RESUMO
A 2-year-old 33 kg female castrated Labrador Retriever was referred for exercise intolerance, hyporexia, and abdominal distention. Point-of-care ultrasound revealed ascites, hepatic congestion, severe pericardial effusion, and cardiac tamponade. Pericardiocentesis was performed, and the chylous nature of the fluid was confirmed by cytology, triglyceride, and cholesterol measurements. Repeated pericardiocentesis was necessary within 24-h after admission, after which a pericardial stay-catheter was placed. Cardiac ultrasound revealed severe tricuspid valve stenosis. Balloon dilatation of the stenotic valve was performed, resulting in a significant drop in the mean diastolic trans-valvular Doppler gradient and long-term resolution of the chylopericardium. No other cause for the pericardial effusion could be identified, suggesting that this is the first described case of chylopericardium due to tricuspid valve stenosis.
Assuntos
Tamponamento Cardíaco , Doenças do Cão , Derrame Pericárdico , Estenose da Valva Tricúspide , Animais , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/veterinária , Dilatação/veterinária , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/terapia , Cães , Feminino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Derrame Pericárdico/terapia , Derrame Pericárdico/veterinária , Pericardiocentese/veterinária , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/terapia , Estenose da Valva Tricúspide/veterináriaRESUMO
With the steadily increasing amount of leadless pacemaker implantations performed worldwide, it has called attention to the delivery difficulty in patients with severe large right heart. Nevertheless, limited studies have reported leadless pacemaker implantation in patients with tricuspid stenosis. Here, we report the successful implantation of leadless pacemaker in a 60-year-old female patient with giant right atrium and tricuspid valve stenosis. It is highlighted that leadless pacemaker should not be discouraged even if there are tricuspid valve stenosis and giant right atrium.
Assuntos
Marca-Passo Artificial , Estenose da Valva Tricúspide , Eletrocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Estenose da Valva Tricúspide/complicações , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/terapiaRESUMO
A 26-year-old female with carcinoid heart disease consisting of severe pulmonary and tricuspid valve stenosis was admitted with line associated sepsis. She recovered from sepsis with antibiotics and aggressive fluid resuscitation but became grossly volume overloaded with evidence of tense ascites and lower extremity edema. She developed worsening renal and hepatic function due to congestive nephropathy and hepatopathy, which did not respond to intravenous diuretics, and she was deemed too sick for surgical pulmonary and tricuspid valve replacement. Pulmonary and tricuspid valvuloplasty was performed as a rescue measure to alleviate her congestive symptoms and improve her candidacy for valve replacement. © 2016 Wiley Periodicals, Inc.
Assuntos
Valvuloplastia com Balão , Doença Cardíaca Carcinoide/terapia , Estenose da Valva Pulmonar/terapia , Estenose da Valva Tricúspide/terapia , Adulto , Doença Cardíaca Carcinoide/diagnóstico por imagem , Doença Cardíaca Carcinoide/fisiopatologia , Ecocardiografia Doppler em Cores , Feminino , Humanos , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/fisiopatologiaRESUMO
The effect of a highly elevated level of right atrial filling pressure on fractional flow reserve (FFR) measurement remains unclear. Transcatheter tricuspid valve intervention, a recently introduced option for inoperable or high-risk patients, represents a unique model of in-vivo physiology to investigate the eventual influence of central venous pressure on coronary FFR measurements. The case is reported of a patient with a degenerated tricuspid surgical bioprosthesis who underwent transcatheter tricuspid valve-in-valve replacement and concomitant coronary functional assessment with FFR. In an experimental model, the significant fall in right atrial pressure did not influence FFR measurements in the presence of angiographically proven mild coronary artery disease.
Assuntos
Função do Átrio Direito , Pressão Atrial , Reserva Fracionada de Fluxo Miocárdico , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Tricúspide/fisiopatologia , Estenose da Valva Tricúspide/fisiopatologia , Valva Tricúspide/cirurgia , Cateterismo Cardíaco , Angiografia Coronária , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/terapia , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/terapiaRESUMO
Percutaneous transcatheter tricuspid balloon valvuloplasty (PTTBV) is an accepted treatment option for symptomatic severe native tricuspid valve stenosis, although surgical tricuspid valve replacement remains the treatment of choice. There have been few reports of successful PTTBV for bioprosthetic tricuspid valve stenosis. We present case reports of 3 patients from our hospital experience. Two of the 3 cases were successful, with lasting clinical improvement, whereas the 3rd patient failed to show a reduction in valve gradient. We describe the standard technique used for PTTBV. We present results from a literature review that identified 16 previously reported cases of PTTBV for bioprosthetic severe tricuspid stenosis, with overall favorable results. We conclude that PTTBV should perhaps be considered for a select patient population in which symptomatic improvement and hemodynamic stability are desired immediately, and particularly for patients who are inoperable or at high surgical risk.
