[Surgical correction of Ebstein's anomaly by tricuspid valvulectomy without prosthetic replacement--a new surgical approach (author's transl)].
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Child, Preschool↗
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Results for “TRICUSPID STENOSIS”
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Atrioventricular discordance: results of repair in 127 patients.
OBJECTIVE: The conventional management of patients with atrioventricular discordance is directed at associated lesions, taking advantage of physiologic "correction"; however, the morphologic right ventricle and tricuspid valve support the systemic circulation. Questions surrounding survival using this approach led us to analyze our institutional results. METHODS: All patients with atrioventricular discordance undergoing biventricular repair were analyzed (n = 127, 1959-1997), excluding those with functionally univentricular hearts. The ventriculoarterial connection associated with atrioventricular discordance varied and was most commonly discordant (87%), but occasionally concordant (6%), double-outlet right ventricle (6%), or double-outlet left ventricle (1%). At initial presentation, the most common lesions associated with atrioventricular discordance were ventricular septal defect (86%), pulmonary stenosis (64%), tricuspid regurgitation (28%), and atrioventricular block (12%). Nine patients underwent a double switch procedure to create ventriculoarterial concordance and the remainder were managed conventionally without correcting discordant connections. RESULTS: Operative mortality was 6% and did not vary by associated lesion. Twenty years after repair, survival was 48%. Within 20 years, 56% of patients required reoperation, usually for atrioventricular valve incompetence (n = 16), pulmonary stenosis (n = 16), or both (n = 3). Pacemakers were required in 50 patients, 4 before repair, 40 within 2 months of repair, and 6 remotely after repair. In early follow-up, the double switch procedure (n = 9) had equivalent mortality and a high pacemaker requirement for atrioventricular block. CONCLUSIONS: Analysis of conventional management of atrioventricular discordance revealed cumulative increases in mortality, systemic atrioventricular valve (tricuspid) replacement, complete atrioventricular block, and incidence of reoperation. Alternative management should be examined.
Adolescent↗
[Surgical results of high grade constriction of tricuspid annulus in DeVega technique for secondary tricuspid regurgitation].
Sixty-six patients were operated on by our high degree constriction technique using DeVega tricuspid annuloplasty from 1985 to 1989. They were 20 men and 46 women, age distributed from 28 to 71 (mean 54.5). Preoperative tricuspid annular diameter ranged from 29 mm to 45 mm, average 36.3 mm. Those were constricted to 27 mm in 38 patients, and to 25 mm in 28 patients. Postoperative residual tricuspid regurgitation was observed in only 8.5% of total cases followed up 14 to 55 months. This results were comparable with other reports. We concluded that our tight constriction DeVega method is considered better to prevent postoperative tricuspid regurgitation than ordinary methods.
Adult↗
[Tricuspid regurgitation evaluated by intraoperative epicardial pulsed Doppler echocardiography: investigation of patients with combined valvular diseases].
To evaluate the grade of tricuspid regurgitation (TR) associated with mitral valve disease and to ascertain the operative procedure for the involved tricuspid valve, epicardial pulsed Doppler echocardiography (PDE) was performed during cardiac surgery. Thirty-two patients with mitral valve disease were studied, 17 of whom had only mitral valve lesion; the remaining 15 had combined mitral and aortic valve disease. The patients' ages ranged from 24 to 63 years and averaged 48.3 years. There were nine men and 23 women. Echocardiographic examinations were performed using a Toshiba SSH-60A for parasternal study and a SSH-11A combined with a SDS-10A with a specially-devised flat transducer for intraoperative use. Intraoperatively, the PDE performed was from the right side of the right atrium (RA), referenced by a four-chamber view and a long-axis view of the right ventricular inflow. The sampling volumes were positioned in the inflow of the right ventricle, immediately above the tricuspid valve, the middle and upper areas of the RA, and adjacent to the interatrial septum. PDE was performed before and immediately after the operative procedure and before chest closure. By severity, TR was classified as non -, mild +/-, moderate +, and severe ++, according to the distances attained by the TR signals from the tricuspid valve orifice, and the velocities and durations of the TR signals during systole. The TR signal was recorded in 23 of 32 patients before surgery, whereas it was determined more adequately in 28 patients by intraoperative epicardial PDE. The gradings of TR via the parasternal approach before surgery were as follows: no TR, in nine cases; mild TR, in three; moderate, in 13; and severe, in seven. Intraoperatively, four patients had none; eight had mild TR; 14, moderate TR; six, severe TR before surgical intervention, respectively. In cases with mild or no TR before surgery, TR was rarely detected by contrast echocardiography using saline solution injected into the right ventricle during surgery. The moderate or severe cases before surgery had moderate or severe TR according to the contrast method during surgery, except for one case not operated on for tricuspid valve disease. Tricuspid valve replacement was performed for two patients, and tricuspid annuloplasty or valvuloplasty for eight.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Improved surgical treatment of tricuspid insufficiency in combined valvular diseases.
