Sujet(s)
Prothèse valvulaire cardiaque , Défaillance de prothèse , Valve atrioventriculaire droite , Humains , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/chirurgie , Prothèse valvulaire cardiaque/effets indésirables , Insuffisance tricuspide/chirurgie , Insuffisance tricuspide/imagerie diagnostique , Femelle , Mâle , Échocardiographie/méthodesRÉSUMÉ
BACKGROUND: Interventional valve implantation into the inferior vena cava (CAVI) lowers venous congestion in patients with tricuspid regurgitation (TR). We evaluated the impact of a reduction of abdominal venous congestion following CAVI on circulating immune cells and inflammatory mediators. METHODS: Patients with severe TR were randomized to optimal medical therapy (OMT) + CAVI (n = 8) or OMT (n = 10). In the OMT + CAVI group, an Edwards Sapien XT valve was implanted into the inferior vena cava. Immune cells and inflammatory mediators were measured in the peripheral blood at baseline and three-month follow-up. RESULTS: Leukocytes, monocytes, basophils, eosinophils, neutrophils, lymphocytes, B, T and natural killer cells and inflammatory markers (C-reactive protein, interferon-gamma, interleukin-2, -4, -5, -10, and tumor necrosis factor-alpha) did not change substantially between baseline and three-month follow-up within the OMT + CAVI and OMT group. CONCLUSION: The present data suggest that reduction of venous congestion following OMT + CAVI may not lead to substantial changes in systemic inflammation within a short-term follow-up. CLINICAL TRIAL REGISTRATION: NCT02387697.
Sujet(s)
Implantation de valve prothétique cardiaque , Médiateurs de l'inflammation , Indice de gravité de la maladie , Insuffisance tricuspide , Veine cave inférieure , Humains , Mâle , Femelle , Veine cave inférieure/imagerie diagnostique , Veine cave inférieure/immunologie , Médiateurs de l'inflammation/sang , Résultat thérapeutique , Insuffisance tricuspide/chirurgie , Insuffisance tricuspide/sang , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/étiologie , Insuffisance tricuspide/immunologie , Adulte d'âge moyen , Implantation de valve prothétique cardiaque/effets indésirables , Implantation de valve prothétique cardiaque/instrumentation , Sujet âgé , Marqueurs biologiques/sang , Facteurs temps , Prothèse valvulaire cardiaque , Valve atrioventriculaire droite/chirurgie , Valve atrioventriculaire droite/physiopathologie , Valve atrioventriculaire droite/immunologie , Valve atrioventriculaire droite/imagerie diagnostique , Cytokines/sang , Conception de prothèse , Études prospectivesSujet(s)
Cathétérisme cardiaque , Implantation de valve prothétique cardiaque , Insuffisance tricuspide , Humains , Insuffisance tricuspide/chirurgie , Insuffisance tricuspide/étiologie , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/imagerie diagnostique , Implantation de valve prothétique cardiaque/effets indésirables , Implantation de valve prothétique cardiaque/instrumentation , Cathétérisme cardiaque/effets indésirables , Cathétérisme cardiaque/instrumentation , Cathétérisme cardiaque/méthodes , Résultat thérapeutique , Prothèse valvulaire cardiaque , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/chirurgie , Valve atrioventriculaire droite/physiopathologie , Femelle , Fonction ventriculaire droite , Mâle , Sujet âgé , Dysfonction ventriculaire droite/étiologie , Dysfonction ventriculaire droite/physiopathologie , Dysfonction ventriculaire droite/imagerie diagnostiqueSujet(s)
