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1.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495170

RESUMO

It is recognised that infective endocarditis is frequently a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged man was admitted with an 8-day history of profuse non-bloody diarrhoea and vomiting. He had no medical history and no identifiable risk factors for infective endocarditis, and so this in combination with the patient's atypical symptoms presented a diagnostic challenge. The patient was eventually diagnosed with a Staphylococcus aureus right-sided infective endocarditis. This case report explores the events which led to this diagnosis and demonstrates a number of unique learning points. It also highlights the importance of maintaining an open mind and being prepared to revise an initial diagnosis in the face of medical uncertainty.


Assuntos
Bacteriemia/diagnóstico , Disenteria/diagnóstico , Endocardite Bacteriana/diagnóstico por imagem , Pneumonia/diagnóstico , Embolia Pulmonar/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Bacteriemia/complicações , Hemocultura , Proteína C-Reativa , Diagnóstico Diferencial , Diarreia/fisiopatologia , Escore de Alerta Precoce , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/fisiopatologia , Humanos , Hipóxia , Ácido Láctico , Leucocitose , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/etiologia , Infecções Estafilocócicas , Insuficiência da Valva Tricúspide/etiologia , Vômito/fisiopatologia
2.
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
3.
Elife ; 92020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320094

RESUMO

Over 1.6 million Americans suffer from significant tricuspid valve leakage. In most cases this leakage is designated as secondary. Thus, valve dysfunction is assumed to be due to valve-extrinsic factors. We challenge this paradigm and hypothesize that the tricuspid valve maladapts in those patients rendering the valve at least partially culpable for its dysfunction. As a first step in testing this hypothesis, we set out to demonstrate that the tricuspid valve maladapts in disease. To this end, we induced biventricular heart failure in sheep that developed tricuspid valve leakage. In the anterior leaflets of those animals, we investigated maladaptation on multiple scales. We demonstrated alterations on the protein and cell-level, leading to tissue growth, thickening, and stiffening. These data provide a new perspective on a poorly understood, yet highly prevalent disease. Our findings may motivate novel therapy options for many currently untreated patients with leaky tricuspid valves.


Assuntos
Matriz Extracelular/metabolismo , Insuficiência Cardíaca/complicações , Hemodinâmica , Insuficiência da Valva Tricúspide/etiologia , Valva Tricúspide/metabolismo , Função Ventricular Esquerda , Função Ventricular Direita , Adaptação Fisiológica , Animais , Modelos Animais de Doenças , Metabolismo Energético , Matriz Extracelular/genética , Matriz Extracelular/patologia , Colágenos Fibrilares/genética , Colágenos Fibrilares/metabolismo , Regulação da Expressão Gênica , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Masculino , Carneiro Doméstico , Transdução de Sinais , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/metabolismo , Insuficiência da Valva Tricúspide/fisiopatologia
4.
J Am Coll Cardiol ; 76(25): 2968-2976, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33334426

RESUMO

BACKGROUND: Hepatorenal dysfunction is a risk factor for mortality in patients with chronic tricuspid regurgitation due to acquired heart disease. Ebstein anomaly is the most common cause of primary tricuspid regurgitation in adults with congenital heart disease, but the prevalence and prognostic implications of hepatorenal dysfunction are unknown in this population. OBJECTIVES: The purpose of this study was to determine the risk factors and prognostic implications of hepatorenal dysfunction, as measured primarily by the use of model for end-stage liver disease excluding international normalized ratio (MELD-XI score), as well as looking at other associated factors. METHODS: This was a retrospective study of adults with Ebstein anomaly who received care at Mayo Clinic from 2003 to 2018. RESULTS: Of 692 patients, the median MELD-XI score was 10.2 (interquartile range: 9.4 to 13.3); 53 (8%) died and 3 (0.4%) underwent heart transplant. MELD-XI was an independent predictor of death/transplant (hazard ratio: 1.32; 95% confidence interval: 1.11 to 2.06; p < 0.001). In the subset of patients with serial MELD-XI scores (n = 416), temporal change in MELD-XI score (ΔMELD-XI) was also a predictor of death/transplant. In the subset of patients who underwent tricuspid valve surgery (n = 344), a post-operative improvement in MELD-XI score (ΔMELD-XI) was associated with improved long-term survival. Impaired right atrial (RA) reservoir strain and elevated estimated RA pressure were associated with worse baseline MELD-XI and ΔMELD-XI scores. CONCLUSIONS: Hepatorenal dysfunction is a predictor of mortality in Ebstein anomaly, and RA dysfunction and hypertension are hemodynamic biomarkers that can identify patients at risk for deterioration in hepatorenal function and mortality. These data highlight the prognostic importance of noncardiac organ-system dysfunction, and provide complementary clinical risk stratification metrics for management of these patients.


