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1.
World Neurosurg ; 136: 83-89, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931241

RESUMO

BACKGROUND: Given recent positive safety evidence, ventriculoatrial (VA) shunt placement may increase in popularity once more. We describe a rare case of Tricuspid regurgitation due to VA shunt catheter tip traversing the valve. CASE DESCRIPTION: A woman aged 42 years with a preexisting VA shunt was referred to this center with 3 months of orthostatic headache, nausea, and palpitations that occurred while sleeping on her right side. An echocardiogram demonstrates a VA shunt catheter in the right atrium during cardiac diastole, which traversed the tricuspid annular plane during cardiac systole. The echocardiogram revealed mild to moderate tricuspid regurgitation. She had no clinical evidence of cardiac failure or arrhythmia and had normal electrocardiogram findings. The catheter tip appeared to be adhered to the underside of the leaflets or to the chordae tendineae. Pulling the catheter tip back could therefore cause irreversible damage to the tricuspid valve. For this reason, the catheter was not removed, and the patient was referred for close follow-up with cardiologists. A literature review was performed to determine where this rare complication fits into the spectrum of VA shunt distal catheter complications, and what techniques can be done to avoid similar occurrences. CONCLUSIONS: This report reiterates the importance of ensuring the tip is carefully placed within the atrium, under fluoroscopic guidance. Although rare, the described complication is difficult to manage once it has occurred.


Assuntos
Cateteres de Demora , Derivações do Líquido Cefalorraquidiano , Falha de Prótese/efeitos adversos , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Adulto , Diástole , Ecocardiografia , Feminino , Cefaleia/etiologia , Humanos , Náusea/etiologia , Sístole , Insuficiência da Valva Tricúspide/etiologia
2.
Int J Cardiovasc Imaging ; 36(1): 33-43, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31432289

RESUMO

Tricuspid annular (TA) size, assessed by 2D transthoracic echocardiography (TTE), has a well-established prognostic value in patients undergoing mitral valve surgery, with TA dilatation triggering simultaneous tricuspid annuloplasty. While TA dilatation is common in patients with dilated atria secondary to atrial fibrillation, little is known about the mechanisms of TA dilatation in patients with sinus rhythm (SR). This study aimed to identify echocardiographic parameters most closely related to the TA size as a potential tool for identification of patients prone to developing TA enlargement. 120 patients with SR underwent clinically indicated TTE, including 30 patients with normal hearts and 90 patients diagnosed with at least one right heart abnormality, defined as: right ventricular (RV) or right atrial (RA) dilatation, ≥ moderate tricuspid regurgitation (TR) and elevated systolic pulmonary artery pressure (sPAP). RA and RV end-diastolic and end-systolic volumes (EDV, ESV) and function were measured using commercial 3D software (TomTec). 3D RV long and short axes were used as surrogate indices of RV shape. Degrees of TR and sPAP were estimated by 2D TTE. 3D TA sizing was performed at end-diastole using 3D custom software. Linear regression analysis was used to identify variables best correlated with TA size, followed by multivariate analysis to identify independent associations. The highest correlations were found between TA area and: RA ESV (r = 0.73; p < 0.01), RV EDV (r = 0.58; p < 0.01), RV end-diastolic long and short axes (r = 0.53, 0.42; both p < 0.01), TR degree (r = 0.40; p < 0.01) and sPAP (r = 0.32; p < 0.01). Multivariate analysis revealed that RA ESV was the only parameter independently associated with TA area (p < 0.05, r = 0.85). In conclusion, RA volume plays an important role in TA dilatation even in patients with normal SR. Understanding of annular remodeling mechanisms could aid in identifying patients at higher risk for TA dilatation, especially those scheduled for mitral valve surgery.


