Asunto(s)
Traumatismos Torácicos , Insuficiencia de la Válvula Tricúspide , Humanos , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/cirugía , Masculino , Traumatismos Torácicos/diagnóstico por imagen , Traumatismos Torácicos/complicaciones , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/lesiones , Válvula Tricúspide/cirugía , Persona de Mediana Edad , AdultoRESUMEN
In cases of uncontrollable hepatic hemorrhage or acute hepatic failure after trauma, liver transplantation can be a lifesaving procedure. Traumatic tricuspid valve injuries are rare, and symptoms can range from indolent to acute right heart failure. When concomitant, traumatic liver transplant and tricuspid injuries have significant physiologic interplay and management implications. We present a 14-year-old male injured in an all-terrain vehicle accident, who sustained a devastating disruption of the common bile duct and celiac artery injury, leading to acute hepatic failure, necessitating a two-stage liver transplantation. He was subsequently found to have a severe traumatic tricuspid injury, which required tricuspid valve replacement. At 4 years post-injury, he is without major complications. This is the first case presentation of the cooccurrence of these complex pathologies. Importantly, we demonstrate the complex decision-making surrounding traumatic liver transplantation and timing of subsequent tricuspid valve repair, weighing the complex interplay of these 2 pathologies.
Asunto(s)
Trasplante de Hígado , Válvula Tricúspide , Heridas no Penetrantes , Humanos , Masculino , Adolescente , Heridas no Penetrantes/cirugía , Heridas no Penetrantes/complicaciones , Válvula Tricúspide/lesiones , Válvula Tricúspide/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Accidentes de Tránsito , Fallo Hepático Agudo/cirugía , Fallo Hepático Agudo/etiología , Lesiones Cardíacas/cirugía , Lesiones Cardíacas/etiologíaAsunto(s)
Traumatismo Múltiple , Rotura del Bazo , Traumatismos Torácicos , Heridas no Penetrantes , Humanos , Válvula Tricúspide/cirugía , Válvula Tricúspide/lesiones , Músculos Papilares/lesiones , Traumatismos Torácicos/complicaciones , Heridas no Penetrantes/complicaciones , Rotura/etiología , Rotura/cirugíaRESUMEN
Structural cardiac injury after blunt trauma is uncommon but usually life-threatening. While tricuspid injury is very rare and potentially lethal, the right heart can accommodate larger volumes and higher pressures in acute tricuspid insufficiency and facilitate initial stabilization prior to definitive valvular repair. ECMO may be used to ameliorate resulting right heart failure. The traumatic force required to cause cardiac structural injury is also associated with pulmonary complications related to pneumothorax, hemothorax, effusion, acute pain secondary to rib fractures, and pulmonary contusions causing hypoxia. We present an unusual case of hypoxia in a trauma patient caused by acute tricuspid regurgitation with pre-existing patent foramen ovale.
Asunto(s)
Foramen Oval Permeable , Lesiones Cardíacas , Insuficiencia de la Válvula Tricúspide , Heridas no Penetrantes , Humanos , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/lesiones , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Lesiones Cardíacas/complicaciones , Lesiones Cardíacas/diagnóstico por imagen , Hipoxia/complicaciones , Heridas no Penetrantes/complicacionesRESUMEN
BACKGROUND: Transcatheter patent arterial duct (PAD) closure in premature infants has been shown to be feasible. Since our early transcatheter PAD closure procedures in premature infants at Hôpital Necker Enfants Malades, we have changed our technique several times to advance the guidewire through the right heart to avoid tricuspid valve damage. AIM: To describe the technique we have been using since May 2019, to report our results with a particular focus on tricuspid leaks and to analyse the potential mechanisms of tricuspid lesion development with previous methods. METHODS: All premature infants weighing<2kg who underwent transcatheter PAD closure with this new technique were included. Demographic data, procedural data, outcome and procedural complications were reviewed, with particular attention to the occurrence of tricuspid regurgitation. RESULTS: Between May 2019 and May 2020, 33 patients were included. Median gestational age was 25 weeks. Median birth weight and procedural weight were 690g (range 490-1065g; interquartile range [IQR] 620-785g) and 1160g (range 900-1900g; IQR 1030-1300g), respectively. Median age at procedure was 35 (IQR 30-46) days. PAD anatomy was evaluated on transthoracic echocardiography only. The median duct diameter was 3 (IQR 2.5-3.2) mm at the pulmonary end. Success rate was 100% (defined as successful closure without residual shunt). One patient had a renal vein thrombosis, which fully resolved with low-molecular-weight heparin anticoagulation. No tricuspid regurgitation or stenosis of the left pulmonary artery or the aorta was seen. One patient died of a superior caval vein obstruction with bilateral chylothorax related to a central catheter thrombosis 56 days after the procedure, unrelated to the catheter procedure. CONCLUSION: In this prospective study, we describe a new technique to avoid tricuspid valve damage and facilitate delivery of the PAD device.
