- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Ebstein anomaly of the tricuspid valve is a congenital malformation, in which there is downward displacement of insertion of septal and posterior leaflets. Anterior leaflet is not usually affected. T...
Ebstein anomaly of the tricuspid valve is a congenital malformation, in which there is downward displacement of insertion of septal and posterior leaflets. Anterior leaflet is not usually affected. The tricuspid valve leaflets are dysplastic. As a result of the displacement, there is poor coaptation of the valve leaflets leading to tricuspid regurgitation, which in turn causes right atrial enlargement of a variable degree depending upon the degree of tricuspid regurgitation.
- Natural history of bivalvular functional regurgitation. [Journal Article]
- EHEur Heart J Cardiovasc Imaging 2018 Dec 01
- CONCLUSIONS: This long-term outcome study shows the multi-faceted nature of FR and defines BVFR as an important clinical entity associated with impaired functional class, adverse cardiac remodelling, and excess risk of mortality. Moderate BVFR conveys similar risk as isolated severe FR reflecting the deleterious impact of the global regurgitant load on the failing heart and the need of an integrated understanding for risk-assessment.
- Altered biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and right ventricular volume overload because of pulmonary regurgitation. [Journal Article]
- AJAm J Physiol Heart Circ Physiol 2018 Dec 01; 315(6):H1691-H1702
- Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in patients with repaired tetralogy ...
Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in patients with repaired tetralogy of Fallot (rToF) to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and pulmonary regurgitation (PR) > 20% ( n = 18) and healthy control subjects ( n = 15) underwent MRI, including four-dimensional flow. A subset of patients ( n = 8) underwent PVR and MRI after surgery. Time-resolved hemodynamic forces were quantified using 4D-flow data and indexed to ventricular volume. Patients had higher systolic and diastolic left ventricular (LV) hemodynamic forces compared with control subjects in the lateral-septal/LV outflow tract ( P = 0.011 and P = 0.0031) and inferior-anterior ( P < 0.0001 and P < 0.0001) directions, which are forces not aligned with blood flow. Forces did not change after PVR. Patients had higher RV diastolic forces compared with control subjects in the diaphragm-right ventricular (RV) outflow tract (RVOT; P < 0.001) and apical-basal ( P = 0.0017) directions. After PVR, RV systolic forces in the diaphragm-RVOT direction decreased ( P = 0.039) to lower levels than in control subjects ( P = 0.0064). RV diastolic forces decreased in all directions ( P = 0.0078, P = 0.0078, and P = 0.039) but were still higher than in control subjects in the diaphragm-RVOT direction ( P = 0.046). In conclusion, patients with rToF and PR had LV hemodynamic forces less aligned with intraventricular blood flow compared with control subjects and higher diastolic RV forces along the regurgitant flow direction in the RVOT and that of tricuspid inflow. Remaining force differences in the LV and RV after PVR suggest that biventricular pumping does not normalize after surgery. NEW & NOTEWORTHY Biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and pulmonary regurgitation were quantified for the first time. Left ventricular hemodynamic forces were less aligned to the main blood flow direction in patients compared with control subjects. Higher right ventricular forces were seen along the pulmonary regurgitant and tricuspid inflow directions. Differences in forces versus control subjects remain after pulmonary valve replacement, suggesting that altered biventricular pumping does not normalize after surgery.
- Transcatheter Tricuspid Valve Repair With a Novel Cinching System. [Journal Article]
- JCJACC Cardiovasc Interv 2018 Nov 23
- Multiplane Intracardiac Echocardiography: A Novel System to Guide Percutaneous Tricuspid Repair. [Journal Article]
- JCJACC Cardiovasc Interv 2018 Nov 23
- Mid-term results of a randomized trial of tricuspid annuloplasty for less-than-severe functional tricuspid regurgitation at the time of mitral valve surgery†. [Journal Article]
- EJEur J Cardiothorac Surg 2018 Dec 04
- CONCLUSIONS: This single-centre prospective randomized trial demonstrated that prophylactic tricuspid annuloplasty irrespective of annular dilatation at the time of mitral surgery reduced the recurrence of moderate or severe FTR at 5-year follow-up and reduced the pulmonary pressure. Nevertheless, the functional capacity, the RV function and the RV dimension remained similar.