Assuntos
Ecocardiografia Tridimensional , Hemodinâmica , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Adulto , Idoso , Pressão Arterial , Função do Átrio Direito , Remodelamento Atrial , Chicago , Dilatação Patológica , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Valva Tricúspide/patologia , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/patologia , Insuficiência da Valva Tricúspide/fisiopatologia , Função Ventricular Direita
4.
J Cardiothorac Surg ; 14(1): 195, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718687

RESUMO

OBJECTIVE: To evaluate the effectiveness of autologous pericardium ring in tricuspid annuloplasty surgery for the treatment of tricuspid regurgitation (TR). METHODS: From December 2010 to December 2012, a total of 107 patients with secondary TR underwent tricuspid annuloplasty. The patients were divided into three groups: autologous pericardium ring group (n = 38), Edwards-MC3 ring group (n = 35), and DeVega group (n = 34). The patients were followed-up for two years. The survival rates and free from hospital readmission rates were measured and analyzed. The patients also received transthoracic echocardiography (TTE) in order to obtain TR regurgitant jet area to right atrial area (STR/STA), diastolic tricuspid annuloplasty diameter (DTAD), right atrial diameter (RAD), and right ventricular diameter (RVD). RESULTS: One patient from DeVega group and one patient from autologous pericardium ring died from low cardiac output syndrome during the perioperative period. In the two-year follow-up period, each group has one instance of death for unclear reasons. One month after operation, the STR/STA, DTAD, RAD, and RVD values in all groups were significantly lower than the pre-operation values (P < 0.05). During the two year follow-up period, DTAD values of patients from DeVega group increased significantly as compared to the values at one month post operation (P<0.05), which is different from the other two groups in which DTAD values remained stable (P>0.05). In both pericardium ring group and Edwards-MC3 group, STR/SRA, remained stable (P>0.05) during the follow-up period, whereas STR/SRA of the DeVega group had showed a tendency of increase (although statistically insignificant, P>0.05). There was no significant difference in the survival rates among three study groups (P > 0.05), but the rate of free from hospital readmission in the DeVega group was significantly lower than those in the other two groups (P < 0.05) during the two-year follow-up period. CONCLUSIONS: Autologous pericardium tissue based ring annuloplasty demonstrated remarkable clinical utility for treating tricuspid regurgitation. It shows similar beneficial results to Edwards-MC3 annuloplasty within a short-term follow-up period, and outperforms the widely used DeVega annuloplasty. Autologous pericardium tissue annuloplasty represents a promising technique for tricuspid annuloplasty and holds great potential for treating tricuspid valve dysfunctions.


Assuntos
Anuloplastia da Valva Cardíaca/métodos , Pericárdio/transplante , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Estudos Retrospectivos , Taxa de Sobrevida , Transplante Autólogo , Resultado do Tratamento
5.
Pan Afr Med J ; 33: 265, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692694

RESUMO

Traumatic tricuspid insufficiency is very rare. In this report we describe an interesting case of a 13-year-old boy who suffered chest trauma from a horse kick. Echocardiography demonstrated a remarkable tricuspid regurgitation with ventricular septal defect. Once assessing the diagnosis, an emergency open heart surgery was necessary to repair the injuries with good results.


Assuntos
Comunicação Interventricular/etiologia , Traumatismos Torácicos/complicações , Insuficiência da Valva Tricúspide/etiologia , Adolescente , Animais , Ecocardiografia , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Cavalos , Humanos , Masculino , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia
6.
J Cardiovasc Med (Hagerstown) ; 20(7): 477-486, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31593560

RESUMO

INTRODUCTION: Significant tricuspid regurgitation is a well recognized indicator of right ventricular dysfunction. Recent studies have shown that significant tricuspid regurgitation is potentially associated with increased mortality in patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR). However, data remained sparse and inconclusive. Thus, we performed a systematic review and meta-analysis of the literature to assess the association between significant tricuspid regurgitation and mortality in post TAVR patients. HYPOTHESIS: Significant tricuspid regurgitation is predictive for higher mortality in patients undergoing TAVR. METHODS: We comprehensively searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published observational studies that reported multivariate analysis of the effects of significant tricuspid regurgitation on all-cause mortality among patients undergoing TAVR. Data from each study were combined utilizing the random-effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Nine cohort studies from August 2011 to May 2018 consisting of 27 614 patients with severe aortic stenosis undergoing TAVR (6255 with and 21 359 without significant tricuspid regurgitation) were included in this meta-analysis. The presence of significant tricuspid regurgitation was associated with higher all-cause mortality (pooled OR = 2.26, 95% CI: 1.45-3.52, P < 0.001). We found that all-cause mortality remained statistically substantial in all subgroups (30-day all-cause mortality: OR = 2.05, 95% CI: 1.20-3.49, P = 0.009; midterm all-cause mortality: OR = 9.67, 95% CI: 2.44-38.31, P = 0.001; and long-term all-cause mortality: OR = 1.48, 95% CI: 1.19-1.85, P < 0.001). Funnel plots and Egger's regression asymmetry test were performed and showed no publication bias. CONCLUSION: Significant tricuspid regurgitation increased risk of mortality by up to two-fold among patients with severe aortic stenosis undergoing TAVR. Our study suggests that significant tricuspid regurgitation should be considered a component of risk stratification tools.