Tricuspid insufficiency is not infrequent in combined valvular diseases. We used Carpentier's De Vega's or Bex's annuloplasty with our own modification in combined tricuspid insufficiency and found the results much more satisfactory compared with previous methods. Of 152 patients with acquired valvular disease, 24 with combined valvular disease underwent one of these procedures. During the same period, three tricuspid valve replacements, using a glutaraldehyde-treated xenograft, were performed in patients with severly damaged tricuspid valves. Simultaneous procedures for other valves were open mitral commissurotomy in 14, mitral valve replacement in 9 and aortic and mitral valve replacement in 4 patients. Despite the seriousness of their preoperative condition, 25 of 27 patients survived, resulting in a mortality rate of 7.4%. We believe that these annuloplasty methods represent a remarkable progress in the treatment of tricuspid valve insufficiency in combined valvular diseases.
Adult↗
Ebstein's anomaly of the tricuspid valve associated with rheumatic mitral stenosis.
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Adult↗
[Ebstein's anomaly: long-term results after modified reconstruction of tricuspid valve without ventricle plication].
Ebstein's anomaly is a rare congenital heart defect in which the hinges of the septal and/or posterior leaflets are displaced downward to the right ventricle. The anterior leaflet is usually not displaced but is enlarged and sail-like and valve closure is likewise displaced downwards. Since 1988 we have operated on 22 patients with Ebstein's anomaly using a modified repair technique of the tricuspid valve. This technique restructures the valve mechanism at the level of the true tricuspid annulus by using the most mobile leaflet for valve closure without plication of the atrialized chamber. We evaluated our long-term results with regard to functional capacity (New York Heart Association functional class), tricuspid valve function, rhythm disturbances and re-operation rate. We quantified the right ventricular function by measuring flow velocity integral of the pulmonary artery (VTIPA). All patients survived the operation. There were two hospital deaths (9%) and the late mortality was 4.5%. The mean followup period was 9 years (range, 1.5 to 13 years) for 19 patients. So far no re-operation has been necessary. Preoperatively, the majority of all patients were in NYHA classes III and IV (79%). After the first postoperative follow-up examination (2.9 months), 17 patients were in NYHA class II. Long-term follow-up examinations showed an additional improvement of 11 patients to NYHA class I. Echocardiographic studies demonstrated a significant improvement of tricuspid valve function. No tricuspid valve stenosis was observed. Significant improvement of VTI(PA) was observed. Analysis of the postoperative deaths demonstrated that all patients were in NYHA class III or IV and had a cardiothoracic ratio of 0.65 or more. A severe reduction in functional capacity seems to be an additional risk factor for mortality beside a cardiothoracic ratio greater than 0.65. We conclude that reconstruction of the tricuspid valve without ventricle plication not only achieves good functional results immediately after the operation but that follow-up examinations demonstrate stable or improved functional capacity in the long term. We postulate that incorporation of the atrialized chamber into the right ventricle may contribute to right ventricular contraction and thereby account for the improved functional capacity of the patients.
Adolescent↗
Diagnosis of tricuspid regurgitation: comparison of jugular venous and liver pulse tracings with combined two-dimensional and Doppler-echocardiography.
The clinical diagnosis of tricuspid regurgitation is difficult in patients after mitral valve replacement. We therefore studied the value of the jugular venous pulse tracing, liver pulse tracing and right atrial size estimated from a two-dimensional echocardiogram for diagnosing tricuspid regurgitation in 57 patients with a Björk-Shiley prosthesis in the mitral position and compared them with Doppler echocardiography. Liver pulse tracings have a higher diagnostic yield than jugular venous tracings which often have carotid pulse artifacts. The liver pulse has a sensitivity of 0.91, a specificity of 0.80. Right atrial dilatation has a sensitivity of only 0.50, but a specificity of 0.88. Likelihood ratios calculated on the basis of the combination of these two methods allow an accurate prediction of the presence or absence of tricuspid regurgitation.
Adult↗
[Tricuspid dysfunction: a new physiopathologic entity. Study by means of Doppler velocimetry].
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Arrhythmias, Cardiac↗
Transesophageal echocardiographic (TEE) evaluation of the mitral and tricuspid valves.
