DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

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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Modified unicaval drainage in reoperative isolated tricuspid valve repair via totally thoracoscopic approach

Perfusion ◽

10.1177/0267659120915659 ◽

2020 ◽

Vol 35 (7) ◽

pp. 649-657

Author(s):

Biao-Chuan He ◽

Ying-Jie Ke ◽

Kan Zhou ◽

Ze-Rui Chen ◽

Jue Yang ◽

...

Keyword(s):

Tricuspid Valve ◽

Venous Drainage ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Thoracoscopic Approach ◽

Significant Difference ◽

Group A ◽

Group B ◽

Drainage Group

Aim: The aim of this study was to investigate the feasibility, safety, and clinical effect of modified unicaval drainage for thoracoscopic reoperative isolated tricuspid valve repair, compared with conventional bicaval drainage. Methods: A total of 45 consecutive cases of patients who underwent thoracoscopic reoperative isolated tricuspid valve repair on beating-heart were enrolled and divided into two groups according to the different venous drainage (Group A: modified unicaval drainage, Group B: conventional bicaval drainage). A retrospective analysis of perioperative data and clinical outcomes were performed and all the surviving cases were followed up. Re-evaluation of echocardiography and electrocardiogram was performed prior to discharge, and at first month, sixth month, and every year follow-up. Results: The overall postoperative 30-day mortality was 4.5% in Group A and 8.7% in Group B. The postoperative tricuspid valve regurgitation grade of both groups decreased significantly from preoperative regurgitation grade, p < 0.001, without intergroup significant difference, p = 0.815. Follow-up duration ranged from 6 to 38 months, there was one death at 24 months in Group A, and another at 9 months in Group B, respectively. Nobody from both groups experienced reintervention for residual tricuspid regurgitation. No significant difference could be identified about the incidence of postoperative morbidities and follow-up adverse events. Conclusion: Both strategies of caval venous drainage can provide satisfactory exposure for thoracoscopic reoperative isolated tricuspid valve repair and equivalent favorable postoperative outcome. And the modified unicaval drainage group may even preserve the anesthetic time and decrease the risk of iatrogenic jugular injury, achieving a more simplified procedure with better cosmetic outcome.

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Prognostic Factors for Late Ventricular Arrhythmias after Repair of Tetralogy of Fallot

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239700500105 ◽

1997 ◽

Vol 5 (1) ◽

pp. 20-24

Author(s):

Fumikazu Nomura ◽

Seiichiro Ikawa ◽

Keishi Kadoba ◽

Masataka Mitsuno ◽

Yoshiki Sawa ◽

...

Keyword(s):

Pulmonary Artery ◽

Right Ventricular ◽

Tetralogy Of Fallot ◽

Ventricular Arrhythmias ◽

Right Atrial ◽

Age At Surgery ◽

Group A ◽

Group B ◽

The Right

During a median follow-up period of 9 years (ranging from 9 months to 25 years), 24-hour ambulatory electrocardiographic studies were undertaken in 155 patients after repair of tetralogy of Fallot. The patients were divided into two groups. Group A consisted of 76 patients in whom the right ventricular approach was used and group B comprised 79 patients whose repair was through the right atrium. A transannular patch was employed in all patients in group A and in none of the patients in group B. Age at surgery was between 1 and 37 years (median age 4.8 years). During follow-up, 37 patients (48.6%) in group A had significant ventricular arrhythmias (Lown grade 2 or higher) and 13 patients (15.4%) in group B had significant ventricular arrhythmias. A close relationship was observed between age at surgery and Lown grade (R2 = 0.374, p < 0.001) and between follow-up duration and Lown grade (R2 = 0.514, p < 0.001), especially when the two groups were analyzed separately (R2 = 0.502, 0.476, p < 0.001). In contrast, no significant relationship was observed between the ratio of right ventricular to left ventricular pressure and Lown grade or between right ventricular systolic pressure and Lown grade. Discriminant analysis revealed risk factors associated with postoperative ventricular arrhythmias are follow-up duration (partial F = 3.22, p < 0.01), right ventricular to pulmonary artery pressure gradient (partial F = 3.35, p < 0.01), and operative method (partial F = 2.4, p < 0.05). Despite antiarrhythmic therapy, 11 of 22 late postoperative deaths occurred suddenly, presumably from ventricular arrhythmias. In this series of patients, the right atrial and pulmonary artery approach significantly reduced the risk of life-threatening ventricular arrhythmias after repair of tetralogy of Fallot.