Cathétérisme cardiaque , Annuloplastie de valves cardiaques , Implantation de valve prothétique cardiaque , Insuffisance tricuspide , Valve atrioventriculaire droite , Humains , Insuffisance tricuspide/chirurgie , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/étiologie , Résultat thérapeutique , Cathétérisme cardiaque/instrumentation , Cathétérisme cardiaque/effets indésirables , Mâle , Implantation de valve prothétique cardiaque/instrumentation , Implantation de valve prothétique cardiaque/effets indésirables , Femelle , Valve atrioventriculaire droite/chirurgie , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/physiopathologie , Sujet âgé , Facteurs de risque , Lésions du système vasculaire/imagerie diagnostique , Lésions du système vasculaire/étiologie , Lésions du système vasculaire/chirurgie , Vaisseaux coronaires/imagerie diagnostique , Vaisseaux coronaires/traumatismes , Vaisseaux coronaires/chirurgie , Lésions traumatiques du coeur/étiologie , Lésions traumatiques du coeur/imagerie diagnostique , Lésions traumatiques du coeur/thérapie , Lésions traumatiques du coeur/chirurgie , Sujet âgé de 80 ans ou plus , Études rétrospectives , Facteurs temps , Prothèse valvulaire cardiaqueSujet(s)
Implantation de valve prothétique cardiaque , Insuffisance tricuspide , Valve atrioventriculaire droite , Humains , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/chirurgie , Résultat thérapeutique , Valve atrioventriculaire droite/physiopathologie , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/chirurgie , Implantation de valve prothétique cardiaque/instrumentation , Implantation de valve prothétique cardiaque/effets indésirables , Hémodynamique , Récupération fonctionnelle , Facteurs de risque , Cathétérisme cardiaque/instrumentationSujet(s)
Insuffisance tricuspide , Valve atrioventriculaire droite , Humains , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/chirurgie , Résultat thérapeutique , Valve atrioventriculaire droite/physiopathologie , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/chirurgie , Implantation de valve prothétique cardiaque/instrumentation , Implantation de valve prothétique cardiaque/effets indésirables , Facteurs de risque , HémodynamiqueSujet(s)
Valeur prédictive des tests , Insuffisance tricuspide , Valve atrioventriculaire droite , Humains , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/physiopathologie , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/physiopathologie , Indice de gravité de la maladie , Pronostic , HémodynamiqueRÉSUMÉ
BACKGROUND: Baseline right ventricular (RV) function derived from 3-dimensional analyses has been demonstrated to be predictive in patients undergoing transcatheter tricuspid valve repair (TTVR). The complex nature of these cumbersome analyses makes patient selection based on established imaging methods challenging. Artificial intelligence (AI)-driven computed tomography (CT) segmentation of the RV might serve as a fast and predictive tool for evaluating patients prior to TTVR. METHODS: Patients suffering from severe tricuspid regurgitation underwent full cycle cardiac CT. AI-driven analyses were compared to conventional CT analyses. Outcome measures were correlated with survival free of rehospitalization for heart-failure or death after TTVR as the primary endpoint. RESULTS: Automated AI-based image CT-analysis from 100 patients (mean age 77 ± 8 years, 63% female) showed excellent correlation for chamber quantification compared to conventional, core-lab evaluated CT analysis (R 0.963-0.966; p < 0.001). At 1 year (mean follow-up 229 ± 134 days) the primary endpoint occurred significantly more frequently in patients with reduced RV ejection fraction (EF) <50% (36.6% vs. 13.7%; HR 2.864, CI 1.212-6.763; p = 0.016). Furthermore, patients with dysfunctional RVs defined as end-diastolic RV volume > 210 ml and RV EF <50% demonstrated worse outcome than patients with functional RVs (43.7% vs. 12.2%; HR 3.753, CI 1.621-8.693; p = 0.002). CONCLUSIONS: Derived RVEF and dysfunctional RV were predictors for death and hospitalization after TTVR. AI-facilitated CT analysis serves as an inter- and intra-observer independent and time-effective tool which may thus aid in optimizing patient selection prior to TTVR in clinical routine and in trials.