In skilled hands, multiplane TEE provides a comprehensive assessment of the anatomy and function of the mitral and tricuspid valves. TEE is uniquely effective in the evaluation of the diverse pathophysiologic processes that cause valvular heart disease.
Echocardiography, Doppler, Color↗
Tricuspid valve repair with papillary muscle shortening for severe tricuspid regurgitation in children.
We describe tricuspid valve repair using papillary muscle shortening for severe tricuspid regurgitation due to leaflet prolapse in children combined with De Vega annuloplasty. The papillary muscle was shortened until the prolapsed leaflet was at the same height as the other nonprolapsed leaflets. Although echocardiographic tricuspid regurgitation tends to increase over time, it rarely requires long-term intervention.
Abnormalities, Multiple↗
[Adult pulmonary valvular stenosis, major stenosing right ventricular hypertrophy and tricuspid insufficiency. Apropos of 2 cases].
2 cases of severe pulmonary valvular stenosis in two young adults aged 21 and 29 years respectively are presented. Despite the degree of stenosis (4 mm jet), the right ventricular pressures did not exceed systemic pressures because of severe tricuspid regurgitation. This dominated the clinical and anatomical findings, causing aneurysmal dilatation of the right atrium and displacement of the tricuspid valve to the left. The diagnosis of Ebstein's anomaly was raised in one case but excluded by echocardiography and angiocardiography. In spite of the severity of the symptoms and peripheral clinical signs, surgery of the right ventricular outflow tract, tricuspid valvuloplasty and resection of part of the right atrium led to a complete and rapid cure, confirmed by catheterisation one month after operation.
Adult↗
[Clinical management of bidirectional cavopulmonary anastomosis].
The procedure of bidirectional cavopulmonary anastomosis (DBCPA) is an effective method for the treatment of some complex congenital heart diseases. The clinical results of the procedure as a part of total cavopulmonary anastomosis were better than those of fontan operation in the treatment of single ventricle and tricuspid atresia. 6 cases were treated by using this procedure in our department in recent years. All of them receives total pulmonary anastomosis, but one this procedure plus ASD closure for the treatment of Ebstein anomaly with tricuspid valve stenosis and right heart hypoplasia. There were 5 cases survived in the early stage and one case died of acute pump failure. And one case died of sepsis two months after operation.
Adolescent↗
[Evaluation of secondary tricuspid regurgitation by intraoperative epicardial pulsed Doppler echocardiography].
Since 1985, we have evaluated secondary tricuspid regurgitation associated with acquired mitral valve disease in patients undergoing open mitral surgery by intraoperative epicardial two-dimensional and pulsed Doppler echocardiography. We found intraoperative pulsed Doppler echocardiography to be a sensitive, safe technique allowing surgeons to evaluate the severity of tricuspid regurgitation intraoperatively, even in critically ill patients who cannot afford preoperative cardiac catheterization. To assess the severity of tricuspid regurgitation intraoperatively, the transducer was placed directly on the right atrium. The ultrasound beam was transmitted into the right atrium at right angles to the tricuspid valve orifice to record intraoperative four-chamber two-dimensional echocardiograms, which were used to detect the sites of eight sample volumes, one in the right ventricle and seven in the right atrium, for pulsed Doppler echocardiography. The pulsed Doppler signals were recorded in each sample volume before and after cardiac procedures. The pansystolic abnormal signals lasting from tricuspid valve closure to the subsequent opening and consisting of components moving away from the tricuspid valve were interpreted as tricuspid regurgitant flows. Without operative correction of the tricuspid valve, secondary tricuspid regurgitation can resolve following mitral valve surgery alone. However, to our knowledge, there are no published reports of objective findings of intraoperative changes of secondary tricuspid regurgitation. Here we present the unique intraoperative pulsed Doppler echocardiographic features of tricuspid regurgitation before and after cardiac procedures. A 30-year-old woman with preoperative diagnosis of aortic regurgitation, mitral stenosis and severe tricuspid regurgitation underwent aortic and mitral valve replacement. The intraoperative pulsed Doppler echocardiograms recorded after pericardiotomy and before cannulation of the heart showed tricuspid regurgitant flow signal in all of the seven sample volumes in the right atrium, which was interpreted as severe tricuspid regurgitation. After surgical procedures, no regurgitant flow from the tricuspid orifice to the right atrium was detected in the eight sample volumes. This suggested that preoperative secondary tricuspid regurgitation improves without operative procedures for the tricuspid valve. All intraoperative echocardiographic procedures were performed within 5 min, and no arrhythmias or other complications related to this technique were noted. Epicardial pulsed Doppler echocardiography is helpful in assessing tricuspid valve function of patients undergoing mitral valve surgery bef
Adult↗
Expression of HLA-DR antigen and smooth muscle cell differentiation markers by valvular fibroblasts in degenerative aortic stenosis.