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Comparison of Ring and Suture Annuloplasty in the Treatment of Tricuspid Regurgitation

10.22541/au.162236440.02075474/v1 ◽

2021 ◽

Author(s):

Mateus Tamba ◽

Quinling Fu ◽

Kaili Han ◽

Xiaoke Sun ◽

Liang Zhang ◽

...

Keyword(s):

Tricuspid Valve ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Optimal Method ◽

Ring Group ◽

Wilcoxon Rank Sum Test ◽

Ring Annuloplasty ◽

Significant Difference ◽

Suture Group

Background: Significant TR is common in patients with cardiac disease and because of its prognostic importance, TV came to the spotlight in the last decades. Functional TR is mostly treated when undergoing left-sided valve surgery, whereas idiopathic TR surgery is uncommon. The aim of this study is to compare the durability of tricuspid valve annuloplasty techniques, and to explore the optimal method for TV repair surgery. Methods: 1005 patients who underwent tricuspid valve repair from February 2012 to March 2019, were retrospectively studied. The patients had tricuspid valve repair while receiving surgery for other cardiac conditions. The study population was divided into Suture group (n=483, 48.1%), and Ring group (n=522, 51.9%). Data variation between and within the groups was analyzed with Mann-Whitney U test, Wilcoxon rank-sum test, and Radit analysis. Results: At two-year follow-up, in the Suture group, none/trace TR subjects were 63.9%, and 1.4% had severe TR; In the Ring group were: 63.9% none/trace, and 0.6% severe. Both groups’ two-year follow-up TR status was significantly different with preoperative TR status (p<0.05). At two-year follow-up, Suture group had 63.9% none/trace and 1.4% severe; and Ring group had 63.9% none/trace and 0.6% severe TR and there was no significant difference between the groups (p>0.05). Conclusions: Both annuloplasty techniques have good short-term outcomes. However, suture annuloplasty deteriorates faster than ring annuloplasty, making the latter to be the ideal technique for TV repair.

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Morphological diversity of the tricuspid posterior leaflet affects surgical complexity for control of tricuspid regurgitation

10.22541/au.162756475.53976114/v1 ◽

2021 ◽

Author(s):

takumi kawase ◽

Yosuke Takahashi ◽

Kenta Nishiya ◽

Noriaki Kishimoto ◽

Kokoro Yamane ◽

...

Keyword(s):

Risk Factor ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Morphological Diversity ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Ring Annuloplasty ◽

Surgical Complexity ◽

Group 2 ◽

Group 1

Abstract Objective: We investigated the effect of morphological diversity of the tricuspid valve with multiple posterior leaflets on the technical outcomes of tricuspid valve repair. Methods: From April 2016 to November 2020, 141 patients were diagnosed with secondary tricuspid regurgitation associated with left heart disease and underwent tricuspid valve repair. We retrospectively analyzed the clinical and echocardiographic data of patients who underwent both preoperative and postoperative transthoracic echocardiography. We divided the patients into two groups according to the surgical technique used to treat tricuspid regurgitation: ring annuloplasty alone (Group 1, n=109) or additional approximation of leaflet edges (edge-to-edge repair) with ring annuloplasty (Group 2, n=32). We measured the morphological diversity of the tricuspid valve during the operation in all patients. Results: The preoperative tricuspid regurgitation score was higher in Group 2 than in Group 1 (2.1±0.78 vs. 1.6±0.7, respectively; p=0.0046), and Group 2 contained more patients with two posterior leaflets than Group 1 [20 (63%) vs. 36 (33%), respectively; p=0.003]. The univariate and multivariate logistic regression analyses showed that the presence of two posterior leaflets was an independent risk factor for additional procedures during tricuspid valve repair (odds ratio, 2.6; 95% confidence interval, 1.1–6.1; p=0.033). Conclusions: Additional procedures to reduce tricuspid regurgitation were required more frequently in patients with two posterior leaflets of the tricuspid valve. The morphological diversity of two posterior leaflets is a potential risk factor for a more complicated tricuspid repair.