Assuntos
Anomalia de Ebstein , Transplante de Coração , Insuficiência Hepática , Testes de Função Renal/métodos , Testes de Função Hepática/métodos , Insuficiência Renal , Insuficiência da Valva Tricúspide , Adulto , Anomalia de Ebstein/complicações , Anomalia de Ebstein/mortalidade , Anomalia de Ebstein/fisiopatologia , Anomalia de Ebstein/cirurgia , Feminino , Transplante de Coração/métodos , Transplante de Coração/estatística & dados numéricos , Insuficiência Hepática/diagnóstico , Insuficiência Hepática/etiologia , Insuficiência Hepática/fisiopatologia , Humanos , Coeficiente Internacional Normatizado , Masculino , Prognóstico , Modelos de Riscos Proporcionais , Insuficiência Renal/diagnóstico , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/epidemiologia , Insuficiência da Valva Tricúspide/etiologia , Estados Unidos/epidemiologia
5.
Am J Cardiol ; 134: 116-122, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32891401

RESUMO

Assessment of right ventricular (RV) systolic function in patients with significant secondary tricuspid regurgitation (STR) remains challenging. In patients with severe aortic stenosis treated with transcatheter aortic valve implantation (TAVI), STR and RV enlargement have been associated with poor outcomes. In these patients, speckle tracking echocardiography (STE) may detect RV systolic dysfunction better than 3-dimensional (3D) RV ejection fraction (EF). The purpose of this study was to investigate the prevalence of RV dysfunction when assessed with STE in patients with significant STR (≥3+) compared with patients without significant STR (<3+) matched for 3D RV dimensions and RVEF on dynamic computed tomography (CT). Patients with dynamic CT data before TAVI were evaluated retrospectively. To assess the performance of RV-free wall strain (RVFWS) for identifying patients with impaired RV systolic function, patients were subsequently matched 1:1 based on age, gender, indexed RV end-diastolic volume (RVEDVi), indexed RV end-systolic volume (RVESVi), RVEF, and left ventricular ejection fraction (LVEF). In a total 267 patients (80 ± 8 years, 48% male), significant STR (≥3+) was observed in 67 patients. Patients with STR≥3+ had larger RVEDVi, larger RVESVi, lower LVEF, and more impaired RVFWS compared with patients with STR<3+ (n = 200). After propensity score matching, patients with STR≥3+ (n = 53) had significantly more impaired RVFWS compared with patients with STR<3+ (n = 53): -18.2 ± 5.0% versus -21.1 ± 3.7%, p = 0.001. In conclusion, patients with significant STR have more pronounced RV systolic dysfunction as assessed with STE than the patients without significant STR despite having similar 3D RV dimensions and RVEF on dynamic CT.


Assuntos
Estenose da Valva Aórtica/cirurgia , Ecocardiografia Doppler/métodos , Tomografia Computadorizada por Raios X/métodos , Substituição da Valva Aórtica Transcateter , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Ecocardiografia , Feminino , Humanos , Masculino , Sístole , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia
6.
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
7.
Am J Cardiol ; 130: 85-93, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32622503