OBJECTIVES: This study was designed to analyze the functional characteristics of fibroblasts present in aortic valves with degenerative stenosis. BACKGROUND: Morphologic analysis of degenerative stenosis of tricuspid aortic valves has revealed an extensive interstitial fibrosis. METHODS: Stenotic aortic valves collected during aortic valve replacement and control valves collected at autopsy were fixed in formaldehyde, cryosectioned and stained with antibodies against leukocyte markers, HLA-DR and intracellular filaments. Fibroblasts isolated from stenotic valve and skin explants were grown in cell culture, and their proliferative activity was analyzed by cell counting and uptake of tritiated thymidine. RESULTS: In the stenotic valves nearly all interstitial cells expressed vimentin, and approximately 60% of the cells also expressed alpha-actin and desmin. HLA-DR was present on inflammatory cells as well as on one-third of the fibroblast-like cells in the interstitium. Macrophages were found in the interstitium and T lymphocytes close to calcium deposits and in subendothelial areas. In control valves, fibroblasts expressed vimentin but not alpha-actin or desmin. Few inflammatory cells were present in these valves, and HLA-DR expression was restricted to the endothelial surface. In culture, stenotic valve fibroblasts had a reduced ability to proliferate in serum and to activate DNA synthesis in response to growth factors compared with skin fibroblasts from the same patient. CONCLUSIONS: The observation that fibroblasts present in aortic valves with degenerative stenosis express smooth muscle cell characteristics and HLA-DR antigen and show signs of cellular senescence in vitro suggests that they are in a state of chronic activation similar to that observed in fibromatosis and scleroderma lesions.
Actins↗
Aneurysmal coronary sinus associated with severe valvular heart disease.
We report a case of aneurysmal coronary sinus complicating severe valvular disease with severe tricuspid regurgitation. Injection in the left superior vena cava outlines the aneurysmal coronary sinus with stasis of the contrast. As this anomaly carries special surgical implication in patients requiring open heart surgery, a correct preoperative diagnosis is mandatory.
Adult↗
Doppler echocardiographic evaluation of pulmonary artery flow after modified Fontan operation: importance of atrial contraction.
Doppler echocardiography was used to evaluate blood flow in the pulmonary artery in 14 patients 2 to 42 months (mean (SD) 17 (12) months) after a modified Fontan operation incorporating a direct atriopulmonary anastomosis. Preoperatively six patients had tricuspid atresia, six had a double inlet left ventricle, and two had pulmonary atresia with an intact ventricular septum. The postoperative rhythm was sinus in 11 patients, junctional in one, ventricular pacing in one, and atrioventricular sequential pacing in one. In one patient the Doppler trace was unsatisfactory for analysis. In all patients forward flow in the pulmonary artery had biphasic peaks related to both atrial and ventricular contraction. The mean (SD) peak flow velocity that was synchronous with atrial contraction was 80 (30) cm/s and that synchronous with ventricular contraction was 74 (23) cm/s. The atrial contribution to total pulmonary artery flow, assessed by velocity-time integrals, varied between 22% and 73% (mean (SD) 45 (14)%). In patients with tricuspid atresia the mean (SD) peak flow velocity with atrial contraction was 90 (27) cm/s and that with ventricular contraction was mean (SD) 68 (24) cm/s. In patients with double inlet left ventricle the mean (SD) peak flow velocity was 67 (36) cm/s with atrial contraction and 80 (25) cm/s with ventricular contraction. The atrial contribution to total pulmonary blood flow in patients with tricuspid atresia was significantly higher (53 (11)%) than in those with double inlet left ventricle (37 (14)%). Pulmonary artery flow after modified Fontan operation was biphasic and was related to both atrial and ventricular contraction. The atrial contribution to pulmonary blood flow is greater in patients with tricuspid atresia than in those with a double inlet left ventricle. The mechanism of the second peak related to ventricular contraction is unknown.
Adolescent↗
Angiographic features of carcinoid heart disease.
Cineangiocardiograms from 2 patients with carcinoid syndrome and cardiac involvement were reviewed. Gross and microscopic pathology specimens were available for 1 case. Both patients exhibited tricuspid valvar stenosis and insufficiency. The area of the pulmonic valve was similar in both with narrowing of the annulus and tapering toward the valve of the proximal pulmonary artery and the subvalvar right ventricular outflow tract, producing an hourglass appearance, which the authors feel is characteristic of this disease.
Angiocardiography↗