Sujet(s)
Intelligence artificielle , Tomodensitométrie , Insuffisance tricuspide , Humains , Femelle , Mâle , Intelligence artificielle/tendances , Sujet âgé , Insuffisance tricuspide/chirurgie , Insuffisance tricuspide/imagerie diagnostique , Sujet âgé de 80 ans ou plus , Tomodensitométrie/méthodes , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/chirurgie , Cathétérisme cardiaque/méthodes , Études de suivi , Implantation de valve prothétique cardiaque/méthodesRÉSUMÉ
Echocardiography, in all its forms (transthoracic echocardiography [TTE], transesophageal echocardiography [TEE], and intracardiac echocardiography [ICE]), is pivotal for the evaluation, guidance, and follow-up of transcatheter tricuspid edge-to-edge repair (TV-TEER) therapies. Although two-dimensional (2D) echocardiography remains essential, three-dimensional (3D) echo with multiplanar reconstruction (MPR) has revolutionized the field of structural imaging. In addition, the advent of 3D ICE has added an important modality to the imaging toolbox, particularly helpful when intraprocedural TEE images are challenging. In this review, we provide a detailed, step-by-step approach for advanced echocardiographic guidance of TV-TEER using 3D MPR.
Sujet(s)
Cathétérisme cardiaque , Insuffisance tricuspide , Valve atrioventriculaire droite , Humains , Cathétérisme cardiaque/méthodes , Échocardiographie/méthodes , Échocardiographie tridimensionnelle/méthodes , Échocardiographie transoesophagienne/méthodes , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/chirurgie , Insuffisance tricuspide/chirurgie , Insuffisance tricuspide/imagerie diagnostique , Échographie interventionnelle/méthodesRÉSUMÉ
BACKGROUND: Tricuspid valve transcatheter edge-to-edge repair (T-TEER) is the most widely used transcatheter therapy to treat patients with tricuspid regurgitation (TR). OBJECTIVES: The aim of this study was to develop a simple anatomical score to predict procedural outcomes of T-TEER. METHODS: All patients (n = 168) who underwent T-TEER between January 2017 and November 2022 at 2 centers were included in the derivation cohort. Additionally, 126 patients from 2 separate institutions served as a validation cohort. T-TEER was performed using 2 commercially available technologies. Core laboratory assessment of procedural transesophageal echocardiograms was used to determine septolateral and anteroposterior coaptation gap, leaflet morphology, septal leaflet length and retraction, chordal structure density, tethering height, en face TR jet morphology and TR jet location, image quality, and the presence of intracardiac leads. A scoring system was derived using univariable and multivariable logistic regression. Endpoints assessed were immediate postprocedural TR reduction ≥2 grades and TR grade moderate or less. RESULTS: The median age was 82 years (Q1-Q3: 78-84 years); 48% of patients were women; and patients presented with severe (55%), massive (36%), and torrential (8%) TR. Five variables (septolateral coaptation gap, chordal structure density, en face TR jet morphology, TR jet location, and image quality) were identified as best predicting procedural outcome and were incorporated in the GLIDE (Gap, Location, Image quality, density, en-face TR morphology) score (range 0-5). TR reduction ≥2 grades and TR grade moderate or less were observed in >90% of patients with GLIDE scores of 0 and 1 and in only 5.6% and 16.7% of those with GLIDE scores ≥4. The GLIDE score was then externally validated in a separate cohort (area under the curve: 0.77; 95% CI: 0.69-0.86). TR reduction significantly correlated with functional improvement assessed by NYHA functional class and 6-minute walk distance at 3 months. CONCLUSIONS: The GLIDE score is a simple, 5-component score that is readily obtained during patient imaging and can predict successful T-TEER.