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Ring, Band or Suture in Tricuspid Annuloplasty for Functional Tricuspid Regurgitation; Which is Better and More Durable?

The Heart Surgery Forum ◽

10.1532/hsf.2517 ◽

2019 ◽

Vol 22 (5) ◽

pp. E411-E415 ◽

Cited By ~ 1

Author(s):

Ahmed Adas ◽

Ahmed Elnaggar ◽

Yehia Balbaa ◽

Ahmed Elashkar ◽

Hesham Mostafa Alkady

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Late Results ◽

Tricuspid Valve Repair ◽

Recurrence Rates ◽

Vena Contracta ◽

Functional Tricuspid Regurgitation ◽

Tricuspid Incompetence ◽

Group B

Background: In this study, we evaluate different annuloplasty modalities to repair functional tricuspid regurgitation. Patients and methods: Between January 2011 and January 2017, 200 patients with moderate or greater functional tricuspid regurgitation received tricuspid valve repair as part of primary surgeries on the left side of their cardiac valves. Of these, 39 patients received rings (Group A), 84 patients received bands (Group B), and 77 patients received suture annuloplasty (Group C). Results: Two patients from Group C were operated on again, during the primary hospital stay due to severe symptomatic tricuspid regurgitation. The degrees of early postoperative tricuspid regurgitation – mean vena contracta and mean jet area – significantly were higher in Group C. During a mean follow-up period of 26 ± 12.6 months, 5 patients within Group C (6.85%) and one patient in Group B (1.3%) were operated on again with tricuspid valve replacement due to severe symptomatic tricuspid incompetence. Also during follow up, mean degrees of tricuspid regurgitation, mean vena contracta, and mean jet areas significantly were higher in Group C. Conclusion: Patients who received rings followed by band annuloplasty had better early and late results with lower recurrence rates than those who received suture annuloplasty

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Effect of Hemiovariectomy on reproductive performance in Chinchila Rabbits.

Nigerian Journal of Animal Production ◽

10.51791/njap.v36i1.1205 ◽

2021 ◽

Vol 36 (1) ◽

pp. 167-174

Author(s):

C. A. Eze ◽

C. P. Nwodo ◽

E. O. Ogbu

Keyword(s):

Birth Weight ◽

Litter Size ◽

Conception Rate ◽

Control Group ◽

Significant Difference ◽

Negative Effect ◽

Group A ◽

Group B ◽

The Right ◽

Reproductive Indices

This work evaluates the effects of hemiovariectomi (37 some reproductive indices such as conception rate, birth weight and birth litter size in Chinchilla breed of rabbits. Thirty females and six males were used for the experiment. The males were examined for breeding soundness before using them to cross the females. The experiment was replicated in two batches of three groups of five females and a male each at different periods. Hemi-ovariectomy was carried out in the right ovary of 10 does (Group A) and left ovary of another 10 does (Group B). Ten females in Group C were not ovariectomised and served as the control group. All groups were served at reproductive maturity by rotating the bucks. Pregnancy was diagnosed using a standard method. The reproductive indices evaluated included conception rate, birth weight and birth litter size. Data were analyzed using percentages, ratios, and analysis of variance (ANOVA) was computed where necessary. Results showed that hemi ovariectomy significantly (P<0.01) reduced the mean litter size, Group A (2.50+58), Group B (3.00+0.71), control (Group C) (6.20+0.84). However, there was increased mean litter birth weight which, differed significantly (P<0.01) from that of the control (27.06), Group A (33.64+1.86) and Group B (33.93=1.75). Also, the conception rate in the treated groups averaged 65% while the control was 80%. There was no significant difference (P>0.05) between the groups in the interval from the introduction of the huck to the does to the time of conception. It is concluded thai hemiovariectomy has negative effect on the conception rate and birth litter size but has positive effect on birth litter weight. The procedure has shown that in highly priced breed of animal with unilateral ovarian uilments such an animal can still be used for breeding using the healthy ovary: The procedure could also be a more reliable method of birth control in pet animals as well as a means of producing heavy weight offspring.