Assuntos
Estenose da Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/mortalidade , Insuficiência da Valva Tricúspide/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Feminino , Humanos , Masculino , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia
8.
Arch Cardiovasc Dis ; 112(10): 604-614, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31558358

RESUMO

BACKGROUND: Severe tricuspid regurgitation (TR) usually remains asymptomatic for a long period, and the diagnosis is often delayed until an advanced stage of right heart failure (RHF). Only a minority of patients are referred for surgery. AIM: To describe the characteristics and prognosis of patients with significant TR, according to aetiology. METHOD: Two-hundred and eight consecutive patients with moderate-to-severe (grade III) or severe (grade IV) TR were included from echocardiography reports between 2013 and 2017. Median follow-up was 18 (6-38) months. RESULTS: Patients (mean age 75 years; 46.6% men) were divided into four groups according to TR aetiology: group 1, primary TR (14.9%); group 2, TR secondary to left heart disease with a history of left heart valve surgery (24.5%); group 3, TR secondary to left heart or pulmonary disease with no history of left valvular surgery (26.5%); and group 4, idiopathic TR (34.1%). During follow-up, 61 patients (29.3%) experienced at least one episode of RHF decompensation requiring hospitalization. Only 11 patients (5.3%) underwent tricuspid valve surgery during follow-up. The 4-year survival was much lower than the expected survival of age- and sex-matched individuals in the general population (56±4% vs. 74%). After adjustment for outcome predictors, patients with idiopathic TR had a higher risk of mortality (adjusted hazard ratio 1.83, 95% confidence interval 1.05-3.21; P=0.034) compared with other groups. CONCLUSIONS: Moderate-to-severe or severe TR is associated with a high risk of hospitalization for RHF and death at 4 years, and a low rate of surgery. Idiopathic TR is associated with worse outcome than other aetiologies.


Assuntos
Insuficiência da Valva Tricúspide/fisiopatologia , Valva Tricúspide/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Ecocardiografia Doppler , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/mortalidade , Insuficiência da Valva Tricúspide/cirurgia
9.
Am J Cardiol ; 124(5): 772-780, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31280838

RESUMO

Persistent tricuspid regurgitation (TR) after transcatheter aortic valve implantation (TAVI) has been reported to increase mortality. The aim of this study was to investigate clinical and echocardiographic determinants and outcome of persistent TR after TAVI. We reviewed 1,085 patients who underwent TAVI. Among them, 100 patients who had ≥moderate TR without organic dysfunction of the tricuspid valve apparatus were studied. Preprocedural and follow-up transthoracic echocardiography after TAVI were analyzed. After TAVI, patients were divided into persistent TR group and improved TR group. Clinical event was defined as all-cause mortality and readmission for heart failure within 1,000 days. Fifty-three (53%) patients had persistent TR, whereas 47 (47%) patients had improved TR. Risk of clinical event was significantly higher in the persistent TR group compared with the improved TR group. Atrial fibrillation (AF) and tricuspid annular dimension (TAD; p <0.05 for all) were independent predictors of persistent TR. Receiver operating characteristic curve showed the optimal cut-off value of TAD for predicting persistent TR was 37 mm. The combination of AF and TAD ≥37 mm was associated with persistent TR (p <0.001). In conclusion, AF and dilated TAD before TAVI predicted persistent TR which was associated with higher all-cause mortality and readmission for heart failure.


Assuntos
Causas de Morte , Ecocardiografia/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/cirurgia , Doença Crônica , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/métodos , Insuficiência da Valva Tricúspide/diagnóstico por imagem
10.
Arch Cardiovasc Dis ; 112(10): 642-651, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31351805

RESUMO

Tricuspid regurgitation has long been a neglected and underestimated entity; its prevalence is significant, and is increasing with the ageing population. Tricuspid regurgitation is often a consequence of chronic left cardiac pathologies or atrial fibrillation. Surgical treatment is recommended for patients with severe symptomatic tricuspid regurgitation or tricuspid annulus dilatation at the time of left heart valve surgery. Secondary tricuspid regurgitation is a complex disease; this review focuses on the need for better understanding of its mechanisms and quantification - mandatory with the advent of new percutaneous treatments.