Sujet(s)
Cathétérisme cardiaque , Échocardiographie transoesophagienne , Valeur prédictive des tests , Récupération fonctionnelle , Insuffisance tricuspide , Valve atrioventriculaire droite , Humains , Femelle , Mâle , Sujet âgé , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/chirurgie , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/physiopathologie , Valve atrioventriculaire droite/chirurgie , Résultat thérapeutique , Sujet âgé de 80 ans ou plus , Reproductibilité des résultats , Études rétrospectives , Facteurs de risque , Techniques d'aide à la décision , Appréciation des risques , Facteurs tempsSujet(s)
Échocardiographie transoesophagienne , Valeur prédictive des tests , Valve atrioventriculaire droite , Humains , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/physiopathologie , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/chirurgie , Pronostic , Indice de gravité de la maladieSujet(s)
Implantation de valve prothétique cardiaque , Insuffisance tricuspide , Valve atrioventriculaire droite , Humains , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/chirurgie , Insuffisance tricuspide/imagerie diagnostique , Résultat thérapeutique , Implantation de valve prothétique cardiaque/instrumentation , Implantation de valve prothétique cardiaque/effets indésirables , Valve atrioventriculaire droite/physiopathologie , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/chirurgie , Récupération fonctionnelle , Délai jusqu'au traitement , Facteurs de risque , Cathétérisme cardiaque/instrumentation , Prothèse valvulaire cardiaque , HémodynamiqueRÉSUMÉ
BACKGROUND: A novel echocardiography-based definition of atrial functional tricuspid regurgitation (A-FTR) has shown superior outcomes in patients undergoing conservative treatment or tricuspid valve transcatheter edge-to-edge repair. Its prognostic significance for transcatheter tricuspid valve annuloplasty (TTVA) outcomes is unknown. OBJECTIVES: This study sought to investigate prognostic, clinical, and technical implications of A-FTR phenotype in patients undergoing TTVA. METHODS: This multicenter study investigated clinical and echocardiographic outcomes up to 1 year in 165 consecutive patients who underwent TTVA for A-FTR (characterized by the absence of tricuspid valve tenting, midventricular right ventricular [RV] dilatation, and impaired left ventricular ejection fraction) and nonatrial functional tricuspid regurgitation (NA-FTR). RESULTS: A total of 62 A-FTR and 103 NA-FTR patients were identified, with the latter exhibiting more pronounced RV remodeling. Compared to baseline, the tricuspid regurgitation (TR) grade at discharge was significantly reduced (P < 0.001 for both subtypes), and TR ≤II was achieved more frequently in A-FTR (85.2% vs 60.8%; P = 0.001). Baseline TR grade and A-FTR phenotype were independently associated with TR ≤II at discharge and 30 days. In multivariate analyses, A-FTR phenotype was a strong predictor (OR: 5.8; 95% CI: 2.1-16.1; P < 0.001) of TR ≤II at 30 days. At 1 year, functional class had significantly improved compared to baseline (both P < 0.001). One-year mortality was lower in A-FTR (6.5% vs 23.8%; P = 0.011) without significant differences in heart failure hospitalizations (13.3% vs 22.7%; P = 0.188). CONCLUSIONS: Direct TTVA effectively reduces TR in both A-FTR, which is a strong and independent predictor of achieving TR ≤II, and NA-FTR. Even though NA-FTR showed more RV remodeling at baseline, both phenotypes experienced similar symptomatic improvement, emphasizing the benefit of TTVA even in advanced disease stages. Additionally, phenotyping was of prognostic relevance in patients undergoing TTVA.
Sujet(s)
Cathétérisme cardiaque , Annuloplastie de valves cardiaques , Implantation de valve prothétique cardiaque , Insuffisance tricuspide , Valve atrioventriculaire droite , Humains , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/chirurgie , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/mortalité , Femelle , Mâle , Sujet âgé , Valve atrioventriculaire droite/physiopathologie , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/chirurgie , Cathétérisme cardiaque/instrumentation , Cathétérisme cardiaque/effets indésirables , Résultat thérapeutique , Facteurs temps , Implantation de valve prothétique cardiaque/effets indésirables , Implantation de valve prothétique cardiaque/instrumentation , Implantation de valve prothétique cardiaque/mortalité , Annuloplastie de valves cardiaques/effets indésirables , Annuloplastie de valves cardiaques/mortalité , Annuloplastie de valves cardiaques/instrumentation , Facteurs de risque , Sujet âgé de 80 ans ou plus , Récupération fonctionnelle , Remodelage ventriculaire , Fonction ventriculaire gauche , Phénotype , Fonction ventriculaire droite , Études rétrospectives , Adulte d'âge moyen , Débit systolique , Valeur prédictive des testsSujet(s)
