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PubMed1992

Influence of age at time of surgery on pre-operative left ventricular mass and postoperative outcome of Fontan operation in children with tricuspid atresia and native pulmonary stenosis.

Purpose of this study was to examine the influence of early (less than two and half years) versus later (greater than four years) age at time of Fontan type palliation in tricuspid atresia with native pulmonary stenosis on outcome with special reference to left ventricular mass and function. Among the 21 patients with tricuspid atresia, twelve (group A) underwent a Fontan type palliation at a median age of one (.6 to 2.5) years and nine (group B) at a median age of 7.5 (4.8 to 28) years. Left ventricular mass was assessed by cross-sectional echocardiography in the apical two and four chamber view. Mass was calculated as difference between epicardial and endocardial volume x 1.05 (specific gravity of heart muscle). Mass divided by volume at end-diastole yielded the mass/volume index. There was a weak correlation between age and left ventricular mass with an r-value of 0.74. Ejection fraction was calculated from the endocardial volume measurements at end-diastole and end-systole. Patient data were compared to normal values previously established in 95 controls, who were age-matched for the patients. Immediately before surgery left ventricular mass was significantly higher in the nine patients, who underwent surgery at a later age. While postoperative stay in hospital and duration of treatment in the intensive care unit did not differ significantly between both groups, the incidence of pleural and pericardial effusions and the duration of insertion of drainage tubes for these effusions differed significantly with the group A patients (under two and half years of age) doing better.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Magnetic resonance imaging of cardiac function and morphology in patients with transposition of the great arteries following Mustard procedure.

In order to assess the diagnostic possibilities of magnetic resonance imaging (MRI), 30 children (mean age 11.5 years) with d-transposition of the great arteries (TGA) corrected by the Mustard procedure were studied. Patient values were compared to those of 10 healthy volunteers. The most important postoperative abnormalities such as baffle leaks, systemic or pulmonary venous obstructions, left ventricular outflow tract (LVOT) stenosis and tricuspid regurgitation were assessed. Cardiac volumes and muscle mass were measured. Baffle leaks were found in 5 and obstruction of the baffle limbs in 6 patients. On gradient echo images 13 patients showed signs of LVOT stenosis and 12 tricuspid incompetence. Right ventricular end diastolic volumes in patients were significantly higher than the left ventricular volumes, but slightly lower than right ventricular volumes in the normals. In patients with TGA and ventricular septal defect (VSD) (n = 7) right ventricular (RV) volumes were found to be higher than in patients with intact ventricular septum (n = 23) and in normals. In contrast to the normal RV function of patients after Mustard surgery only patients with previous VSD showed a diminished RV ejection fraction. The muscular mass in TGA patients showed a ratio of 1.9:1 between right and left ventricles. In normals the ratio was 1:1.5. Magnetic resonance imaging allows a quantitative insight into the ventricular function and the morphology of the heart after inflow correction. Thus, it supplements the noninvasive evaluation of TGA patients.

Adolescent↗
PubMed1989

[Identification of congenital cardiac malformation and in utero arrhythmia by fetal echocardiography].

UNLABELLED: M-mode, 2D and Pulsed Doppler Echocardiography were performed on 111 fetuses of high-risk pregnancies. Fetal gestation ages ranged 16-41 weeks. Six congenital cardiac diseases were detected in utero and confirmed at autopsy in 4 cases, and one by Pulsed Doppler Echocardiography after delivery. These included a rhabdomyoma, an endocardial fibroelastosis with hydrops, a pulmonary stenosis with tricuspid regurgitation, a VSD, a VSD with descending aortic stenosis, an AV canal defect with single atrium and single AV valve with regurgitation. Arrhythmia was diagnosed in 23 fetuses, 9 had transient sinus bradycardia, 8 had premature atrial contraction, 2 had premature ventricular contraction which disappeared after birth, 4 had sustained sinus bradycardia, one of them combined PVC occurring in bigeminy and trigeminy, which continued after birth. These 4 fetuses had congenital heart disease. CONCLUSION: (1) 2 DE and PDE are the most valuable non-invasive technique for detection of fetal structural cardiac abnormalities. (2) M-mode and PDE make correct rhythm diagnosis in fetus. (3) The fetus with transient sinus bradycardia or PAC usually has a favorable prognosis. Sustained bradycardia has a more ominous prognosis, particularly if associated with heart abnormalities. (4) Fetal hydrops may associate with congestive cardiac failure in uterus. The incidence of cardiac disease is high in hydrops.

Adult↗
PubMed2002

T lymphocyte infiltration in non-rheumatic aortic stenosis: a comparative descriptive study between tricuspid and bicuspid aortic valves.