Assuntos
Valvuloplastia com Balão , Bioprótese , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Falha de Prótese , Estenose da Valva Tricúspide/terapia , Valva Tricúspide/cirurgia , Idoso , Cateterismo de Swan-Ganz , Ecocardiografia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Índice de Gravidade de Doença , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/fisiopatologiaRESUMO
BACKGROUND: There are limited reports of severe tricuspid valve stenosis in dogs and limited data regarding treatment and outcome. OBJECTIVE: To evaluate clinical signs, echocardiographic features, and outcome of balloon valvuloplasty (BV) in dogs with severe tricuspid valve stenosis (TVS) in which BV was attempted. ANIMALS: Five client-owned dogs with severe TVS. METHODS: Records were retrospectively reviewed and data collected regarding signalment, clinical signs, diagnostic findings, procedures, and outcome. RESULTS: All dogs were Labrador Retrievers. Presenting complaints included episodic weakness/syncope (4/5), abdominal distension (4/5), lethargy (2/5), and exercise intolerance (2/5). The median and range of measurements before BV were as follows: TV mean velocity 1.5 m/s (range 1.4-1.7 m/s); velocity-time integral (VTI) 79.8 cm (42.4-99.1 cm); and TV maximum velocity 2.9 m/s (2.3-3.2 m/s). Measurements (available for 3 of 5 dogs) after BV were as follows: TV mean velocity 1.15 m/s (0.9-1.4 m/s); VTI 44.95 cm (41.4-54.8 cm); and TV maximum velocity 1.15 m/s (1.9-2.3 m/s). The procedure was attempted in all dogs and completed in 4/5 dogs. The largest balloon diameter ranged from 15 mm to 25 mm, and length ranged from 4 cm to 5 cm. Right atrial pressure decreased in 4/5 dogs. All but 1 dog had clinical improvement after BV, but recurrence of clinical signs occurred (2/5). Tricuspid regurgitation worsened in 1 dog culminating in right heart failure and euthanasia. CONCLUSIONS AND CLINICAL IMPORTANCE: BV can be an effective treatment; however, clinical signs can recur. Right heart failure due to worsened TR is a potential complication in dogs with pre-existing moderate-to-severe TR.
Assuntos
Valvuloplastia com Balão/veterinária , Doenças do Cão/terapia , Estenose da Valva Tricúspide/veterinária , Animais , Cães , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/veterinária , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Estenose da Valva Tricúspide/terapiaRESUMO
Percutaneous valved stent implantation is precluded in small infants because large delivery sheaths and large devices. We describe a procedure in a 1-year-old boy in whom a 19 mm Epic™ valve in tricuspid position had become dysfunctional. As the internal diameter of the prosthetic valve was about 16 mm, the only available valve was the Melody™ valved stent. Technical modifications were required to address issues like venous access, the bulky delivery system, and the length of the valved stent. The Melody™ valved stent was surgically trimmed and mounted on a 16 mm Tyshak balloon, access was provided transhepatically through a short 18 Fr sheath. After deployment, the intrahepatic route was sealed with two vascular plugs (8 and 10 mm) in tandem. The procedure was uncomplicated with perfect valve function 18 months after implant. © 2016 Wiley Periodicals, Inc.
Assuntos
Bioprótese , Cateterismo Cardíaco/instrumentação , Cateterismo Periférico/métodos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Veias Hepáticas , Stents , Insuficiência da Valva Tricúspide/terapia , Estenose da Valva Tricúspide/terapia , Valva Tricúspide/cirurgia , Valvuloplastia com Balão , Cateterismo Cardíaco/métodos , Anuloplastia da Valva Cardíaca , Ecocardiografia Doppler em Cores , Ecocardiografia Doppler de Pulso , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Lactente , Masculino , Desenho de Prótese , Falha de Prótese , Punções , Recuperação de Função Fisiológica , Recidiva , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/cirurgia , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/fisiopatologiaRESUMO
Spindle cell sarcomas of the right atrium are extremely rare primary cardiac tumours with very few cases reported in the medical literature. The prognosis of this malignant neoplasm remains poor due to delay in diagnosis, early metastasis and few available therapeutic options. It responds poorly to chemotherapy and radiotherapy. Surgical excision is the mainstay of treatment. We report a 42-year-old man, who presented to emergency room with dyspnoea and fatigue (New York Heart Association classification II) since 1â month. Transthoracic echocardiogram showed massive pericardial effusion with tamponade. The patient underwent emergency pericardiocentesis; postpericardiocentesis echocardiogram showed large right atrial mass involving the right ventricle and the tricuspid valve causing tricuspid stenosis. Findings were confirmed by cardiac CT scan. Percutaneous transvenous biopsy was carried out which revealed spindle cell sarcoma.