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A case report of isolated severe valve stenosis in a previous tricuspid valve repair: an integrated multimodality imaging and invasive haemodynamic evaluation

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa147 ◽

2020 ◽

Vol 4 (4) ◽

pp. 1-5

Author(s):

Jesper Khedri Jensen ◽

Christian Alcaraz Frederiksen ◽

Mads Jønsson Andersen ◽

Steen Hvitfeldt Poulsen

Keyword(s):

Case Report ◽

Tricuspid Valve ◽

Multimodality Imaging ◽

Rare Condition ◽

Tricuspid Valve Repair ◽

Valve Prosthesis ◽

Case Summary ◽

Ring Annuloplasty ◽

Final Treatment ◽

The Right

Abstract Background Tricuspid valve (TV) stenosis is a very rare condition and the aetiology is primarily due to rheumatic disease, carcinoid disease, congenital heart disease, endocarditis, and following degeneration of biological valve prosthesis. Case summary We present a 45-year-old man with a rare case of symptomatic TV stenosis (TS) in a previously isolated TV repair. A meticulous multimodality diagnostic approach is presented in order to determine the severity of the TS and to evaluate the right ventricular function. Discussion This case report presents an integrated multimodality imaging and haemodynamic approach to evaluate and document the suspicion of development of a symptomatic significant stenosis in a previous TV repair. The initial TV repair was done without ring annuloplasty, because only the anterior leaflet was affected and bicuspidalization of the valve made it patent. In addition, minimizing the amount of implanted material was intended to minimize the risk of reinfection. The final treatment was performed as a TV replacement with insertion of a bioprosthesis.

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Bicaval Anastomosis Reduces Tricuspid Regurgitation after Heart Transplantation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230501300313 ◽

2005 ◽

Vol 13 (3) ◽

pp. 251-254 ◽

Cited By ~ 15

Author(s):

Kook-Yang Park ◽

Chul-Hyun Park ◽

Yang-Bin Chun ◽

Mi-Seung Shin ◽

Kyung-Chun Lee

Keyword(s):

Heart Transplantation ◽

Tricuspid Regurgitation ◽

Survival Rates ◽

Standard Technique ◽

Ischemic Time ◽

Significant Difference ◽

Group A ◽

Group B ◽

Bicaval Anastomosis ◽

Late Postoperative Period

The standard surgical technique utilizing two atrial cuff anastomoses has been used in the majority of transplant centers until recently when bicaval anastomoses was introduced. The purpose of this study was to compare the prevalence of tricuspid regurgitation after the bicaval and standard techniques of anastomosis. Heart transplantation was performed in 43 patients at our institution from April 1994 to December 2003: 15 by the standard technique (group A) and 28 by the bicaval technique (group B). No differences in pre-transplant diagnosis, donor age, immunosuppression, rejection treatment, or graft ischemic time were evident between the two groups. The prevalence of tricuspid regurgitation (≥ moderate) was higher after the standard technique (36.4% vs. 10.5%; p < 0.05). Survival rates at 1 and 3 years in group A were 87% and 55%, and 86% and 78% in group B, with a significant difference in the 3-year mortality. The bicaval anastomosis technique was found to be associated with a lower incidence of tricuspid regurgitation during the late postoperative period, and should be preferred for heart transplantation.

