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4.
Am J Case Rep ; 22: e928089, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33456048

RESUMO

BACKGROUND Severe tricuspid valve regurgitation (TR) is associated with high cardiovascular mortality. Safe and feasible interventional approaches to treat severe TR are of clinical relevance. The MitraClip is a device that has been approved by the US Food and Drug Administration (FDA) for the repair of mitral valve lesions. Percutaneous femoral venous access with fluoroscopic and echocardiographic guidance is used to deliver a cobalt-chromium clip to secure the mitral valve leaflets. We report on an 85-year-old man with tricuspid valve regurgitation who underwent percutaneous edge-to-edge tricuspid valve leaflet plication with the new, advanced MitraClip XTR System. CASE REPORT An 85-year-old man with severe TR due to annulus dilation of the right ventricle and short septal leaflet presented repeatedly at our hospital with severe right heart failure symptoms. Transesophageal echocardiography revealed severe TR with a large coaptation gap size of 10.6 mm. Percutaneous edge-to-edge valve repair with the new-generation MitraClip System XTR with wider clip arms could overcome the large coaptation gap. We achieved a strong reduction of TR after deploying 2 MitraClips XTR. The patient recovered quickly and has not been admitted to hospital due to heart failure symptoms since the intervention for more than 6 months. CONCLUSIONS Previous studies have shown the safety and effectiveness of the MitraClip device and supported FDA approval for tricuspid valve repair. This report of a patient with complex tricuspid regurgitation demonstrated the feasible use of the new MitraClip XTR System, which improved edge-to-edge tricuspid valve repair due to its increased span and improved grip.


Assuntos
Anuloplastia da Valva Cardíaca/instrumentação , Insuficiência da Valva Tricúspide/cirurgia , Idoso de 80 Anos ou mais , Cateterismo Cardíaco , Anuloplastia da Valva Cardíaca/métodos , Humanos , Masculino , Insuficiência da Valva Tricúspide/diagnóstico por imagem
8.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500310

RESUMO

A 41-year-old woman was referred to tertiary cardiothoracic surgery centre following embolisation of the Amplatzer patent foramen ovale (PFO) closure device to septal leaflet of tricuspid valve with reopening of PFO. Two years earlier, she presented with thalamic stroke, and she was found to have a PFO following investigations. The following year she underwent transcatheter closure. Six months after the percutaneous closure, she presented again with significant periods of shortness of breath. Imaging studies revealed the migration and embolisation of PFO closure device to the septal leaflet of tricuspid valve with reopening of the foramen and significant tricuspid valve regurgitation. She underwent open heart surgery using cardiopulmonary bypass for retrieval of the device, closure of the foramen and repair of the tricuspid valve. The patient recovered well without any significant issues following surgery.


Assuntos
Anuloplastia da Valva Cardíaca , Remoção de Dispositivo , Forame Oval Patente/cirurgia , Falha de Prótese/efeitos adversos , Dispositivo para Oclusão Septal , Insuficiência da Valva Tricúspide/etiologia , Valva Tricúspide/cirurgia , Adulto , Ecocardiografia , Feminino , Humanos , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia
10.
Zhonghua Yi Xue Za Zhi ; 100(40): 3147-3151, 2020 Nov 03.
Artigo em Chinês | MEDLINE | ID: mdl-33142396

RESUMO

Objective: To summarize the etiology and surgical treatment experience of tricuspid valve disease due to permanent pacemaker lead. Methods: The medical records of 22 patients who underwent tricuspid valve operation for tricuspid valve disease due to permanent cardiac pacemaker lead from January 2008 to December 2017 were retrospectively reviewed. There were 12 males and 10 females, with a mean age of (62.6±12.1) years old (45-82 years old). All patients underwent tricuspid valve surgery via open thoracotomy under general anesthesia, including 8 patients through median thoracotomy approach, 4 patients through right mini-thoracotomy approach, and 10 patients with endoscopy-assisted and totally endoscopic technique. Moreover, 8 patients underwent tricuspid valve replacement, and 14 patients received tricuspid valve repair. Results: During the operation, 10 cases of severe tricuspid regurgitation were detected due to valve and subvalvular structures dysfunction involved in the pacing electrode, 7 cases showed tricuspid annulus dilation, and pacing electrode-related infective endocarditis were involved in the tricuspid valve of 5 cases. Compared with conventional median thoracotomy surgery, the amount of postoperative drainage fluid and hospitalization time after minimally invasive surgery (including right mini-thoracotomy and endoscopic surgery) were significantly reduced [281(120, 489) ml vs 368(180, 560) ml, P=0.02; 9.2(4.8, 14.5) d vs 11.2(6.3, 16.9) d, P=0.03]. Postoperative echocardiographic data showed that the size of the right atrium and ventricle in these patients was significantly reduced compared with preoperative data, and their cardiac function were normal. There was no difference of pacing electrode parameters between pre-and postoperative period. All 22 patients were cured and discharged, with no valve-and pacemaker-related complications. Conclusions: Patients with tricuspid valve disease due to permanent cardiac pacemaker lead should actively undergo surgery including tricuspid replacement or repair according to different etiologies, which exhibit satisfactory outcomes. Minimally invasive endoscopic tricuspid surgery is a new technique for the treatment of isolated tricuspid valve disease, with less surgical trauma and faster recovery.