BACKGROUND: The two most common causes of aortic stenosis are primary "degenerative" calcification of tricuspid aortic valves and secondary calcification of congenital bicuspid valves. T lymphocyte infiltration occurs in stenotic tricuspid aortic valves, indicating an inflammatory component, but it has not been shown whether it also occurs in stenotic bicuspid valves. OBJECTIVE: To compare non-rheumatic tricuspid and bicuspid stenotic aortic valves for the presence and distribution of T lymphocytes. SETTING: University hospital. PATIENTS AND DESIGN: Valve specimens were obtained from 29 patients (15 women, 14 men, mean age 69 years (range 52-81 years)), referred to the hospital for aortic valve replacement because of symptomatic aortic valve stenosis. There were 17 tricuspid valves (from 10 women and seven men, mean age 71 years) and 12 bicuspid valves (from five women and seven men, mean age 67 years). To identify mononuclear inflammatory cells, sections were stained with antibodies for CD3 (pan-T cell antigen, Dako 1:400) and then graded histologically according to the degree of T cell infiltrate. RESULTS: T lymphocyte infiltration was present in both tricuspid and bicuspid stenotic aortic valves, without any significant differences in extent or localisation. CONCLUSIONS: Stenotic bicuspid aortic valves show the same degree of T lymphocyte infiltration as degenerative tricuspid aortic valves. Inflammation needs to be considered in the pathogenesis of acquired aortic stenosis, irrespective of the primary valve anomaly.

Aged↗
PubMed1989

Long-term follow-up after Carpentier tricuspid valvuloplasty.

To study the long-term results of tricuspid valvuloplasty, pre- and postoperative (51 +/- 17 months) echocardiographic and catheterization data were collected from 51 patients (aged 59 +/- 9 years). Because of severe mitral stenosis all patients received a heterograft in the mitral position and underwent reconstructive tricuspid surgery with Carpentier rings. With regard to postoperative clinical outcome three patient groups were distinguished: 37 patients (group A) showed clear clinical improvement; in seven patients mild, and in three patients moderate tricuspid regurgitation persisted. A mild tricuspid stenosis of less than 4 mm Hg mean diastolic gradient was found in 11 patients. Patients in group B (n = 8) showed no clinical improvement, but there was persistence of moderate tricuspid regurgitation associated with nearly unchanged pulmonary hypertension in five patients and moderate tricuspid stenosis in two. Six patients (group C) showed deterioration of their clinical status; in two patients a severe degree of tricuspid regurgitation persisted, and four patients were first seen with a tricuspid stenosis with a mean diastolic gradient greater than 7 mm Hg. Analysis of postoperative data showed that tricuspid stenosis may develop during surgery in patients with slightly shrunken valve leaflets. Although the area of the anterior tricuspid leaflet was slightly underestimated, we found that long-term results of tricuspid valve annuloplasty with a Carpentier ring were encouraging. Doppler echocardiography for detection of tricuspid regurgitation and transvalvular pressure gradient showed results identical to hemodynamic data and is a suitable and sensitive method for evaluating postoperative results after tricuspid valve annuloplasty.

Aged↗
PubMed2005

Plasma NT-proBNP is a potential marker of disease severity and correlates with symptoms in patients with chronic rheumatic valve disease.

BACKGROUND: A noninvasive marker of disease severity and presence of symptoms is required in patients with chronic rheumatic valve disease (RVD). AIMS: We sought to test the utility of measuring of N-terminal pro-B type natriuretic peptide (NT-proBNP) in chronic phase RVD. We also evaluated whether echocardiographic measures are interrelated with NT-proBNP levels. METHODS: The study comprised 92 patients with RVD (mean age of 40+/-14 years) and 50 age/gender-matched control subjects. Functional status was assessed. Detailed echocardiographic examination was performed and mitral valve score was estimated. Venous blood samples were taken for measuring the level of NT-proBNP. RESULTS: The plasma levels of NT-proBNP rose with increasing severity of mitral valve stenosis (p<0.001), increasing severity of mitral valve score (p<0.001), increasing severity of clinical symptom (p<0.001), increasing severity of mitral regurgitation (p<0.013), presence of mitral valve calcification (p<0.001), presence of tricuspid valve stenosis (p<0.001), increasing severity of tricuspid regurgitation (p<0.011), presence of aortic stenosis (p=0.043), decreasing left ventricular ejection fraction (p<0.001), presence of left atrial thrombus (p=0.0019), and with increasing left atrium dimensions (p=0.002). CONCLUSION: NT-proBNP levels in patients with chronic RVD are a potential marker of disease severity and correlates with symptoms.

Adolescent↗
PubMed1998

Hepatoatrial anastomosis and tricuspid valve replacement in Budd-Chiari syndrome 8.

The rare complication of tricuspid valve stenosis due to displacement of a peritoneovenous shunt catheter developed in a patient with Budd-Chiari syndrome. Surgical management included shunt removal and tricuspid valve replacement combined with hepatoatrial anastomosis. The tricuspid valve was replaced with a bioprosthesis, and liver resection opened the stenotic confluence of the hepatic veins. The right atrium was sutured to the liver capsule, thereby restoring physiologic hepatic venous blood flow.

Aged↗