Assuntos
Ecocardiografia/métodos , Hemodinâmica , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Valva Tricúspide/fisiopatologia , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/cirurgia
12.
Am J Cardiol ; 124(4): 594-598, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31208699

RESUMO

Tricuspid annular (TA) dilation is a key process in functional tricuspid regurgitation, but normal TA dimensions using cardiovascular magnetic resonance have not been established. We measured TA diameters in 66 healthy volunteers, aged 38 ± 11 years, during 3 different phases of the cardiac cycle (end-systole, early diastole, and end-diastole) and in 2 routinely acquired cardiovascular magnetic resonance imaging planes (4-chamber [4C] and right ventricular inflow-outflow [RVIO]). Three readers independently measured each value and 1 reader repeated measurements 1 month apart. The upper limit of normal (ULN) was calculated as 1.96 standard deviations above the mean. We assessed inter- and intraobserver reliability using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. We found the TA diameter largest during early diastole in the 4C view with an ULN of 43 mm (22 mm/m2). Men had larger absolute TA diameters (36 mm, 95% CI 27 to 44 mm) than women (30 mm, 95% CI 23 to 37 mm) but not after indexing for body surface area (both 18 mm/m2). In the RVIO view, the largest TA diameter occurred during early diastole with a ULN value of 46 mm (27 mm/m2). In this view, females had a larger indexed TA than men (21 mm/m2 vs 17 mm/m2). Reproducibility of measurements was excellent in all cardiac phases with an inter-rater ICC between 0.90 to 0.96 and an intrarater ICC 0.89 to 0.96. In conclusion, we have provided normative data regarding TA dimensions in routinely acquired 4C and RVIO views, and these values are larger than the current thresholds of annular dilation measured by echocardiography. Gender differences with the TA diameter in the RVIO view may be an important finding with consideration of future tricuspid devices.


Assuntos
Imagem Cinética por Ressonância Magnética/métodos , Valva Tricúspide/diagnóstico por imagem , Adulto , Dilatação Patológica/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Valores de Referência , Reprodutibilidade dos Testes , Valva Tricúspide/anatomia & histologia , Insuficiência da Valva Tricúspide/diagnóstico por imagem
13.
Semin Thorac Cardiovasc Surg ; 31(3): 526-534, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150828

RESUMO

To review the outcome after atrioventricular valve replacement in single ventricle patients. The medical records of 37 consecutive patients who underwent initial valve replacement between 2001 and 2016 were reviewed. Actuarial survival rates were 73%, 65%, and 59% at 1, 5, and 10 years, respectively. Multivariate analysis indicated body surface area <0.28 m2 (P = 0.007; hazard ratio, 31.1), preoperative inotropic support (P < 0.001; hazard ratio, 24.5), primary valve replacement (P = 0.044; hazard ratio, 6.1), oversized prosthesis (P = 0.001; hazard ratio, 14.5), and intra- or postoperative extracorporeal membrane oxygenation support (P < 0.001; hazard ratio, 53.2) were the risk factors for mortality. Cumulative incidences of redo replacement were 11%, 17%, and 17% at 1, 5, and 10 years, respectively. There was no risk factor for redo replacement. Among 11 patients undergoing valve replacement before or at the time of bidirectional cavopulmonary shunt, all 4 patients who reached Fontan completion survived. Among 13 patients undergoing valve replacement after bidirectional cavopulmonary shunt, only 3 patients reached Fontan completion. Among 11 patients undergoing valve replacement after Fontan completion, there were 3 operative mortalities and 2 late mortalities. For 7 of 8 hospital survivors, cardiac index improved from 2.2 L/min/m2 (interquartile range, 2.0-2.4) to 3.4 (2.8-3.7) (P = 0.002). Atrioventricular valve replacement was a reasonable choice of treatment for single ventricle patients. For small patients with impaired ventricular function who had no choice other than valve replacement, commercially available valves were oversized and outcomes remained poor.


