perioperative mortality was high, as was long-term mortality. However, a high percentage of survivors were barely symptomatic after follow up.

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P3367Echocardiographic assessment of right ventricle function in patients with severe tricuspid regurgitation and correlates with outcomes

European Heart Journal ◽

10.1093/eurheartj/ehz745.0243 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Gavazzoni ◽

E V Vizzardi ◽

A C Castiello ◽

R R Raddino ◽

L P B Badano ◽

...

Keyword(s):

Heart Disease ◽

Right Ventricle ◽

Tricuspid Regurgitation ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Cox Regression ◽

Free Wall ◽

Severe Tricuspid Regurgitation ◽

Rv Function

Abstract Background/Introduction Speckle tracking echocardiography has been recently proposed as an accurate and sensitive measure of right ventricle (RV) function that could integrate other more conventional parameters. This tool can be important in the clinical context of severe tricuspid regurgitation (TR), since TAPSE is not fully representative of global RV function and can overestimate this in presence of severe TR. Purpose Evaluate the prognostic relevance of different parameters of RV structure and function derived from 2D and speckle tracking echocardiographic analysis of clinically stable patients with severe TR referred for routine follow up in the context of many etiologies of left side heart disease (secondary TR). Methods The present is a retrospective analysis of prospectively acquired echocardiographic studies including patients with severe secondary TR in the context of left side heart disease. Fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV global longitudinal strain (RVLS) and RV free-wall longitudinal strain (RVFWLS) as well as LV function were measured. As suggested in previous studies, we also aimed to explored the use in this population of: i)RVLS/pulmonary systolic arterial pressure (PASP); ii) RVFWLS (average lateral 3 segments strain)/IVSLS (average medial 3 segment strain) as index of RV-LV dependency. The composite end-point of this study included death for any cause and heart failure hospitalization. Results 61 patients (mean age 58±20 years, 65% men), were included. After a mean follow up period of 3,6±2 years 57% of patients reached the combined end-point. At Cox regression univariate analysis a significant correlation with outcomes was found for RVend-diastolic diameter (HR 0,42, p: 0.018), right atrial area (HR: 3, p: 0.02), RVFWLS/IVSLS (HR: 0.5, p: 0.020), RVLS/PASP (HR 0.186, p: 0.039). In multivariable Cox-regression model we found that LVEF, RV dimension and RVFWLS/IVSLS were independently related to outcome; this last one parameter showed the best correlation with outcomes. Conclusions In asymptomatic and clinically stable patients with severe secondary TR longitudinal function of RV free wall is not related to outcomes but RV-arterial coupling and the ratio between deformation of free wall and septal wall of RV are good predictors of clinical deterioration at follow up. The last one conceptually represents the interaction between RV and LV in secondary TR and allows a real “correction” of those effects of severity of TR on the base to apex gradient of lateral wall longitudinal deformation (TR increases movement of basal segments).

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Correction of Traumatic Tricuspid Insufficiency Using the Double Orifice Technique

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230501300310 ◽

2005 ◽

Vol 13 (3) ◽

pp. 238-240 ◽

Cited By ~ 3

Author(s):

Guo-Hua Luo ◽

Wei-Guo Ma ◽

Han-Song Sun ◽

Jian-Ping Xu ◽

Li-Zhong Sun ◽

...

Keyword(s):

Tricuspid Regurgitation ◽

Tricuspid Insufficiency ◽

Ring Annuloplasty ◽

Repeat Operation ◽

Valve Function ◽

Tricuspid Incompetence ◽

Traumatic Tricuspid Regurgitation ◽

Anterior Papillary Muscle ◽

Double Orifice

Traumatic tricuspid insufficiency is an uncommon clinical condition and surgical procedures vary. In this paper we report our experience in treating traumatic tricuspid insufficiency using the double orifice technique. From January 2000 to September 2003, 10 patients with traumatic tricuspid regurgitation were admitted to our hospital, 5 of whom were corrected using the double orifice technique. There were 4 males and 1 female with ages ranging from 31 to 52 years. Preoperative transthoracic echocardiography (TTE) detected severe tricuspid regurgitation in 4 patients and moderate tricuspid regurgitation in 1 patient. At surgery, tear of the tricuspid anterior papillary muscle was found in 2 cases and anterior chordal rupture in 3 cases. The valves were successfully repaired using the double orifice technique in combination with ring annuloplasty. There was no repeat operation, no operative complications or deaths. Before discharge, TTE detected normal tricuspid valve function in 2 cases and tiny regurgitation in 3 cases. After a follow up of 8 to 36 months, TTE demonstrated normal valve function in 1 patient and tiny regurgitation in 4 patients. The double orifice technique appears to be a simple but effective method of repairing traumatic tricuspid incompetence. Satisfactory clinical outcomes can be produced in carefully selected patients.

