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Objective To evaluate the function of tricuspid annulus using omni-directional M-mode echocardioraphy(OME) in patients during mitral valve replacement(MVR) ,and provide a reference for clinical decision about concomitant tricuspid annuloplasty for patients under MVR . Methods Twenty-five normal subjects were selected as control group . Thirty-three patients under MVR for mitral stenosis were divided into tricuspid annuloplasty group( TVP group , n =17) and non-tricuspid annuloplasty group( NTVP group , n =16) .Transesophageal echocardiography ( TEE) was performed before and after surgery . The right ventricular fractional area change( RVFAC) ,maximal tricuspid annular diameter( TADmax) ,tricuspid annular fractional shortening( TAFS) and tricuspid regurgitation( TR) degree were detected by 2D and color Doppler echocardiography . OME and quantitative tissue velocity imaging(QTVI) were used to measure the peak systolic velocity of tricuspid annular ,which were defined as Sm and St . Results In the TVP group , TADmax decreased and TR degree improved significantly compared with preoperative date ( P< 0 .05) . Preoperative Sm had nagative correlation with TADmax/BSA ( r = -0 .53 , P <0 .01) and RVFAC( r =0 .87 , P < 0 .01) ,and positive correlation with TAFS ( r = 0 .68 , P < 0 .01) . Conclusions The peak systolic velocity of tricuspid annulus measured by OME can assess the function of tricuspid annulus additionally ,and provide a reference for clinical decision about concomitant tricuspid annuloplasty for patients under MVR .
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@#Objective To evaluate long-term clinical results in patients who underwent mitral valve replacement and suture tricuspid annuloplasty. Methods We included 401 patients who underwent mitral valve replacement and suture tricuspid annuloplasty in our hospital between January 2006 and March 2011. There were 309 females and 92 males at age of 17-71 (46.2±12.0) years. All patients were investigated by echocardiography at postoperative 5 years. The tricuspid valve procedures consisted of bicuspidization, modified Kay annuloplasty and leaflet repair according to the actual conditions. Results The patients were followed up for 5–10 (7.4±1.4) years. As compared with preoperation, the right atrium (RA, 7.6±13.0 mm vs. 49.3±13.2 mm), right ventrium (RV, 23.2±4.7 mm vs. 22.0±3.6 mm), left atrium (LA, 59.7±19.0 mm vs. 53.6±14.7 mm, left ventrium (LV, 49.3±8.6 mm vs. 47.7±6.2 mm), tricuspid of end-distolic diameters (TEDD, 35.9±5.7 mm vs. 32.8±5.9 mm) and tricuspid of end-systolic diameters (TESD, 9.4±5.7 mm vs. 26.5±4.9 mm) of patients decreased significantly at postoperation (P<0.01). As compared with preoperation, left ventricular ejection fraction (LVEF, 60.3%±8.9% vs. 61.7%±8.3%) and left ventricular fractional shortening (LVFS, 32.6%±6.3% vs. 33.8%±5.5%) raised significantly at postoperation (P<0.01). As compared with preoperation, the constituent rate of tricuspid regurgitation (TR) improved significantly at postoperation (P<0.01). Conclusion Tricuspid annuloplasty adopting TEDD as a surgical indication is reasonable for patients with mitral diseases. Combined and individualized suture tricuspid annuloplasty can obtain better long-term results. It is needed to order aggressive diuretics treatment for patients with postoperative TR.