Assuntos
Cardiopatias Congênitas/fisiopatologia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Função Ventricular , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/mortalidade , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Ventrículos do Coração/anormalidades , Ventrículos do Coração/diagnóstico por imagem , Humanos , Lactente , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Recuperação de Função Fisiológica , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , 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/mortalidade , Insuficiência da Valva Tricúspide/fisiopatologia
15.
BMJ Case Rep ; 12(6)2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31253659

RESUMO

Hypereosinophilic syndrome (HES) is a rare systemic condition, defined as a persistently elevated eosinophil count associated with end organ damage and the absence of a primary cause. Cardiac involvement occurs in about 50% of patients with HES. Myocardial infiltration results in endomyocardial fibrosis, valve dysfunction and mural thrombus. The atrioventricular valves are almost always involved, resulting in regurgitation due to leaflet restriction, most commonly affecting the posterior mitral valve leaflet. Surgical management remains challenging in patients with HES with limited data on the choice of valve surgery. We describe the case of a 17-year-old woman with HES complicated by congestive cardiac failure secondary to severe mitral and tricuspid regurgitation. Because of refractory heart failure despite medical therapy, surgical mitral and tricuspid valve repair was performed, and an excellent 24-month outcome was achieved. We believe this is the first report of double valve repair in this rare condition.


Assuntos
Insuficiência Cardíaca/etiologia , Síndrome Hipereosinofílica/complicações , Insuficiência da Valva Mitral/complicações , Valva Mitral/cirurgia , Insuficiência da Valva Tricúspide/complicações , Valva Tricúspide/cirurgia , Adolescente , Ecocardiografia/métodos , Feminino , Insuficiência Cardíaca/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , 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
16.
Ann Vasc Surg ; 60: 477.e1-477.e6, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075472

RESUMO

Pulsating varicose veins are a rare clinical finding and are mainly derived from tricuspid regurgitation or right heart failure. The precise causes and optimal treatment of this phenomenon have been poorly recorded in the literature. Here, we describe a 56-year-old woman who presented to our medical center with bilateral varicose veins, heaviness, and edema in her lower limbs. The duplex revealed an arterial-like pulsating flow in the superficial and deep veins of the lower extremities, in addition to severe tricuspid regurgitation. Symptoms improved after the patient was given compression therapy using elastic stockings. In this article, we also review six other cases from the literature and discuss the therapies that would be reasonable in some conditions.


Assuntos
Extremidade Inferior/irrigação sanguínea , Insuficiência da Valva Tricúspide/complicações , Varizes/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Fluxo Pulsátil , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Meias de Compressão , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Varizes/terapia
17.
J Pak Med Assoc ; 69(5): 761-763, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31105313

RESUMO

Strongyloidiasis is a human parasitic disease caused by infection of Strongyloidesstercoralis. It can manifest from asymptomatic eosinophilia in an immunocompetent host and disseminate the disease in the immunocompromised ones. The inconsistency of eosinophilia and low sensitivity of a standard microscopic stool examination makes it difficult to diagnose the disease. We report a case of chronic strongyloidiasis who, despite being immunocompetent, developed dissemination. The patient was a 30-years-old male who presented with diarrhoea, vomiting, high-grade fever and dyspnoea. On examination, he was pale, oedematous and had ascites with systolic murmurs in tricuspid area. After a fullworkup for differentials, biopsy confirmed the diagnosis of strongyloidiasis. Echocardiogram revealed vegetations on mitral and tricuspid valves and regurgitation through the valves, which confirmed dissemination to endocardium. A course of Ivermectin 9 mg daily for two weeks eradicated the infection in time. In conclusion, awareness for physicians and the use of various diagnostic methods like serology, endoscopy and biopsy should be considered for high risk patients.


Assuntos
Endocardite/diagnóstico , Imunocompetência , Estrongiloidíase/diagnóstico , Adulto , Anemia/diagnóstico , Anemia/terapia , Antiparasitários/uso terapêutico , Ascite/diagnóstico por imagem , Transfusão de Sangue , Dieta Rica em Proteínas , Duodeno/patologia , Endocardite/terapia , Hidratação , Hematínicos/uso terapêutico , Humanos , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/terapia , Imunoglobulina E/imunologia , Ivermectina/uso terapêutico , Masculino , Insuficiência da Valva Mitral/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Estrongiloidíase/imunologia , Estrongiloidíase/patologia , Estrongiloidíase/terapia , Tomografia Computadorizada por Raios X , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Ultrassonografia
18.
Pediatr Cardiol ; 40(5): 1035-1040, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31065756