Asunto(s)
Cateterismo Cardíaco/instrumentación , Conducto Arterioso Permeable/terapia , Dispositivo Oclusor Septal , Válvula Tricúspide/fisiopatología , Peso al Nacer , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/mortalidad , Conducto Arterioso Permeable/diagnóstico por imagen , Conducto Arterioso Permeable/mortalidad , Conducto Arterioso Permeable/fisiopatología , Edad Gestacional , Lesiones Cardíacas/etiología , Lesiones Cardíacas/fisiopatología , Humanos , Lactante , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recien Nacido Extremadamente Prematuro , Recién Nacido , Paris , Recuperación de la Función , Factores de Tiempo , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/lesiones , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/fisiopatología , Estenosis de la Válvula Tricúspide/etiología , Estenosis de la Válvula Tricúspide/fisiopatologíaAsunto(s)
Bioprótesis , Cuerdas Tendinosas/cirugía , Matriz Extracelular/trasplante , Lesiones Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Tricúspide/cirugía , Válvula Tricúspide/cirugía , Cuerdas Tendinosas/diagnóstico por imagen , Cuerdas Tendinosas/lesiones , Cuerdas Tendinosas/fisiopatología , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Lesiones Cardíacas/fisiopatología , Humanos , Persona de Mediana Edad , Diseño de Prótesis , Recuperación de la Función , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/lesiones , Válvula Tricúspide/fisiopatología , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/fisiopatologíaRESUMEN
In May-Thurner syndrome, or iliac vein compression syndrome, the left common iliac vein is compressed between the right common iliac artery and corresponding vertebral body, increasing patient risk for deep vein thrombosis. Iliac vein stenting for patients with symptomatic May-Thurner syndrome has become standard practice in many centers. This article describes a patient whose stent embolized completely to the right ventricle, destroying most structures in its path.
Asunto(s)
Angioplastia/efectos adversos , Angioplastia/métodos , Procedimientos Quirúrgicos Cardíacos/métodos , Remoción de Dispositivos/métodos , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Atrios Cardíacos/lesiones , Ventrículos Cardíacos/lesiones , Vena Ilíaca/cirugía , Síndrome de May-Thurner/cirugía , Stents/efectos adversos , Vasos Coronarios/cirugía , Atrios Cardíacos/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Ventrículos Cardíacos/cirugía , Humanos , Masculino , Persona de Mediana Edad , Válvula Tricúspide/lesiones , Válvula Tricúspide/cirugíaRESUMEN
BACKGROUND: Tricuspid valve injury can occur during implantation of a SAPIEN valve in the pulmonary position. We describe our experience using a long Gore DrySeal (GDS) sheath to protect the tricuspid valve during advancement of the Commander delivery system. METHODS: Retrospective single center review of all patients who underwent placement of a SAPIEN valve in the right ventricular outflow tract between January 2016 and April 2020. Patients were divided into two groups: delivery of the valve using standard technique (Group I), and with the use of a GDS (Group II), for comparison. RESULTS: There were 48 patients in total: 25 in Group I and 23 in Group II. In Group II, the first 10 patients had a 29 mm S3 placed through a 26 French (Fr), 65 cm GDS. We then performed additional crimping of the S3 onto the balloon after the balloon catheter was withdrawn to position the valve on the balloon outside the body. Subsequently, seven had a 29 mm S3 placed through a 24 Fr GDS, and four had a 26 mm S3 placed through a 22 Fr GDS including one weighing 16 kg. Two had a 23 mm S3 placed through a 22Fr GDS as the 20Fr GDS was not available in our lab. Severe tricuspid valve injury occurred in 2/25 (8%) of Group I patients and 0/23 of Group II patients. CONCLUSION: Use of a long GDS may protect the tricuspid valve from injury during implantation of the S3 valve in the pulmonary position, and is technically feasible in smaller patients.