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Transcatheter Tricuspid Valve Intervention in Patients With Right Ventricular Dysfunction or Pulmonary Hypertension

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009685 ◽

2021 ◽

Vol 14 (2) ◽

Author(s):

Guillem Muntané-Carol ◽

Maurizio Taramasso ◽

Mizuki Miura ◽

Mara Gavazzoni ◽

Alberto Pozzoli ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Hazard Ratio ◽

Severe Tricuspid Regurgitation ◽

Increased Risk ◽

Procedural Success

Background: Scarce data exist on patients with right ventricular dysfunction (RVD) or pulmonary hypertension (PH) undergoing transcatheter tricuspid valve intervention. This study aimed to determine the early and midterm outcomes and the factors associated with mortality in this group of patients. Methods: This subanalysis of the multicenter TriValve (Transcatheter Tricuspid Valve Therapies) registry included 300 patients with severe tricuspid regurgitation with RVD (n=244), PH (n=127), or both (n=71) undergoing transcatheter tricuspid valve intervention. RVD was defined as a tricuspid annular plane systolic excursion <17 mm, and PH as an estimated pulmonary artery systolic pressure ≥50 mm Hg. Results: Mean age of the patients was 77±9 years (54% women). Procedural success was 80.7%, and 9 patients (3%) died during the hospitalization. At a median follow-up of 6 (interquartile range, 2–12) months, 54 patients (18%) died, and the independent associated factors were higher gamma-glutamyl transferase values at baseline (hazard ratio, 1.02 for each increase of 10 u/L [95% CI, 1.002–1.04]), poorer renal function defined as an estimated glomerular filtration rate <45 mL/min (hazard ratio, 2.3 [95% CI, 1.22–4.33]), and the lack of procedural success (hazard ratio, 2.11 [95% CI, 1.17–3.81]). The grade of RVD and the amount of PH at baseline were not found to be predictors of mortality. Most patients alive at follow-up improved their functional class (New York Heart Association I–II in 66% versus 7% at baseline, P <0.001). Conclusions: In patients with severe tricuspid regurgitation and RVD/PH, transcatheter tricuspid valve intervention was associated with high procedural success and a relatively low in-hospital mortality, along with significant improvements in functional status. However, about 1 out of 5 patients died after a median follow-up of 6 months, with hepatic congestion, renal dysfunction, and the lack of procedural success determining an increased risk. These results may improve the clinical evaluation of transcatheter tricuspid valve intervention candidates and would suggest a closer follow-up in those at increased risk. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03416166.

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Prognostic impact and post-procedural development of severe tricuspid regurgitation in patients undergoing transcatheter edge-to-edge mitral valve repair

European Heart Journal ◽

10.1093/ehjci/ehaa946.1926 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Kavsur ◽

C Iliadis ◽

C Metze ◽

M Spieker ◽

V Tiyerili ◽

...

Keyword(s):