RESUMO

Tricuspid valve regurgitation (TR) increases adverse outcomes in children with hypoplastic left heart syndrome (HLHS). Changes in tricuspid valve (TV) annulus and leaflet geometry have been described but the underlying causes for TR in HLHS remain uncertain. We aimed to examine the association between left ventricular (LV) size and TR in infants with HLHS as right ventricular (RV)-LV interactions may be important in TR development. Echocardiograms of 50 infants with HLHS were reviewed. LV size, RV function, TR grade, TV annulus z-score, and aortic arch obstruction were examined at birth and 1 year of age (or the latest study post-bidirectional Glenn anastomosis if the patient was < 1 year of age). 24/50 (48%) had severe LV hypoplasia and 26/50 (52%) had mild/moderate LV hypoplasia. At 1 year, 10/24 (42%) with severe LV hypoplasia had moderate/severe TR versus 0/26 in the mild/moderate LV hypoplasia group (p = 0.0002). TR progressed ( ≥ 1 grade) in 14/24(58%) with severe LV hypoplasia versus 5/26 (19%) with mild/moderate LV hypoplasia (p = 0.008). In this cohort, no association was found between the degree of TR and either RV function, TV annular z-score, or arch obstruction; or between the degree of LV hypoplasia and either RV function or TV annular z-score. In infants with HLHS, the severity and progression of TR is associated with the severity of LV hypoplasia. The mechanism for this association needs further exploration but suggests a role for RV-LV interactions in the development of TR.


Assuntos
Síndrome do Coração Esquerdo Hipoplásico/complicações , Insuficiência da Valva Tricúspide/etiologia , Criança , Ecocardiografia , Feminino , Idade Gestacional , Ventrículos do Coração/patologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico por imagem , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Lactente , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Função Ventricular Direita
19.
Circ Arrhythm Electrophysiol ; 12(5): e007124, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31060371

RESUMO

BACKGROUND: Endocardial pacemaker leads and right ventricular (RV) pacing are well-known causes of tricuspid valve, mitral valve, and cardiac dysfunction. Lead-related adverse consequences can potentially be mitigated by leadless pacemaker (LP) therapy by eliminating the presence of a transvalvular lead. This study assessed the impact of LP placement on cardiac and valvular structure and function. METHODS: Echocardiographic studies before and 12±1 months after LP implantation were performed between January 2013 and May 2018 at our center and compared with age- and sex-matched controls of dual-chamber transvenous pacemaker recipients. RESULTS: A total of 53 patients receiving an LP were included, of whom 28 were implanted with a Nanostim and 25 with a Micra LP device. Tricuspid valve regurgitation was graded as being more severe in 23 (43%) patients at 12±1 months compared with baseline ( P<0.001). Compared with an apical position, an RV septal position of the LP was associated with increased tricuspid valve incompetence (odds ratio, 5.20; P=0.03). An increase in mitral valve regurgitation was observed in 38% of patients ( P=0.006). LP implantation resulted in a reduction of RV function, according to a lower tricuspid annular plane systolic excursion ( P=0.003) and RV tricuspid lateral annular systolic velocity ( P=0.02), and a higher RV Tei index ( P=0.04). LP implantation was further associated with a reduction of left ventricular ejection fraction ( P=0.03) and elevated left ventricular Tei index ( P=0.003). The changes in tricuspid valve regurgitation in the LP group were similar to the changes in the dual-chamber transvenous pacemaker control group (43% versus 38%, respectively; P=0.39). CONCLUSIONS: LP therapy is associated with an increase in tricuspid valve dysfunction through 12 months of follow-up; yet it was comparable to dual-chamber transvenous pacemaker systems. Furthermore, LP therapy seems to adversely impact mitral valve and biventricular function.


Assuntos
Estimulação Cardíaca Artificial/efeitos adversos , Insuficiência da Valva Mitral/etiologia , Valva Mitral/fisiopatologia , Marca-Passo Artificial , Insuficiência da Valva Tricúspide/etiologia , Valva Tricúspide/fisiopatologia , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Direita/etiologia , Função Ventricular Esquerda , Função Ventricular Direita , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologia
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