RESUMO

Cardiac implantable electronic devices (CIED) implantations may cause lead-induced tricuspid regurgitation (LITR). Although patients with CIED have the risk of functional non-lead induced TR (Non-LITR). This study aimed to compare of clinical outcome between LITR and Non-LITR. The mechanism of TR was determined by 3-dimensional echocardiography. The primary end point was heart failure (HF) hospitalizations after CIED implantation. In patients with HF events, subsequent clinical outcomes after HF hospitalization were compared between no TR, LITR, and Non-LITR groups. In eligible 373 patients, 67 patients had HF hospitalization, of whom worsened TR was observed in 49 patients. In the remaining 307 patients, worsened TR was observed in only 10 patients (3.3%). Of the 49 patients with worsened TR, 18 patients (37%) had LITR. In 67 patients with HF hospitalization, 25 patients (37%) met rehospitalization. All severe LITR persisted after HF events. Meanwhile, severe Non-LITR improved to moderate or mild level. Cox proportional hazard model analyses revealed LITR was the independent risk factor of rehospitalization. Both LITR and Non-LITR were common at HF events after CIED implantations. However, LITR persisted and might contribute to a worse prognosis. In patients with TR after CIED implantations, 3-dimensional echocardiography should be performed to diagnose the LITR accurately, which may contribute to improving the clinical outcome.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Marca-Passo Artificial/efeitos adversos , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
Int J Hematol ; 112(5): 631-639, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32700192

RESUMO

Pulmonary hypertension (PH) is emerging as a complication of myeloproliferative neoplasms (MPNs). This was a prospective study conducted at Chiang Mai University Hospital. The primary objective was to determine the prevalence of high echocardiographic probability of PH in MPNs patients. The secondary objectives were to determine risk factors of PH and the correlation between risk factors and peak tricuspid regurgitation velocity (TRVmax). All MPNs patients aged over 18 years, including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), were enrolled. All eligible patients underwent echocardiography for evaluation of the probability of PH in line with the 2015 European Society of Cardiology (ESC) and the European Respiratory Society (ERS) Guidelines. Sixty-six patients with a median age of 59 years were enrolled. There were 35 PV, 25 ET, and 6 PMF patients included. The prevalence of high echocardiographic probability of PH was 4.55% (2 ET and 1 PMF). Risk factors associated with high echocardiographic probability of PHT were not analyzed. There were three risk factors associated with increased TRVmax, specifically lower hemoglobin, older age, and the presence of JAK2V617F mutation. The prevalence of high echocardiographic probability of PH in MPNs patients was 4.55%.


Assuntos
Ecocardiografia , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Transtornos Mieloproliferativos/complicações , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Feminino , Hemoglobinas/deficiência , Humanos , Janus Quinase 2/genética , Masculino , Pessoa de Meia-Idade , Mutação , Policitemia Vera , Prevalência , Mielofibrose Primária , Probabilidade , Estudos Prospectivos , Fatores de Risco , Trombocitemia Essencial , Insuficiência da Valva Tricúspide/etiologia
9.
PLoS One ; 15(6): e0235230, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589674

RESUMO

This study aimed to investigate the prevalence and clinical significance of lead-related tricuspid regurgitation (TR) in patients with permanent pacemaker (PM). A total of 2,533 patients who underwent permanent PM implantation between January 2008 and December 2017 in a single center were retrospectively reviewed. Among them, 429 patients who underwent transthoracic echocardiography within 90 days before implantation and were followed up at least 3 months after PM implantation were included. Patients who had pre-existing grade 3 or 4 TR, had a single atrial lead, or had undergone tricuspid valve surgery before PM implantation were excluded. Occurrence of PM-related TR (PMTR) was defined as worsening of TR by at least 2 grades on follow-up echocardiography. Cardiovascular outcomes were defined as the composite of cardiovascular death and hospitalization for heart failure. During the median follow-up of 855 days, 42 (9.8%) patients had PMTR and 86 (20.0%) presented with cardiovascular outcomes. In the multivariate logistic regression analysis, the presence of atrial fibrillation (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.27-4.09, p = 0.037]) and history of open-heart surgery (HR: 3.34, 95% CI: 1.68-6.68, p<0.001) were independently associated with PMTR. Patients with PMTR showed significantly higher cardiovascular events than those without (45.2 vs. 17.3%, log-rank p<0.001). Furthermore, PMTR was independently associated with the primary outcome (HR: 2.45, 95% CI: 1.43-4.22, p = 0.001). In conclusion, the occurrence of TR in patients with permanent PM is not uncommon. PMTR is associated with atrial fibrillation, the history of open-heart surgery, and poorer cardiovascular outcomes.