Assuntos
Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Sarcoma/complicações , Sarcoma/diagnóstico por imagem , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/etiologia , Adulto , Ecocardiografia Transesofagiana , Evolução Fatal , Átrios do Coração/diagnóstico por imagem , Humanos , Pericardiocentese , Tomografia Computadorizada por Raios X , Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/terapiaRESUMO
Bioprosthetic valves degenerate over time. Transcatheter valve-in-valve procedures have become an attractive alternative to surgery. However, every valve increasingly diminishes the diameter of the valvar orifice. We report a 12-year-old female who had a previous transcatheter tricuspid valve-in-valve procedure; cracking the ring of a Carpentier Edwards Perimount valve by means of an ultrahigh pressure balloon allowed implantation of a further larger percutaneous valve. The advantage of this novel approach permits enlarging the inner valve diameter and may facilitate future interventions and prolong time to surgery. © 2016 Wiley Periodicals, Inc.
Assuntos
Valvuloplastia com Balão , Bioprótese , Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Falha de Prótese , Insuficiência da Valva Tricúspide/terapia , Estenose da Valva Tricúspide/terapia , Valva Tricúspide/cirurgia , Cateterismo Cardíaco/métodos , Criança , Ecocardiografia Doppler de Pulso , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pressão , Desenho de Prótese , Radiografia Intervencionista , Recidiva , Retratamento , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/cirurgia , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/fisiopatologiaRESUMO
A 51-year-old woman was diagnosed as severe stenosed tricuspid bioprosthetic valve. She had developed an encephalopathy due to elevated serum ammonia concentration caused by congestive hepatic failure. Re-tricuspid valve replacement was deemed too risky, and balloon bioprosthetic valvuloplasty was instead planned. This procedure was successfully performed using a standard mitral valvuloplasty protocol. The 30-mm INOUE-BALLOON was inflated five times. The mean pressure gradient across the bioprosthetic valve decreased from 7.8 to 3.5 mmHg, and the tricuspid valve orifice area increased from 1.09 to 3.13 cm(2), without worsening of the tricuspid valve regurgitation. Finally, her hepatic encephalopathy was dramatically improved.
Assuntos
Valvuloplastia com Balão/métodos , Encefalopatia Hepática/terapia , Estenose da Valva Tricúspide/terapia , Bioprótese , Contraindicações , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca , Encefalopatia Hepática/complicações , Humanos , Pessoa de Meia-Idade , Falha de Prótese , Insuficiência da Valva Tricúspide/complicações , Estenose da Valva Tricúspide/complicaçõesAssuntos
Bioprótese , Cateterismo Cardíaco/instrumentação , Corpos Estranhos/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Falha de Prótese , Insuficiência da Valva Tricúspide/terapia , Estenose da Valva Tricúspide/terapia , Valva Tricúspide/cirurgia , Cateterismo Cardíaco/métodos , Remoção de Dispositivo , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Corpos Estranhos/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pessoa de Meia-Idade , Desenho de Prótese , Reoperação , Falha de Tratamento , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/mortalidade , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/etiologiaRESUMO
BACKGROUND: Transcatheter valve-in-valve (VIV) implantation in failing bioprosthesis is an emerging field in cardiology. AIM: To report on a French multicentre experience and a literature review of tricuspid VIV implantation. METHODS: We approached different institutions and collected 10 unpublished cases; a literature review identified 71 patients, including our 10 cases. Clinical aspects and haemodynamic data are discussed. RESULTS: Among our 10 unpublished cases, the reason for implantation was significant tricuspid stenosis (n = 4), significant tricuspid regurgitation (n = 1) or mixed lesion (n = 5). Implantation was performed under general anaesthesia at mean age 28 ± 17 years. The 22 mm Melody valve was implanted in seven patients; the Edwards SAPIEN valve was implanted in three patients. The procedure succeeded in all cases, despite two embolizations in the right cardiac chambers; in both cases, the valve was stabilized close to the tricuspid annulus using a self-expandable stent, before implantation of a second Edwards SAPIEN valve. Functional class improved in all but one case. Mean diastolic gradient decreased from 9 ± 2.45 mmHg to 3.65 ± 0.7 mmHg (p = 0.007); no more than trivial regurgitation was noticed. Among the published cases, the Melody valve was implanted in 41 patients, the Edwards SAPIEN valve in 29 patients and the Braile valve in one patient. Short-term results were similar for our 10 cases, but mid-term results are not yet available. CONCLUSIONS: Tricuspid VIV implantation using the Melody or Edwards SAPIEN valves is a feasible and effective procedure for selected patients with failing bioprosthesis.