Assuntos
Doenças das Valvas Cardíacas , Marca-Passo Artificial , Insuficiência da Valva Tricúspide , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/cirurgia
12.
J Cardiothorac Surg ; 15(1): 152, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600335

RESUMO

BACKGROUND: Congenitally corrected transposition of great arteries (CCTGA) is caused by atrioventricular and ventriculoarterial discordance. Cases of CCTGA with spontaneous chordae rupture of tricuspid valve have not been reported before. CASE PRESENTATION: Here we diagnosed a 38-year-old man, who was found CCTGA 14 years ago, as spontaneous chordae rupture by real-time three dimentional transesophageal echocardiography (RT-3D-TEE). The present case is the first report to describe a CCTGA patient combine with spontaneous chordae rupture in tricuspid valve. After tricuspid valve replacement, the patient was uneventful after 6 years' follow-up. CONCLUSION: We reported a rare case with spontaneous chordae rupture of tricuspid valve in a CCTGA patient and explored its etiology here. RT-3D-TEE is an important supplement to 2-dimentional transthoracic echocardiography and can provide more accurate detections in tricuspid valve diseases in CCTGA.


Assuntos
Cordas Tendinosas/patologia , Transposição Congênita Corrigida de Grandes Artérias/complicações , Ruptura Espontânea/complicações , Insuficiência da Valva Tricúspide/etiologia , Prolapso da Valva Tricúspide/complicações , Adulto , Cordas Tendinosas/diagnóstico por imagem , Ecocardiografia , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Ruptura Espontânea/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia
13.
J Cardiothorac Surg ; 15(1): 146, 2020 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-32552843

RESUMO

BACKGROUND: Redo isolated tricuspid valve surgery is associated with a high morbidity and mortality, and its optimal timing remains controversial. Hence, here we reviewed the early and midterm results of simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery in patients at high risk. METHODS: A total of 32 consecutive patients underwent a redo isolated tricuspid valve surgery using minimally invasive, beating-heart technique through a right lateral thoracotomy in our center between June 2016 and April 2020. The mean age of patients was 57.4 ± 8.3 years, and 18 patients (56.3%) were women. The mean preoperative EuroSCORE was 7.8 ± 1.4 (range: 6-11). Follow-up was 87.1% complete, with a mean duration of 26.3 ± 12.3 months. RESULTS: Both in-hospital and 30-day mortalities were 3.1%. Tricuspid valve replacement with bioprosthesis was performed in 30 patients (93.8%), and the remaining two patients (6.2%) underwent tricuspid repair (annuloplasty and leaflet reconstruction). The mean cardiopulmonary bypass time was 81.5 ± 29.0 min. The overall in-hospital duration and intensive care unit (ICU) times were 13.6 ± 7.6 days and 4.1 ± 2.8 days, respectively. Postoperative complications included prolonged ventilation in six patients (18.8%), acute kidney injury in three patients (9.4%), and neurologic event, wound infection, or permanent third-degree atrioventricular block, in one patient (3.1%) each. A total of 96.9% patients were discharged uneventfully. Four patients were lost to follow-up; there were no midterm deaths in patients who were followed up. CONCLUSIONS: Simplified, minimally invasive, beating-heart technique for redo tricuspid valve surgery is both feasible and safe, and the early and midterm results are excellent.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Reoperação/métodos , Toracotomia/métodos , Insuficiência da Valva Tricúspide/mortalidade , Insuficiência da Valva Tricúspide/cirurgia , Adulto , Idoso , Valva Aórtica/cirurgia , Bioprótese , Ponte Cardiopulmonar , Cuidados Críticos , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Risco , Valva Tricúspide/cirurgia , Adulto Jovem
14.
Asian Cardiovasc Thorac Ann ; 28(7): 404-412, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32515208

RESUMO

BACKGROUND: Contemporary nationwide data from mainland China on trends in mitral valve surgery are scarce. The purpose of the present study was to review a single-center experience with mitral valve surgery over a 10-year period in East China. METHODS: Between July 2009 and June 2019, 3238 consecutive patients who underwent mitral valve surgery in our center were retrospectively reviewed. The patients were evenly divided into three periods: July 2009 to October 2012 (period I), November 2012 to February 2016 (period II), March 2016 to June 2019 (period III). RESULTS: The 3238 patients included 536 (16.6%) who had mitral valve repair and 2702 (83.4%) who had mitral valve replacement. Early mortalities for mitral valve repair and mitral valve replacement were 0.2% and 0.9%, respectively. There were trends towards a higher proportion of degenerative valve lesions (24.6%, 35.8%, 54.7% in periods I, II, and III, respectively) and a lower proportion of rheumatic valve lesions (71.0%, 62.6%, 38.0%) in more recent years. The proportions of minimally invasive surgery (0.7%, 2.1%, 30.2%), mitral valve repair (8.3%, 15.4%, 27.5%), use of a bioprosthesis (10.1%, 17.0%, 23.1%), and concomitant tricuspid valve procedures (13.2%, 28.5%, 46.0%) increased dramatically, while early mortality remained constant during the 10-year period (1.0%, 0.3%, 0.9%). CONCLUSIONS: In the past 10 years, the spectrum of mitral valve disease experienced a trend towards more degenerative valve lesions and less rheumatic valve lesions in East China. Mitral valve repair, bioprostheses, tricuspid valve repair, and minimally invasive surgery have been more often applied in recent years.