Assuntos
Marca-Passo Artificial/efeitos adversos , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/epidemiologia , Idoso , Feminino , Humanos , Masculino , Prevalência , Prognóstico , Estudos Retrospectivos , Insuficiência da Valva Tricúspide/etiologia
10.
Pediatr Cardiol ; 41(6): 1153-1159, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32394061

RESUMO

We determined the prevalence and factors associated with tricuspid regurgitation (TR) in adults with repair of right ventricular (RV) outflow obstruction. A total of 256 patients (128 males) were studied at 25.7 ± 7.2 years after surgery, of whom 179 had repaired tetralogy of Fallot (TOF), 31 had pulmonary atresia with intact ventricular septum (PAIVS), and 46 had pulmonary stenosis (PS). The mitral and tricuspid annulus diameters, maximum right atrial (RA) area, RV end-systolic and end-diastolic areas, and tricuspid and pulmonary regurgitation were assessed using echocardiography. The prevalence of moderate-to-severe TR was 20.7%. Subgroup analysis revealed that prevalence was greater in patients with repaired TOF (20.7%) and PAIVS (35.5%) than PS patients (10.9%). As a group, severity of TR was found to be correlated with RA area (r = 0.35, p < 0.001), RV end-diastolic (r = 0.28, p < 0.001) and end-systolic (r = 0.22, p = 0.001) areas, and tricuspid valve annulus diameter (r = 0.15, p = 0.022). Moderate-to-severe TR was associated with development of cardiac arrhythmias with an odds ratio of 2.9 (95% CI 1.1 to 8.1, p = 0.031). Multivariate analysis revealed maximum RA area (ß = 0.36, p = 0.016) as an independent determinant of severity of TR. Moderate-to-severe TR occurs in about one-fifth of adults with repaired TOF, PAVIS, and PS and is associated with RA dilation and risk of development of cardiac arrhythmias.


Assuntos
Insuficiência da Valva Tricúspide/etiologia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Adulto , Arritmias Cardíacas/etiologia , Estudos Transversais , Ecocardiografia , Feminino , Átrios do Coração/patologia , Humanos , Masculino , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/complicações , Adulto Jovem
11.
J Cardiothorac Surg ; 15(1): 105, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434521

RESUMO

BACKGROUND: Surgical closure of atrial septal defect (ASD) is contraindicated in the condition with severe pulmonary arterial hypertension (PAH), whereas ASD closure in an effective intervention to normalize the structure and function of the right heart after previously experiencing volume overload due to shunting from the defect. This study aimed to evaluate normalization of the right heart and emergence of PAH after surgical closure of ASD. METHODS: This retrospective study was carried out in 45 patients over 18 years who had undergone surgical closure of ASD. The study has the aim to evaluate the morphological and functional parameters before and after the surgical approach and the preoperative factors that influenced the development of pulmonary arterial hypertension (PAP) after the ASD closure. RESULTS: The majority of subjects were female (73.3%) although there were no significant differences between males and females from the various parameters. The average of mPAP in the group that experienced PAH was higher than non-PAH group after ASD closure (p = 0.019, 31.23 ± 12.70 mmHg vs 24.07 ± 13.08 mmHg). Significant differences were found in the Right Atrium (RA) dimension, Right Ventricle (RV) dimension, Tricuspid Regurgitation Velocity (TRV) and Tricuspid Annular Plane Systolic Excursion (TAPSE) between before and at 6 months after ASD closure (p = 0.000, p = 0.000, p = 0.000, p = 000, respectively). The sensitivity of the predictive model to estimate PAH at 6 months after surgical closure of ASD was 58%, with a specificity of 62.5%. CONCLUSION: Structural and functional normalization of the right heart occurs at 6 months after surgical closure of ASD with the decrease of RA and RV dimensions and improvement from tricuspid regurgitation. Emergence of PAH after ASD closure was influenced by higher mPAP before surgical approach.