Asunto(s)
Cateterismo Cardíaco/instrumentación , Lesiones Cardíacas/prevención & control , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Hemodinámica , Válvula Pulmonar/cirugía , Insuficiencia de la Válvula Tricúspide/prevención & control , Válvula Tricúspide/fisiopatología , Adolescente , Adulto , Valvuloplastia con Balón , Cateterismo Cardíaco/efectos adversos , Niño , Femenino , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Lesiones Cardíacas/fisiopatología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Masculino , Diseño de Prótesis , Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/fisiopatología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/lesiones , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/fisiopatología , Adulto JovenRESUMEN
The use of peripherally inserted central catheters (PICCs) has expanded substantially for drug delivery in clinical practice in recent years. However, PICC lines expose patients to potential complications associated with an increasing incidence of infective endocarditis. We herein report a case of a 57-year-old woman who was diagnosed with tricuspid valve endocarditis by echocardiography. The most probable cause was direct injury to the tricuspid valve by the tip of a PICC line with excessive length in the right heart. The vegetation disappeared with conservative treatment after removal of the PICC line. Clinicians must maintain vigilance against any suspected PICC-related infection in febrile patients with a PICC line. For echocardiographers, precise evaluation of the position of the PICC tip and the detection of endocarditis is important to devise the optimal clinical strategy.
Asunto(s)
Cateterismo Periférico/efectos adversos , Cateterismo Periférico/instrumentación , Catéteres de Permanencia/efectos adversos , Endocarditis/etiología , Lesiones Cardíacas/etiología , Válvula Tricúspide/lesiones , Antibacterianos/uso terapéutico , Tratamiento Conservador , Remoción de Dispositivos , Endocarditis/diagnóstico por imagen , Endocarditis/terapia , Femenino , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/terapia , Humanos , Persona de Mediana Edad , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagenAsunto(s)
Lesiones Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Rotura/cirugía , Esternotomía , Válvula Tricúspide/lesiones , Accidentes por Caídas , Adulto , Bioprótesis , Lesiones Cardíacas/etiología , Prótesis Valvulares Cardíacas , Humanos , Masculino , Pericardio/lesiones , Rotura/etiología , Resultado del Tratamiento , Válvula Tricúspide/cirugíaAsunto(s)
Accidentes de Tránsito , Lesiones Cardíacas/complicaciones , Insuficiencia de la Válvula Tricúspide/etiología , Válvula Tricúspide/lesiones , Heridas no Penetrantes/complicaciones , Adulto , Procedimientos Quirúrgicos Cardíacos/métodos , Ecocardiografía , Femenino , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/cirugía , Humanos , Rotura , Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/diagnóstico , Insuficiencia de la Válvula Tricúspide/cirugía , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/cirugíaRESUMEN
Tricuspid valve (TV) avulsion is rare and ordinarily does not require emergent intervention. We present the case of a polytrauma patient with traumatic TV avulsion who ultimately required urgent TV replacement in the setting of hemodynamic instability. Urgent TV replacement may be warranted after careful consideration of patient risk factors and clinical context.
Asunto(s)
Traumatismo Múltiple/complicaciones , Pared Torácica/lesiones , Válvula Tricúspide/lesiones , Válvula Tricúspide/cirugía , Ecocardiografía Transesofágica , Femenino , Humanos , Persona de Mediana Edad , Insuficiencia de la Válvula Tricúspide/diagnósticoRESUMEN
Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.
O traumatismo cardíaco é comum em acidentes com veículos automotores. Uma mulher com 50 anos de idade foi transportada para nosso hospital após sofrer múltiplos traumatismos em um acidente de automóvel quando dirigia em alta velocidade. Após admissão à unidade de terapia intensiva, uma ultrassonografia cardíaca revelou ruptura traumática de músculo papilar da valva tricúspide e forame oval patente, enquanto se observou, no exame físico, o sinal de Lancisi. Foi realizado tratamento cirúrgico com anuloplastia da valva e fechamento do forame oval patente; durante o ato cirúrgico, diagnosticou-se ruptura oculta do átrio direito.