Assuntos
Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Tricúspide/terapia , Estenose da Valva Tricúspide/terapia , Valva Tricúspide/cirurgia , Adolescente , Adulto , Bioprótese , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Criança , Feminino , França , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Resultado do Tratamento , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/fisiopatologia , Estenose da Valva Tricúspide/diagnóstico , Estenose da Valva Tricúspide/fisiopatologia , Adulto JovemAssuntos
Cateterismo Cardíaco/métodos , Remoção de Dispositivo/métodos , Veia Femoral , Implante de Prótese de Valva Cardíaca/métodos , Veias Jugulares , Cardiopatia Reumática/cirurgia , Insuficiência da Valva Tricúspide/terapia , Estenose da Valva Tricúspide/terapia , Valva Tricúspide/cirurgia , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Feminino , Veia Femoral/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/terapia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Veias Jugulares/diagnóstico por imagem , Flebografia , Cardiopatia Reumática/diagnóstico , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/diagnóstico , Estenose da Valva Tricúspide/etiologiaRESUMO
OBJECTIVES: We describe the first report of a transcatheter Sapien implantation in a native tricuspid valve after multiple failed surgical repairs with a lack of prosthetic material and radiographic landmarks. METHODS AND RESULTS: A 47-year old female underwent multiple valve repairs and replacements including three tricuspid valve repairs without surgical ring or bioprosthesis implantation. She developed signs of right heart failure associated with a mixed tricuspid disease combining a severe stenosis and regurgitation. After surgical turn down, a revalvulation using a transcatheter approach was attempted. The challenges in this case were the absence of a stiff region to anchor the percutaneous valve, the lack of radiographic landmarks and the difficulties of precise annulus measurements. The applied strategy was -under general anesthesia and extracorporeal membrane oxygenation-: balloon sizing, prestenting of the tricuspid annulus using covered stents followed by Sapien valve implantation through the femoral vein under fluoroscopy and transoesophageal echocardiography (TEE). The procedure was successfull, solving the tricuspid leak and stenosis (peak gradient from 22 to 3 mm Hg) using two Sapien for a perfect positioning. It was complicated by pulmonary bleeding due to a distal wire exit, treated successfully by coil embolization. The clinical and echocardiographic outcome was good up to 5 months. CONCLUSIONS: Transcatheter Sapien valve implantation in a native tricuspid valve after failed multiple surgical repairs is feasible by the femoral vein. Technical challenges due to the lack of rigid landing zone and fluoroscopic markers were solved by prestenting and valve implantation under bi-plane fluoroscopic and TEE guidance.
Assuntos
Cateterismo Cardíaco/instrumentação , Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Tricúspide/terapia , Estenose da Valva Tricúspide/terapia , Valva Tricúspide/cirurgia , Valvuloplastia com Balão , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pessoa de Meia-Idade , Desenho de Prótese , Radiografia Intervencionista , Falha de Tratamento , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/cirurgia , Estenose da Valva Tricúspide/diagnóstico , Estenose da Valva Tricúspide/fisiopatologia , Estenose da Valva Tricúspide/cirurgiaAssuntos
Valvuloplastia com Balão/métodos , Cateterismo Cardíaco/métodos , Marca-Passo Artificial/efeitos adversos , Estenose da Valva Tricúspide/terapia , Adulto , Bloqueio Atrioventricular/terapia , Ecocardiografia Transesofagiana , Falha de Equipamento , Feminino , Humanos , Radiografia Torácica , Estenose da Valva Tricúspide/diagnóstico , Estenose da Valva Tricúspide/etiologiaRESUMO
BACKGROUND: A 64-year-old female with rheumatic heart disease and multiple prior valve replacements presented with progressive oedema, ascites and dyspnoea on exertion. INVESTIGATION: Physical examination, transthoracic echocardiography, intracardiac echocardiography, transoesophageal echocardiography, right heart cathetherisation, computed tomography. DIAGNOSIS: She had a mitral homograft and Physio ring in the tricuspid position, and presented with severe bioprosthetic tricuspid valve stenosis (mean gradient 16 mmHg) and right-sided heart failure. TREATMENT: A transcatheter 26 mm Edwards SAPIEN valve was placed in the tricuspid position, resulting in near normalisation of tricuspid valve gradient. This represents the first report of a combined valve-in-ring (VIR) and valve in a homograft valve (VIV) SAPIEN implantation.
