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At least 667 records · Page 37Linked to original sources
PubMed1997

Tricuspid valve repair in children with hypoplastic left heart syndrome during staged surgical reconstruction.

BACKGROUND: The purpose of this study was to determine the incidence of moderate to severe tricuspid valve regurgitation in children with hypoplastic left heart syndrome (HLHS) undergoing staged surgical reconstruction, to assess the mechanisms responsible, and to evaluate the efficacy of surgical repair. METHODS AND RESULTS: We retrospectively reviewed clinical and echocardiographic data of 59 consecutive patients with HLHS operated on at our institution. Patients with a moderate or severe degree of tricuspid regurgitation (> or =2+) demonstrated by color flow Doppler echocardiography before the hemi-Fontan or Fontan operation who underwent tricuspid valve repair were included. Patients with HLHS and coexisting atrioventricular septal defect were excluded from the study. Severity of insufficiency was graded on a scale from 1 to 4+ by Doppler color flow mapping. Tricuspid valve morphology, degree of tricuspid valve regurgitation, and right ventricular function were assessed before and after tricuspid valvuloplasty. Eight patients (8/59; 14%) were found to have a minimum of 2+ tricuspid valve regurgitation before hemi-Fontan or Fontan operations. In five of eight patients (62%; Group A), the valve was found to be myxomatous, thickened, and redundant. There were multiple regurgitant jets in three of five (60%) patients in this group. In three of eight patients (37%; Group B), the valve had a normal echocardiographic appearance and regurgitation was the result of a lack of complete leaflet coaptation. All eight patients underwent tricuspid valvuloplasty, and all experienced a decrease in regurgitation. In five of eight (62%) patients, there was a reduction in insufficiency of two grades of severity and in three of eight (37%) patients, there was a one-grade improvement. Tricuspid valve stenosis was not documented in any of the patients after tricuspid valvuloplasty. In seven of eight (87%) patients, right ventricular function was assessed as fair before tricuspid valvuloplasty repair and improved to good in five of seven (71%) patients after the procedure. The remaining patient had good function both at baseline and after tricuspid valvuloplasty. CONCLUSIONS: Moderate to severe tricuspid valve regurgitation is a common finding in patients with HLHS undergoing staged surgical reconstruction and can result from either abnormal valve morphology or incomplete leaflet coaptation. Tricuspid valvuloplasty during either the hemi-Fontan or Fontan stages of reconstruction carries a high success rate and is associated with improved right ventricular function.

Child↗
PubMed2002

Application of FFT analyzed cardiac Doppler signals to fuzzy algorithm.

Doppler signals, recorded from the output of tricuspid, mitral, and aorta valves of 60 patients, were transferred to a personal computer via 16-bit sound card. The fast Fourier transform (FFT) method was applied to the recorded signal from each patient. Since FFT method inherently cannot offer a good spectral resolution at highly turbulent blood flows, it sometimes leads to wrong interpretation of cardiac Doppler signals. In order to avoid this problem, firstly six known diseased heart signals such as hypertension, mitral stenosis, mitral failure, tricuspid stenosis, aorta stenosis, aorta insufficiency were introduced to fuzzy algorithm. Then, the unknown heart diseases from 15 patients were applied to the same fuzzy algorithm in order to detect the kinds of diseases. It is observed that the fuzzy algorithm gives true results for detecting the kind of diseases.

Algorithms↗
PubMed1984

Noninvasive assessment of valve lesions with Doppler ultrasound.

Noninvasive assessment of valvular lesions with Doppler echocardiography is based on determination of velocities of blood flow in the region of cardiac valves, adjacent cardiac chambers and in the large vessels. Obstructions lead to an increase in the velocity of flow in the region of the stenosis which can be registered with the Doppler technique. Through application of the Bernoulli equation, from the maximal velocity, the pressure gradient across the stenotic valve can be calculated. Additionally, the severity of the stenosis is reflected in the temporal course of the velocity curve of the jet through the stenosed valve. For this purpose, in mitral stenosis, the pressure half-time is employed and, in aortic stenosis, the peak of the velocity curve during systole is used. The severity of tricuspid and pulmonic stenosis can also be classified with a method analogous to that used in obstruction of the left heart. The diagnosis of valvular incompetence is based on the detection of regurgitant flow. The extent of regurgitant flow into the proximal cardiac chamber enables semiquantitative classification of severity. The intensity of the jet through the incompetent valve is also indicative of the size of the regurgitant volume. Similar to that in obstructive lesions, the temporal course of the velocity curve is also related to the severity. In association with high-grade regurgitant lesions, there is a premature decrease in the velocity curve. Additionally, the severity of aortic regurgitation can be assessed on the basis of the extent of regurgitant flow in the descending aorta or the subclavian arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Double outlet right ventricle with discordant atrioventricular connection. Clinical study].