Assuntos
Implante de Prótese de Valva Cardíaca/tendências , Anuloplastia da Valva Mitral/tendências , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Padrões de Prática Médica/tendências , Cardiopatia Reumática/cirurgia , Adulto , Idoso , Bioprótese/tendências , China , Feminino , Próteses Valvulares Cardíacas/tendências , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Anuloplastia da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/mortalidade , Estenose da Valva Mitral/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/mortalidade , Cardiopatia Reumática/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/fisiopatologia , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/cirurgia
16.
J Card Surg ; 35(7): 1464-1470, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32445193

RESUMO

OBJECTIVES: To elucidate the impact of regulation of tricuspid regurgitation (TR) using tricuspid annuloplasty on postoperative changes in right ventricular (RV) systolic and diastolic functions. METHODS: We enrolled 69 patients who underwent aortic or mitral valve surgery between July 2016 to March 2018 without recurrence. Patients with concomitant coronary artery bypass grafting or a history of previous cardiovascular surgery were excluded, remaining 45 patients enrolled. Patients were divided into two groups according to concomitant tricuspid annuloplasty (T: n = 12 vs non-T: n = 33). RV global longitudinal strain (RVGLS), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), and early tricuspid inflow velocity/early diastolic tricuspid annular velocity ratio (tricuspid E/e') were assessed as functional indices at preoperative, postoperative and 1-year follow-up periods. RESULTS: RVFAC deteriorated postoperatively but recovered at follow-up in group T, whereas that in group non-T showed gradual deterioration overtime. RVGLS and TAPSE showed similar temporary deterioration and recovery between groups. Tricuspid E in group T increased postoperatively and showed significant difference, which was kept until follow-up period. Tricuspid e' decreased postoperatively, and recovered slightly in both groups. As a result, postoperative RV diastolic function (tricuspid E/e') showed significant difference between groups. This difference was maintained until follow-up. CONCLUSIONS: RV systolic function deteriorated postoperatively, but there was a tendency to improve at follow-up regardless of tricuspid annuloplasty. RV diastolic function may potentially be impaired when TR was regulated by tricuspid annuloplasty.


Assuntos
Diástole , Ventrículos do Coração/fisiopatologia , Anuloplastia da Valva Mitral , Complicações Pós-Operatórias/fisiopatologia , Sístole , Insuficiência da Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita , Idoso , Velocidade do Fluxo Sanguíneo , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Valva Tricúspide/fisiopatologia
17.
Medicine (Baltimore) ; 99(19): e20058, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384471

RESUMO

RATIONALE: A cardiac foreign body can cause thrombosis or infection, but sometimes it may not cause any symptoms in a patient. The diagnosis is mainly performed using a radiological examination. Especially, ultrasound is useful not only for detecting the foreign body but also for hemodynamic findings. However, the disadvantage of ultrasound is that it cannot be used where shadows are generated because of poor permeability. The transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) for identifying posterior cardiac structures because the probe is located in the esophagus behind the heart. Here, we report on the incidental finding of a foreign body in the left atrium through TEE during cardiac surgery. It did not cause any symptoms or signs for 20 years. PATIENT CONCERNS: A 75-year-old female patient with severe tricuspid regurgitation underwent tricuspid valve replacement (TVR) under general anesthesia. She had a history of mitral valve replacement (MVR) and tricuspid annuloplasty surgery 20 years ago. DIAGNOSIS: A hyper-echoic floating intracardiac foreign body was observed in the left atrium during TEE examination. It was not detected in the preoperative imaging studies such as X-ray, computed tomography, TTE. INTERVENTIONS: The cardiac foreign body found using TEE was visually confirmed through an incision in the left atrium. A long and thin foreign body was located in the right upper pulmonary vein to the left atrium, which was considered to be a left atrial catheter used during the MVR surgery performed 20 years ago. After removing the foreign body, the planned TVR operation proceeded. OUTCOMES: After removing the intracardiac foreign body and TVR, the patient was admitted into the intensive care unit followed by the general ward as planned, and discharged without any complications. LESSONS: TEE was very useful for diagnosing a foreign body in the posterior part of the heart. TEE performed during the perioperative period should be performed beyond the level of re-confirming the findings of TEE performed prior to surgery. If a retained catheter is detected, it may be appropriate to remove it considering the risk of complications.


Assuntos
Cateteres Cardíacos , Ecocardiografia Transesofagiana , Corpos Estranhos/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Idoso , Feminino , Humanos , Achados Incidentais , Período Intraoperatório
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