Asunto(s)
Foramen Oval Permeable/etiología , Atrios Cardíacos/cirugía , Músculos Papilares/lesiones , Válvula Tricúspide/lesiones , Accidentes de Tránsito , Anuloplastia de la Válvula Cardíaca/métodos , Femenino , Foramen Oval Permeable/diagnóstico , Foramen Oval Permeable/cirugía , Atrios Cardíacos/lesiones , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/etiología , Lesiones Cardíacas/cirugía , Humanos , Persona de Mediana Edad , Músculos Papilares/cirugía , Válvula Tricúspide/cirugíaRESUMEN
RESUMO O traumatismo cardíaco é comum em acidentes com veículos automotores. Uma mulher com 50 anos de idade foi transportada para nosso hospital após sofrer múltiplos traumatismos em um acidente de automóvel quando dirigia em alta velocidade. Após admissão à unidade de terapia intensiva, uma ultrassonografia cardíaca revelou ruptura traumática de músculo papilar da valva tricúspide e forame oval patente, enquanto se observou, no exame físico, o sinal de Lancisi. Foi realizado tratamento cirúrgico com anuloplastia da valva e fechamento do forame oval patente; durante o ato cirúrgico, diagnosticou-se ruptura oculta do átrio direito.
ABSTRACT Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.
Asunto(s)
Humanos , Femenino , Músculos Papilares/lesiones , Válvula Tricúspide/lesiones , Foramen Oval Permeable/etiología , Atrios Cardíacos/cirugía , Músculos Papilares/cirugía , Válvula Tricúspide/cirugía , Accidentes de Tránsito , Foramen Oval Permeable/cirugía , Foramen Oval Permeable/diagnóstico , Anuloplastia de la Válvula Cardíaca/métodos , Atrios Cardíacos/lesiones , Lesiones Cardíacas/cirugía , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/etiología , Persona de Mediana EdadAsunto(s)
Traumatismos Torácicos/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/lesiones , Heridas no Penetrantes/diagnóstico por imagen , Anciano , Ecocardiografía Transesofágica , Lesiones Cardíacas/diagnóstico por imagen , Humanos , Masculino , Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Heridas no Penetrantes/complicacionesRESUMEN
Objective: To investigate the indication and midterm outcomes of surgical treatment of traumatic tricuspid insufficiency. Methods: Totally 19 patients with traumatic tricuspid insufficiency who underwent surgical treatment at Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University from January 2002 to January 2018 were included in this retrospective study. There were 12 male and 7 female patients, aged (43.1±12.9) years (range: 17-68 years). The main causes of traumatic tricuspid insufficiency included blunt chest trauma following high-speed vehicle accidents (17 patients) and high-fall trauma (2 patients). The preoperative New York Heart Association functional class was class â ¡ in 5 patients, class â ¢ in 12 patients, and class â £ in 2 patients. The mechanism of tricuspid insufficiency included anterior chordal rupture in 9 patients, anterior papillary muscle rupture in 3 patients, anterior and posterior chordal or papillary muscle rupture in 4 patients, laceration of leaflet combined with chordal rupture in 2 patients and infection combined with anterior papillary muscle rupture in 1 patient. Anular dilation and enlargement of the right ventricle were observed in all the patients. Paired t test was used to evaluate the echocardiogratic results at preoperation, postoperation and follow-up. Independent sample rank sum test was used to evaluate the intervals between trauma and surgery in tricuspid valve repair group and tricuspid valve replacement group. Results: Tricuspid valve repair was successful in 8 patients, and 11 patients underwent valve replacement. Among the patients who underwent valve replacement, 6 patients received mechanical valve and 5 received bioprosthetic valve. The interval from trauma to surgery of the valve repair group and valve replacement group were 8.5(10.0) months (range: 0.1-13.0 months) and 72.0 (108.0) months (range: 2.0-228.0 months), respectively. Concomitant procedures included debridement in scalp trauma (1 patient), internal fixation of femoral fracture (1 patient). One patient died from liver failure 10 days after operation and the remaining patients survived. Eighteen patients were followed up for (94±50) months, 15 patients were in New York Heart Association functional class â and 3 patients in class â ¡. One patient received redo-tricuspid valve replacement because of mechanical valve failure at the 11 years of follow-up. Conclusions: The midterm outcomes of surgical treatment of severe traumatic tricuspid insufficiency were satisfactory. Early diagnosis and surgical invention were recommended to achieve successful valve repair.