Assuntos
Cateterismo Cardíaco , Implante de Prótese de Valva Cardíaca/métodos , Anuloplastia da Valva Mitral , Valva Mitral/cirurgia , Estenose da Valva Tricúspide/terapia , Valva Tricúspide/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Cateterismo Cardíaco/instrumentação , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Pessoa de Meia-Idade , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Desenho de Prótese , Falha de Prótese , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Estenose da Valva Tricúspide/diagnóstico , Estenose da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/fisiopatologiaRESUMO
In the light of the recommendations published in 2012 by the European Society of Cardiology, the present article provides a review of the assessment, diagnosis and drug therapy of frequent cardiac valvular disease in adults. Congenital valvular heart disease, as well as pathology of the pulmonary valve and tricuspid stenosis, which are less frequent, will not be discussed here.
Assuntos
Doenças das Valvas Cardíacas/patologia , Guias de Prática Clínica como Assunto , Adulto , Diagnóstico Diferencial , Europa (Continente) , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/terapia , Humanos , Estenose da Valva Pulmonar/diagnóstico , Estenose da Valva Pulmonar/patologia , Estenose da Valva Pulmonar/terapia , Sociedades Médicas , Estenose da Valva Tricúspide/diagnóstico , Estenose da Valva Tricúspide/patologia , Estenose da Valva Tricúspide/terapiaRESUMO
Percutaneous balloon tricuspid valvotomy was successfully performed in a 45-year-old female with congenitally corrected transposition of great arteries with severe rheumatic left atrioventricular (tricuspid) valve stenosis. Technical modifications in the standard procedure were made keeping in mind the left-handed ventricular loop, left and anterior aorta, wedged pulmonary valve between the interatrial septum and the mitral valve with deviation of the atrial septum away from the ventricular septum, side-by-side positioned ventricles with an added superoinferior obliquity produced by excessive tilting, and an abnormal orientation of ventricular mass in relation to the thorax, with the apex pointing slightly rightwards. A final valve area of 1.4 cm(2) and a fall in the peak/mean left atrial pressures from 37/32 mm Hg to 13/10 mm Hg were achieved without complications. This case of percutaneous transvenous commissurotomy is unique in view of the rarity of the combination of this congenital heart disease and rheumatic heart disease and successful commissurotomy in such an unusual cardiac anatomy using the Inoue technique.
Assuntos
Valvuloplastia com Balão , Cateterismo Cardíaco , Cardiopatia Reumática/terapia , Transposição dos Grandes Vasos/complicações , Estenose da Valva Tricúspide/terapia , Transposição das Grandes Artérias Corrigida Congenitamente , Ecocardiografia Doppler , Feminino , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Radiografia Intervencionista , Cardiopatia Reumática/complicações , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/fisiopatologia , Transposição dos Grandes Vasos/fisiopatologia , Resultado do Tratamento , Estenose da Valva Tricúspide/complicações , Estenose da Valva Tricúspide/diagnóstico , Estenose da Valva Tricúspide/fisiopatologiaAssuntos
Anuloplastia da Valva Cardíaca , Fármacos Cardiovasculares/uso terapêutico , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/terapia , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/terapia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/terapia , Terapia Combinada , Procedimentos Endovasculares , Doenças das Valvas Cardíacas/etiologia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/terapia , Estenose da Valva Mitral/diagnóstico , Estenose da Valva Mitral/etiologia , Estenose da Valva Mitral/terapia , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/terapia , Estenose da Valva Tricúspide/diagnóstico , Estenose da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/terapiaRESUMO
We describe the case of 7-day-old neonate with pulmonary atresia, intact ventricular septum, and severe tricuspid valve (TV) dysplasia who underwent a Starnes right ventricular exclusion procedure (RVEP). The patient had severe tricuspid stenosis and regurgitation and right ventricular dysfunction after perforation and balloon dilation of the pulmonary valve.