Assuntos
Comunicação Interatrial/cirurgia , Hipertensão Arterial Pulmonar/diagnóstico , Adulto , Ecocardiografia , Feminino , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Complicações Pós-Operatórias/fisiopatologia , Hipertensão Arterial Pulmonar/complicações , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Hipertensão Arterial Pulmonar/fisiopatologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Insuficiência da Valva Tricúspide/etiologia , Adulto Jovem
13.
Am J Hematol ; 95(7): 766-774, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32243618

RESUMO

In the US, mortality in sickle cell disease (SCD) increases after age 18-20 years. Biomarkers of mortality risk can identify patients who need intensive follow-up and early or novel interventions. We prospectively enrolled 510 SCD patients aged 3-20 years into an observational study in 2006-2010 and followed 497 patients for a median of 88 months (range 1-105). We hypothesized that elevated pulmonary artery systolic pressure as reflected in tricuspid regurgitation velocity (TRV) would be associated with mortality. Estimated survival to 18 years was 99% and to 25 years, 94%. Causes of death were known in seven of 10 patients: stroke in four (hemorrhagic two, infarctive one, unspecified one), multiorgan failure one, parvovirus B19 infection one, sudden death one. Baseline TRV ≥2.7 m/second (>2 SD above the mean in age-matched and gender-matched non-SCD controls) was observed in 20.0% of patients who died vs 4.6% of those who survived (P = .012 by the log rank test for equality of survival). The baseline variable most strongly associated with an elevated TRV was a high hemolytic rate. Additional biomarkers associated with mortality were ferritin ≥2000 µg/L (observed in 60% of patients who died vs 7.8% of survivors, P < .001), forced expiratory volume in 1 minute to forced vital capacity ratio (FEV1/FVC) <0.80 (71.4% of patients who died vs 18.8% of survivors, P < .001), and neutrophil count ≥10x109 /L (30.0% of patients who died vs 7.9% of survivors, P = .018). In SCD children, adolescents and young adults, steady-state elevations of TRV, ferritin and neutrophils and a low FEV1/FVC ratio may be biomarkers associated with increased risk of death.


Assuntos
Anemia Falciforme , Insuficiência da Valva Tricúspide , Adolescente , Adulto , Anemia Falciforme/sangue , Anemia Falciforme/complicações , Anemia Falciforme/mortalidade , Anemia Falciforme/fisiopatologia , Biomarcadores/sangue , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Ferritinas/sangue , Seguimentos , Humanos , Contagem de Leucócitos , Masculino , Neutrófilos , Estudos Prospectivos , Taxa de Sobrevida , Insuficiência da Valva Tricúspide/sangue , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/mortalidade , Insuficiência da Valva Tricúspide/fisiopatologia , Estados Unidos/epidemiologia , Adulto Jovem
14.
Rev. chil. cardiol ; 39(1): 16-23, abr. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1115445

RESUMO

ANTECEDENTES: El reemplazo protésico de la válvula tricúspide es un procedimiento infrecuente, con elevada mortalidad y morbilidad operatoria, independientemente de la etiología de la insuficiencia tricuspídea. Persiste aún una discusión respecto al tipo de prótesis a utilizar, mecánica o biológica. OBJETIVO: Analizar nuestros resultados perioperatorios y alejados en el reemplazo valvular tricuspídeo, comparando ambos tipos de prótesis. MÉTODO: Revisión de la Base de Datos de nuestro Servicio de Cirugía Cardiovascular para el periodo enero 1991 - diciembre 2017. Identificados los pacientes con reemplazo valvular tricuspídeo (RVT); se revisaron los protocolos operatorios y los ecocardiogramas. La supervivencia se certificó a través del Registro Civil e Identificación de Chile. RESULTADOS: Se identificaron 83 pacientes con RVT (76% mujeres), los que representaron el 0,7% del total de las cirugías con circulación extracorpórea y el 2,1% de las cirugías valvulares para el periodo en estudio. La edad promedio fue 49±16,5 años. Cuarenta y nueve casos (59%) correspondieron a reoperaciones y otros 49 tuvieron un procedimiento asociado. En 40 pacientes (48%) se utilizó una prótesis mecánica y en 43 (52%) una biológica. La mortalidad operatoria global fue 9,6% (8 pacientes, 4 con una prótesis mecánica y 4 con una biológica). El seguimiento se completó en el 100%, con un promedio de 7,1 años. Veintiocho pacientes fallecieron durante el seguimiento; la principal causa fue insuficiencia cardiaca. Así, la supervivencia a 5 años fue 70,3 ± 5,3% y a 10 años 58 ± 6,3%, sin diferencia significativa entre ambos tipos de prótesis. Siete pacientes se reoperaron durante el seguimiento (5 casos con prótesis biológica y 2 mecánica). CONCLUSIÓN: El RVT continúa siendo un procedimiento infrecuente, con mayor incidencia en mujeres, en la quinta década de la vida. La mayoría de los pacientes presentaba comorbilidad y había tenido cirugía cardiovascular previa. La mitad de estos recibió una prótesis mecánica y la otra, biológica. No hubo diferencias significativas entre ambos tipos de prótesis en cuanto a mortalidad operatoria, supervivencia alejada o reoperación.