The clinical and anatomic findings were reviewed in 17 patients with double-outlet right ventricle and atrioventricular discordance. Ten cases had atrial situs solitus, seven with right-sided heart three with left-sided heart. Seven cases had atrial situs inversus, five with left-sided heart and two with right-sided heart. All cases presented ventricular septal defect, 13 subvalvar pulmonary stenosis, two tricuspid regurgitation and two complete atrioventricular block. The spatial relationship between the arterial valves are variable. Most cases in atrial situs solitus had a left-sided and anterior aorta and all patients in atrial situs inversus had a right-sided and anterior aorta. In this study we compared the anomalies found in our cases with double outlet right ventricle with those in 58 patients with corrected transposition. Absolute, relative and attributable risks were calculated for the presence of subvalvular pulmonary stenosis, ventricular septal defect, tricuspid regurgitation and atrioventricular block for each the two groups. We concluded that patients with double-outlet right ventricle are more prone to present ventricular septal defect and subvalvar pulmonary stenosis, while those with corrected transposition have a greater likelihood of presenting with tricuspid regurgitation and atrioventricular block. There is no typical clinical picture for the malformations. Symptoms depend upon the associated anomalies. The final diagnosis is best achieved by the echocardiographic and angiocardiographic studies, but electrocardiogram and chest radiograph may suggest the presence of a discordant atrioventricular connection.

Adolescent↗
PubMed1992

Long-term results of porcine bioprostheses in the tricuspid position.

Between 1974 and 1990, 58 patients underwent tricuspid valve replacement with porcine bioprostheses (Hancock 42, Carpentier-Edwards 16) during multiple valve replacement (double, 21; triple, 37). Perioperative mortality was 12%; 16 patients died later, mostly from cardiac causes. Actuarial survival (1 patient lost to follow-up) was 81% +/- 11% at 5 years, and 60 +/- 17% at 10 years. Reoperation because of Hancock prosthesis deterioration was performed in 2 patients at 11 and 15 years, respectively. At last follow-up (mean 108 +/- 48 months), 82% of survivors (28/34) were functionally improved. Doppler echocardiography was performed in 29 patients in February 1991. In 21 patients, after 88 +/- 40 months of follow-up, the bioprosthesis was normal, there was no leaflet malformation, no significant tricuspid regurgitation and the mean diastolic transprosthetic gradient (DTPG) was 3.8 +/- 1.7 mmHg. In 7 patients (follow-up: 129 +/- 40 months, P less than 0.05), there was moderate dysfunction (all Hancock prostheses) with leaflet sclerosis, tricuspid regurgitation grade 2, and mean DTPG 5.7 +/- 1.8 mmHg (P less than 0.05). Only 1 patient (Hancock prosthesis implanted in 1981) had severe tricuspid prosthesis stenosis with very thickened leaflets and mean DTPG 13 mmHg. Pulmonary artery hypertension (most often fixed) was present in 11 patients, associated with a poor functional result and a significantly higher DTPG. We conclude that porcine bioprostheses in tricuspid position have an acceptable long-term durability and satisfactory performance. Prosthetic dysfunction correlates with the length of follow-up of patients and with the presence of fixed pulmonary artery hypertension.

Adult↗
PubMed1995

[Mitral and aortic annular enlargement for small mitral annulus after mitral annuloplasty].

Mitral and Aortic valve rings were enlarged in a 70-year-old female with tiny mitral annulus after mitral annuloplasty before. She had undergone aortic valve replacement with No. 21 SJM valve and Kay's annuloplasty 10 years previously. The reoperation was needed because of mitral stenosis and tricuspid regurgitation. We applied the Manouguian technique for the enlargement of the mitral annulus because it was too small to implant a prosthetic valve, even though the Aortic prosthetic valve was functioning well. As too tight a mitral annuloplasty may make the possibility of mitral stenosis real, we should make the annulus remain wide enough.

Aged↗