- Transcatheter Closure of Perimembranous Ventricular Septal Defects in Children using a Wire-Drifting Technique. [Journal Article]
- CClinics (Sao Paulo) 2018 Nov 29; 73:e371
- CONCLUSIONS: Transcatheter closure of perimembranous ventricular septal defects with the WT is safe and effective in children.
- Impact of Tricuspid Regurgitation and Right Ventricular Dysfunction on Outcomes After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. [Review]
- CCClin Cardiol 2018 Dec 04
- CONCLUSIONS: Both baseline moderate or severe TR and RV dysfunction worsen prognosis after TAVR and careful assessment of right heart function should be done for clinical decision by the heart team before the TAVR procedure.
- [Surgical management of atrioventricular valve regurgitation in functional single ventricle]. [Journal Article]
- ZWZhonghua Wai Ke Za Zhi 2018 Dec 01; 56(12):922-927
- Objective: To evaluate the early- and mid-term outcomes of surgical atrioventricular valve (AVV) intervention in patients with functional single ventricle (FSV). Methods: The clinical data of 40 co...
Objective: To evaluate the early- and mid-term outcomes of surgical atrioventricular valve (AVV) intervention in patients with functional single ventricle (FSV). Methods: The clinical data of 40 consecutive FSV patients who underwent surgical AVV intervention between January 2008 and December 2017 at Department of Cardiac Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University were reviewed retrospectively. There were 25 male and 15 female patients. The median age at AVV intervention was 4.5 to 204.0 months (M(Q(R)): 42.5 (59.7) months), and the median body weight was 6.0 to 55.4 kg (M(Q(R)): 13.8 (8.1) kg). The systemic AVV morphology included common AVV in 21 patients, mitral valve in 7 patients, tricuspid valve in 3 patients, and both mitral and tricuspid valve in 9 patients. At first surgical intervention, 15 patients had severe, 25 patients had moderate AVV regurgitation. The timings of the initial surgical intervention were at the first palliative, Glenn, between Glenn and Fontan, and Fontan stage in 5, 23, 4, and 8 patients, respectively. The methods of the initial surgical intervention were AVV repair in 31 patients, AVV replacement in 9 patients. Actuarial survivals were estimated by the Kaplan-Meier method. Prognosis factors for atrioventricular valve reoperation were analyzed using the Cox regression hazard model. Results: There were 6 early deaths, with a mortality of 15.0%. Thirty-four survival patients received a follow-up of 1 to 117 months (M(Q(R)): 44 (34) months). Survival of patients after the initial surgical intervention were 85.0% (95% CI: 74.0% to 95.9%), 79.3% (95% CI: 66.6% to 92.0%), and 79.3% (95% CI: 66.6% to 92.0%) at 1 year, 5 years and 10 years, respectively. In all, only 13 patients completed the Fontan procedure. Six patients underwent 8 reoperations, including AVV replacement in 5 patients, redo AVV repair in 3 patients. Freedom from AVV reoperation at 1 and 5 years was 89.8% (95% CI: 78.8% to 100%) and 79.4% (95% CI: 64.7% to 94.1%), respectively. Multivariate Cox regression analysis revealed that common AVV (HR=3.53, 95% CI: 1.63-7.67, P=0.020) was the prognosis factors for AVV reoperation. Conclusions: The early- and mid-term outcomes of surgical AVV intervention in FSV patients are not satisfactory. The mortality and reoperation rate are still high, and common AVV predicts the AVV reoperation after the initial surgical intervention.
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- Early and Late Outcomes of Isolated Tricuspid Valve Surgery Following Valvular Surgery. [Journal Article]
- ATAnn Thorac Cardiovasc Surg 2018 Nov 28
- CONCLUSIONS: Early and late outcomes of isolated TVS after valvular surgery seem to be satisfactory. Special attention should be paid to heart failure following TVP.