Cathétérisme cardiaque , Sélection de patients , Valve atrioventriculaire droite , Humains , Cathétérisme cardiaque/effets indésirables , Cathétérisme cardiaque/instrumentation , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/chirurgie , Valve atrioventriculaire droite/physiopathologie , Résultat thérapeutique , Détermination de l'admissibilité , Implantation de valve prothétique cardiaque/effets indésirables , Implantation de valve prothétique cardiaque/instrumentation , Facteurs de risque , Femelle , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/chirurgie , Insuffisance tricuspide/physiopathologie , Mâle , Sujet âgéRÉSUMÉ
PURPOSE: There is currently limited information on the utility of transthoracic echocardiography (TTE)-derived Doppler parameters for assessing bioprosthetic tricuspid valve (BTV) dysfunction. Our study aimed to establish the precision and appropriate reference ranges for routinely collected transthoracic Doppler parameters in the assessment of BTV dysfunction. METHODS: We retrospectively evaluated 100 BTV patients who underwent TTE. Based on redo surgical confirmation or more than 2 repeat TTE or transesophageal echocardiography (TEE) examinations, patients were allocated to normal (n = 61), regurgitant (n = 24), or stenotic (n = 15) BTV group. Univariate and multivariate binary logistic regression were performed to identify TTE Doppler parameters that detected BTV dysfunction. RESULTS: The VTI ratio (VTITV/VTILVOT) was the most accurate Doppler parameter for detecting BTV dysfunction, with a ratio of >2.8 showing 84.6% sensitivity and 90.2% specificity. VTI ratio > 3.2, mean gradient (MGTV) > 6.2 mmHg and pressure half-time > 218 ms detected significant BTV stenosis, with sensitivities of 100%, 93.3% and 93.3% and specificities of 82.4%, 75.3% and 87.1%, respectively. After multivariate analysis, the VTI ratio > 2.8 (OR = 9.00, 95% CI = 2.13-41.61, p = .003) and MGTV > 5.1 mmHg (OR = 6.50, 95% CI = 1.69-27.78, p = .008) were the independent associations of BTV dysfunction. With these cutoff values, 75.0%-92.2% of normal and 62.5%-96.0% of dysfunctional BTV were identified. CONCLUSIONS: Doppler parameters from TTE can accurately identify BTV dysfunction, particularly with VTI ratio > 2.8 and MGTV > 5.1 mmHg, to assess the need for additional testing with TEE.
Sujet(s)
Bioprothèse , Échocardiographie-doppler , Prothèse valvulaire cardiaque , Sensibilité et spécificité , Valve atrioventriculaire droite , Humains , Femelle , Mâle , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/physiopathologie , Adulte d'âge moyen , Échocardiographie-doppler/méthodes , Études rétrospectives , Reproductibilité des résultats , Sujet âgé , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/imagerie diagnostiqueSujet(s)
Insuffisance tricuspide , Valve atrioventriculaire droite , Humains , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/chirurgie , Insuffisance tricuspide/étiologie , Résultat thérapeutique , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/physiopathologie , Valve atrioventriculaire droite/chirurgie , Implantation de valve prothétique cardiaque/effets indésirables , Implantation de valve prothétique cardiaque/instrumentation , Facteurs de risque , Facteurs temps , Cathétérisme cardiaque/effets indésirables , Cathétérisme cardiaque/instrumentation , HémodynamiqueSujet(s)
Défaillance cardiaque , Insuffisance tricuspide , Humains , Défaillance cardiaque/physiopathologie , Défaillance cardiaque/diagnostic , Défaillance cardiaque/complications , Insuffisance tricuspide/physiopathologie , Insuffisance tricuspide/imagerie diagnostique , Insuffisance tricuspide/complications , Valve atrioventriculaire droite/imagerie diagnostique , Valve atrioventriculaire droite/physiopathologieRÉSUMÉ
The concomitant large atrial septal defect closure, endocardial biatrial cryoablation and tricuspid valve replacement with mitral homograft in a patient with adult congenital heart disease is presented. Because of the severely dilated right ventricle and leaflet tenting, tricuspid valve replacement was considered. The patient refused both mechanical and stented biological prosthesis due to personal beliefs, therefore, the alternative valve substitute was proposed. Relevant decision-making process, preoperative diagnostic work-up and surgical technique are highlighted with satisfactory outcomes.