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<p>A 75-year-old man with underlying arteriosclerosis obliterans presented with acute heart failure secondary to rest pain of the right lower extremity. Echocardiogram showed severe mitral regurgitation, moderate tricuspid regurgitation and a low cardiac function (ejection fraction : 27%). Right toe gangrene developed in association with continuous acute heart failure. He underwent mitral valve replacement, tricuspid annuloplasty, right common femoral artery-posterior tibial artery bypass and amputation of the right toes in single-stage surgery. There were no major complications during his hospital stay. After surgery, his symptoms significantly improved.</p>
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<p>An 82-year-old man was referred to our hospital for heart failure due to severe mitral regurgitation and severe tricuspid regurgitation. We performed mitral annuloplasty and tricuspid annuloplasty (TAP). Three weeks after surgery, he developed hemolytic anemia (HA). Transesophageal echocardiography revealed a defect in the left ventricular outflow tract that communicated directly with right atrium, and the jet was striking with the TAP prosthetic ring. HA was not controlled, so we performed re-operation. The defect was found in the atrioventricular membranous septum. The defect was closed and TAP was performed using an autologous pericardial roll again. We report a rare case of acquired left ventricular to right atrium communication after TAP.</p>
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Objective To assess and compare the the results of tricuspid annuloplasty performed with the Edwards MC3 and Kay methode.Methods From January 2010 to May 2014, 759 patients with function tricuspid regurgitation(FTR) secondary to left-sided valve disease received tricuspid annuloplasty.Cardiac ultrasound Heartbeat diagram were made to confirm the degree of tricuspid regurgitation, the diameter of tricuspid annulus, the pressure of pulmonary artery and the heart function both in the left and the right, and so on.Of them, 355 cases of male, female 404 cases, at the mean age of(54.1 ± 8.3) years old, with the heart function classical(NYHA) : Ⅰ 13, Ⅱ 177, Ⅲ 400, Ⅳ 169, the mean left ventricles ejection fraction(LVEF) was 0.53 ±0.04, the mean pulmonary artery pressure was(62.5 ± 17.6) mmHg(1 mmHg =0.133 kPa).The diagnosis include rheumatic heart disease 517 cases, degenerative disease 209 cases and infective endocarditis 33 cases.The operation include mitral annuloplasty 132 case, mitral replacement 295 cases, mitral annuloplasty and aortic replacement 20 cases, mitral and aortic replacement 388 cases, CABG 86 cases and Maze Ⅲ methode 23 cases.The degree of tricuspid regurgitation before the operation were class Ⅰ 88, Ⅱ 189, Ⅲ 352 and V 130.From January 2010 to May 2012, 447 cases received Kay' s methods and 312 cases received MC3 annuloplasty ring during May 2012 to May 2014.In the MC3, We use the rings in 28mm size were 79 cases, 30 mm 155 cases, 32 mm 66 cases and 34 mm 12 cases.Results There were no death, reoperation and adverse events in both groups.There were no diffent in the aorta block time, the circulation bypass time, the time of mechanical ventilation, stay in ICU and in the hospital(P ＞ 0.05).All the patient were followed up regularity.The rat of follow up was 90.4％ (686/759), and the mean time of follow up was(39.9 ± 7.7) month.The patients' s EF increased, inner diameter of the right ventricle decreased in both group.There were no severe TR in the patients in the Kay group within 3 months, and 1 case of severe TR 1 year later, as 5 cases at 2 years and 12 cases after 2 years.The regurgitation volume of tricuspid was (3.4 ± 1.4) ml at the moment of 3 month, (6.5 ± 2.1) ml at 1 year, (7.9 ± 2.5) ml at 2 years and (12.4 ± 4.7)ml 2 years later.In the MC3 group, there were no severe TR in the patients during all the stage of fellow-up.There were on regurgitation in the patient within 3 months, 1 case of Class Ⅲ of TR at 1 year and 3 cases of Class Ⅲ at 2 years, without worse TR happen.At the same stage as in MC3 group, the regurgitation volume was(2.9 ±0.9) ml,(3.5 ±1.3) ml and(3.4 ±2.1) ml.The result in MC3 group was similar with Kay group(P ＞0.05) in short term, but much better in the long-term(P ＜ 0.05).Conclusion The Kay methode has good early result, but not the same good in the long-term, which can be applied in the elder persons or the patient without long Life expectancy.And the MC3 ring can correct the FTR enduringly and effectually, specifically the size in small one which behaves perfectly.The MC3 ring should be used in the young patient or the patient wants more.
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0.05).The proportion of TR degree improved in patients of two groups in a short-term.However,the difference of TR in long-term between two groups was statistically significant(P
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There are various surgical techniques in repairing Ebstein anomaly, but residual tricuspid regurgitation and compromized right heart function may ensue in some cases. We report our clinical experience of Ebstein anomaly and atrial flutter in a 19-year-old male patient who underwent simple modified tricuspid annuloplasty, bi-directional cavopulmonary shunt and cryoablation of cavotricuspid isthmus.
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Humans , Male , Young Adult , Atrial Flutter , Cryosurgery , Ebstein Anomaly , Heart , Heart Bypass, Right , Tricuspid Valve InsufficiencyABSTRACT
There are various surgical techniques in repairing Ebstein anomaly, but residual tricuspid regurgitation and compromized right heart function may ensue in some cases. We report our clinical experience of Ebstein anomaly and atrial flutter in a 19-year-old male patient who underwent simple modified tricuspid annuloplasty, bi-directional cavopulmonary shunt and cryoablation of cavotricuspid isthmus.