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Surgical Repair versus Conservative Treatment for Moderate Functional Tricuspid Regurgitation in Concomitant with Mitral Valve Surgery

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v2i2.123 ◽

2020 ◽

Vol 2 (2) ◽

pp. 70-75

Author(s):

Moataz Rezk ◽

Shimaa Moustafa ◽

Nora Singab ◽

Ashraf Elnahas

Keyword(s):

Mitral Valve ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Surgical Repair ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Functional Tricuspid Regurgitation ◽

Group A ◽

Group B ◽

Valve Lesion

Background: Management of moderate functional tricuspid regurgitation (FTR) secondary to left-sided valve lesion is controversial. The objective of this study was to compare the short-term results of surgical repair versus conservative treatment for moderate functional tricuspid regurgitation in concomitant with mitral valve surgery. Methods: Our study included 60 patients with mitral valve lesion and moderate functional tricuspid regurgitation. Patients were divided into 2 groups; group A included 30 patients whose tricuspid valve disease were managed conservatively, and group B included 30 patients who had tricuspid valve band annuloplasty. Results: Preoperative clinical and echocardiographic data were comparable between groups. There was no difference regarding mechanical ventilation time (6 .13 ± 3.02 vs. 7.01 ± 4.14 hours; p= 0.291), or intensive care unit stay (51.42 ± 12.1 vs. 52.31 ± 15.32 hours; p=0.614) in group A and B respectively. There was a significant improvement in the degree of tricuspid valve regurgitation in group B early postoperative (moderate tricuspid regurgitation reported in 22 (73.3%) vs. 4 (13.3%); p<0.001) and at 3 months (moderate tricuspid regurgitation 11 (36.7%) vs. 2 (6.7%); p<0.001) and 6 months follow up (moderate tricuspid regurgitation 10 (30%) vs. 2 (6.7%); p<0.001) in group A and B respectively. After 6-months, 20 (66.7%) patients in group A had dyspnea grade I compared to 26 (86.7%) patients in group B; p=0.021. Conclusion: Although the correction of the left-sided lesion improved the degree of TR in some patients, concomitant repair of the tricuspid valve could produce better improvement in the clinical outcome when compared to the conservative approach.

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Length and Depth of the Central Sulcus: A Postmortem Study

Bangladesh Journal of Anatomy ◽

10.3329/bja.v11i1.20504 ◽

2014 ◽

Vol 11 (1) ◽

pp. 19-24

Author(s):

Kanij Fatema ◽

Shamim Ara ◽

Mushfika Rahman ◽

Halima Afroz ◽

Anjuman Ara Sultana ◽

...

Keyword(s):

Right Hemisphere ◽

Age Groups ◽

Central Sulcus ◽

Cross Sectional ◽

Male And Female ◽

Significant Difference ◽

Group A ◽

The Difference ◽

Group B ◽

The Right

Context: The central sulcus, which is located between the primary motor and primary somatic sensory cortex is an important structure and landmark of the cerebral hemisphere. Morphology of the central sulcus varies with age, sex, manual skill, handedness and in many diseases. This study is carried out to establish a normal standard in different age groups in length and depth of the central sulcus. Materials and Methods: A cross-sectional, analytical type of study was conducted in the department of Anatomy, Dhaka Medical College, on one hundred and forty (140) on human cerebral hemispheres. The samples were divided into four different age groups i.e. Group A (20-29 years), Group B (30-39 years), Group C (40-49 years) and Group D (50-59 years). All the samples were studied morphologically. Results: The mean length of central sulcus was 102.89±3.55 mm to 96.83±3.92 mm in male and 98.00±5.17 mm to 96.29±2.56 mm in female. Depth of the central sulcus was 20.02±2.41 mm to 21.50±2.21 mm in male and 20.50±2.57 mm to 21.36±1.87 mm in female. The difference in mean length of the right central sulcus between male and female was statistically significant in group A (p<0.05) and B (p<0.05). The difference in mean depth of the central sulcus between male and female was not statistically significant in any age groups. No significant difference was found between right and left hemisphere for both length and depth of the central sulcus. The difference in mean length and depth of the central sulcus between different age groups for both left and right hemisphere was not statistically significant in any age group. Conclusion: The length and depth of the central sulcus showed gradual decreasing values with advancing age. DOI: http://dx.doi.org/10.3329/bja.v11i1.20504 Bangladesh Journal of Anatomy, January 2013, Vol. 11 No. 1 pp 19-24

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