Regression Analysis ◽

Mitral Regurgitation ◽

Tricuspid Regurgitation ◽

Odds Ratio ◽

Survival Rates ◽

Right Atrial ◽

Prognostic Impact ◽

Severe Tricuspid Regurgitation ◽

Significant Difference

Abstract Purpose The aim of this study was to investigate the clinical impact and post-procedural development of tricuspid regurgitation (TR) in patients undergoing the MitraClip procedure for severe mitral regurgitation. Methods In this present multicentre study, we included 940 patients undergoing MitraClip implantation for symptomatic mitral regurgitation from August 2010 to September 2018. Patients were categorized according to concomitant TR (none or mild vs moderate vs severe) and the prognostic impact of TR on 1-year mortality was evaluated. Moreover, in 377 patients, we assessed 3-months echocardiographic controls to further analyse the post-procedural development of TR. Results At baseline, concomitant TR was graded none/mild in 393 (42%), moderate in 316 (34%), and severe in 231 (25%) patients. During 1-year follow-up, 141 of 940 (15%) patients died. According to mild/none, moderate and severe TR, mortality rates were 13%, 12%, and 23%, respectively, revealing a higher prevalence of death in patients with severe TR (p=0.001). Kaplan-Meier analysis and log-rank test confirmed inferior survival rates for patients with severe TR (p=0.001), while there were no significant difference in survival rates between patients with none/mild vs moderate TR (p=0.561). Regarding 1-year mortality, multivariate cox regression analysis, revealed an odds ratio of 1.739 (1.024–2.953; p=0.041), associated with severe TR. After 3-months follow-up, echocardiography in 377 patients showed following TR grade distributions: 44% none/mild, 37% moderate and 19% severe TR. In 100 patients (27%), TR improved by one or more grades, while 64 patients (17%) showed a TR worsening. In patients with severe TR at baseline, 42 of 91 (46%) patients showed a reduction in TR of one or more grades. Patients with severe TR at baseline, who showed a TR improvement during 3-months follow-up, had lower rates of 1-year mortality (p=0.025). For these patients, in regression analysis, right atrial area was revealed as only predictor of TR improvement after MitraClip procedure [odds ratio 0.958 (0.918–0.999); p=0.046]. Conclusion One-fourth of patients undergoing MitraClip procedure for mitral regurgitation had concomitant severe tricuspid regurgitation which was predictive for worse prognosis. Post-procedural TR improvement of one or more grades was frequent in these patients and was associated with higher survival-rates. Funding Acknowledgement Type of funding source: None

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Abstract 4684: Differences in Baseline Features and Long Term Follow-Up Post-Transcatheter Closure in Patients with Secundum Atrial Septal Defect - A Cohort Study

Circulation ◽

10.1161/circ.118.suppl_18.s_929-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Gerald Yong ◽

Paul Khairy ◽

Pierre de Guise ◽

Reda Ibrahim

Keyword(s):

Cohort Study ◽

Tricuspid Regurgitation ◽

Substantial Reduction ◽

Severe Tricuspid Regurgitation ◽

Group I ◽

Long Term Follow Up ◽

Pulmonary Arterial ◽

Asd Closure

Patients with atrial septal defects (ASD) may develop pulmonary arterial hypertension (PAH). We aimed to explore predictors of PAH and characterize the evolution of pulmonary arterial systolic pressures (PASP) after transcatheter ASD closure. A cohort study was performed on 215 consecutive patients who underwent attempted transcatheter ASD closure, of which 194 were successful. Patients were classified into 4 groups based on PAH severity derived from baseline echocardiographic PASP estimates: no PAH (<40mmHg; Group I, n=107), mild PAH (40 –50mmHg; Group 2, n=62), moderate PAH (50 – 60mmHg; Group 3, n=27), and severe PAH (≥60mmHg; Group 4, n=19). Follow-up echocardiography was performed at a median of 10 months (IQR 3, 25 months). Independent predictors of moderate or severe baseline PAH were older age (OR 1.10 per year, p<0.0001), larger ASD size (OR 1.13 per mm, p=0.0052), female gender (OR 3.9, p=0.0313) and moderate or severe tricuspid regurgitation (OR 3.6, p=0.0043). Post closure, baseline PAH severity was associated with a greater likelihood of a ≥5mmHg reduction in PASP (33.7%, 73.9%, 79.2%, 100.0%, in Groups 1 to 4, p <0.0001) and larger reduction in PASP (median reduction 0, 8, 17, 22 mmHg in Groups 1 to 4, p<0.0001). However, likelihood of normalization of PASP (<40mmHg) was inversely correlated with baseline PAH severity (90.2%, 71.7%, 66.7%, 23.5% for Groups 1 to 4, p<0.0001). Higher baseline PASP (OR 1.20 per mmHg, p<0.0001), younger age (OR 0.97, p=0.0202), and smaller body surface area (OR 0.13 per m 2 , p=0.0210) independently predicted a ≥5mmHg reduction in PASP. Among patients with moderate or severe baseline PAH, normalization of PASP occurred in 48.8%, and was independently predicted by a lower baseline PASP (OR 0.91 per mmHg, p=0.0418) and absence of moderate or severe tricuspid regurgitation preceding ASD closure (OR 0.139, p=0.0420). In patients with ASD, severity of PAH is modulated by age, gender, defect size, and presence of moderate or severe tricuspid regurgitation. Patients with moderate or severe PAH benefit from a substantial reduction in PASP post-transcatheter ASD closure, but PASP remains elevated in a sizeable proportion of patients, warranting close long-term follow-up.

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