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At least 73 records · Page 4Linked to original sources
PubMed1986

Mitral valve stenosis and pure tricuspid valve regurgitation: comparison of necropsy patients having simultaneous mitral and tricuspid valve replacements with necropsy patients having simultaneous mitral valve replacement and tricuspid valve anuloplasty.

Clinical and morphologic observations are described in 30 patients (23 [77%] of whom were in functional class III or IV) who underwent replacement of the mitral valve for mitral stenosis and either simultaneous replacement (13 patients, group I) or anuloplasty (17 patients, group II) of the tricuspid valve for pure tricuspid valve regurgitation. Comparison of the 13 patients in group I with the 17 patients in group II disclosed similar mean ages (55 vs 58 years), similar average preoperative right ventricular systolic pressures (64 vs 61 mm Hg), similar average right atrial mean pressures (10 vs 9 mm Hg), similar average left ventricular systolic pressures (126 vs 120 mm Hg), similar average pulmonary artery wedge-left ventricular mean diastolic pressures (16 vs 18 mm Hg), similar cardiac indexes (2.1 vs 2.0 liters/min/m2), similar mean heart weights (507 vs 535 g), and similar percents with grossly visible foci of left ventricular necrosis (15% vs 12%) and fibrosis (23% vs 12%). Of the 13 patients in group I, 10 (77%) died early (less than or equal to 60 days of tricuspid valve replacement) and 3 (23%) died late (29, 37 and 120 months); of the 17 patients in group II, 14 (82%) died early and 3 (18%) died late (4, 9 and 98 months). The causes of early death in the 2 groups were different: of the 10 patients in group I who died early, the cause was excessive bleeding in 5, low cardiac output of undetermined etiology in 3, dysfunction of both prostheses in 1 and cerebral insult in 1; of the 14 patients in group II who died early, none died from excessive bleeding, 4 from decreased cardiac output of uncertain cause, 5 from left ventricular inflow obstruction (produced by a Starr-Edwards ball-valve prosthesis in 4 and from a Starr-Edwards disc prosthesis in 1), 1 from left ventricular outflow obstruction (by a porcine bioprosthesis), 2 from technical mishaps (incision into left ventricular free wall with rupture in 1 and ligation of the left circumflex coronary artery with resulting acute myocardial infarction in 1) and 2 died suddenly for reasons not determined. Of the 6 patients dying greater than 60 days after operation, 4 died from chronic congestive cardiac failure, 1 from a cerebral embolus and 1 from prosthetic valve endocarditis.

Adult↗
PubMed1990

[Congenital mitral and tricuspid double stenosis].

The authors report the case of a child followed up from the age of 4 months to the age of 15 for asymptomatic congenital heart disease. Initial clinical examination showed the presence of a systolic murmur and a diastolic rumble in the xiphoid area with signs of right atrial dilatation-hypertrophy. During follow-up, an apical diastolic rumble was detected with left atrial dilatation from the age of 3. Doppler echocardiography carried out recently showed double mitral and tricuspid valve stenosis with two-dimensional appearances of doming of both valves and moderate transvalvular pressure gradients with slight elevation of pulmonary artery pressures on the Doppler study. The very early detection of the malformation and the continuous follow-up of this patient indicate the congenital and not rheumatic origin of this double valve stenosis.

Adolescent↗
PubMed1990

[A rare case of congenital tricuspid stenosis treated with modified Fontan operation].

A rare case of congenital tricuspid stenosis treated with modified Fontan operation was reported. The patient was 13 years old boy and his chief complaint was cyanosis. Cyanosis appeared in his neonatal period and squatting developed in his childhood. He underwent Blalock's shunt operation at 5 years of age. His exercise tolerance was limited at the admission for the radical operation. Angiocardiography showed the annular stenosis of tricuspid valve and the moderate hypoplasia of right ventricle. The right ventricular volume was 56 ml (equivalent to 35% of the normally expected right ventricular volume) and the diameter of tricuspid annulus was 13 mm (equivalent to 58% of the normally expected diameter). Atrial septal defect was associated with but pulmonary stenosis did not exist. His left ventricular function was good and pulmonary vascular resistance was not raised. A diagnosis of tricuspid stenosis was made and Fontan's repair was considered to be possible for his correction. Operative findings showed normal architecture of tricuspid valve with the three leaflets but tricuspid annulus was narrow. Tricuspid valve stenosis was considered to be caused by the hypoplasia of tricuspid ring and surgical dilatation was found to be difficult. Therefore, modified Fontan operation (RA-RV connection) was performed. His cyanosis disappeared and exercise tolerance was improved after the operation. Cardiac catheterization and angiocardiography were performed 8 months and 28 months after the operation. His righ ventricular volume was increased to 123 ml (equivalent to 57% of the normally expected volume) followed by RA-RV connection.

Adolescent↗
PubMed1989

A prospective study comparing the haemodynamic with the cross-sectional echocardiographic diagnosis of rheumatic tricuspid stenosis.

The value of cross-sectional echocardiography in the diagnosis of tricuspid valve stenosis is not clearly established. We prospectively studied by cardiac catheterization 42 consecutive patients, with a mean age of 29 +/- 11 years, who exhibited the cross-sectional echocardiographic features of tricuspid valve stenosis, defined as: diastolic doming of all three tricuspid leaflets and leaflet thickening with restrictive motion. To expose occult and amplify borderline tricuspid diastolic gradients, simultaneous right atrial and right ventricular pressures were recorded in the basal state, after incremental infusions of normal saline to 200, 400, 500, 700 or 1000 ml until a mean right atrial pressure of 12 mmHg was achieved, and finally after intravenous administration of 0.6 mg of atropine. Eighteen patients, Group 1, (43%) exhibited mean tricuspid diastolic gradients greater than 2 mmHg after saline infusion, increasing from a mean of 4 +/- 2 to 9 +/- 3 mmHg, (P less than 0.001), 14 (33%) having gradients greater than 2 mmHg in the basal state, together with four (10%) increasing from 1.7 +/- 0.2 to 4.5 +/- 1.2 mmHg (P less than 0.01) after provocation with fluid challenge. In the remaining 24 patients, Group 2, (57%) the mean tricuspid diastolic gradient was less than 2 mmHg, both at rest and after provocative manoeuvres. We conclude that the cross-sectional echocardiographic features of tricuspid valve stenosis are not a precise indicator of tricuspid valve stenosis. Provocative manoeuvres during haemodynamic studies are required to expose occult or amplify borderline tricuspid diastolic gradients in a minority of patients with the cross-sectional echocardiographic features of tricuspid stenosis.

Adolescent↗
PubMed1981

[Calcification of the tricuspid annulus].

Tricuspid annular calcification was observed on cardiac screening of a 50 year old woman with congenital valvular pulmonary stenosis and confirmed by angiography. At operation, the tricuspid annular calcification was palpable but there was no interference with valvular function. There was no associated disease process in this patient. Phosphate and calcium metabolism was normal. Tricuspid annular calcification is very rare: 7 other reported cases, aged 42 to 51 years old. All patients had right ventricular hypertension usually caused by pulmonary stenosis. Tricuspid valve function was normal in all cases. The pathogenesis is discussed: a premature degenerative process favored by right ventricular hypertension may be responsible. This would appear to be the first case to be published in France.

Calcinosis↗