BACKGROUND: Tricuspid valve replacement (TVR) is an uncommon surgical procedure, associated with high mortality and morbidity. The use of biological or mechanical prostheses in TVR has advantages and disadvantages and, therefore, there persists a debate regarding the choice of one or other type of prostheses. AIM: To analyze our operative and long-term surgical results, comparing both types of prosthetic valves. METHODS: The Data Base of the Cardiovascular Surgery Service was reviewed for the period between January 1991 and December 2017. 83 patients with TVR were identified, the operative notes and echocardiogram reports were analyzed. Survival was obtained from the Chilean Civil Identification Service. RESULTS: 83 patients (76% women) had TVR. They represented 0.7% of the total cases operated on with extracorporeal circulation and 2.1% of all valve disease cases, for the study period. Mean age was 49±16.5 years. 49 cases (59%) were reoperations and another 49 had an associated procedure. In 40 patients (48%) a mechanical prosthesis was used and in 43 (52%) a biological one was implanted. Operative mortality rate was 9.6% (8 patients, had a mechanical valve and the other 8, a biological one). Follow-up was 100% completed, with an average of 7.1 years. 28 patients died during follow-up; the main cause of death was heart failure. Five-year survival rate was 70.3 ± 5.3% and at 10 years it was 58 ± 6.3%, without significant difference the type of prostheses. Seven patients were re-operated during follow-up (5 cases corresponded to a biological prostheses and 2 to a mechanical one). CONCLUSION: TVR is still an infrequent surgical procedure, more commonly performed in women, on the fifth decade of life. Most patients presented comorbidities and had a previous cardiovascular surgical operation. Half of them received a mechanical prosthesis and half a biological one. There was no significant difference between both types of prostheses related to surgical mortality, long-term survival or reoperation.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/métodos , Circulação Extracorpórea , Reoperação , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/mortalidade , Bioprótese , Comorbidade , Análise de Sobrevida , Seguimentos , Resultado do Tratamento , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos
15.
Ann Thorac Surg ; 110(3): e165-e167, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32142810

RESUMO

Transcatheter edge-to-edge tricuspid valve repair is emerging as an alternative therapeutic option in symptomatic patients with severe tricuspid regurgitation deemed unfit for open surgery. However, the presence of a dehiscent ring usually prevents transcatheter tricuspid valve intervention. Herein, we report a case of torrential tricuspid regurgitation secondary to ring dehiscence successfully treated with a MitraClip.


Assuntos
Anuloplastia da Valva Cardíaca , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Tricúspide/cirurgia , Idoso , Feminino , Humanos , Reoperação , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia
16.
Ann Thorac Surg ; 110(3): e153-e155, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32142816

RESUMO

Inferior vena cava filters are used for patients with pulmonary embolism or those with risk of embolization. Here we present a case of a 38-year-old man who underwent placement of an inferior vena cava filter because of deep vein thrombosis. The operating arm fractured and embolized to the posteromedial papillary muscle of mitral valve and the posterior inferior wall of the left ventricle through right atrium and atrioventricular septum, leading to large symptomatic mitral and tricuspid insufficiency and pericardial tamponade. Here we report a rare case where the filter migrated to the left ventricle and destroyed the mitral valve.


Assuntos
Migração de Corpo Estranho/diagnóstico , Ventrículos do Coração , Insuficiência da Valva Mitral/etiologia , Valva Mitral/lesões , Insuficiência da Valva Tricúspide/etiologia , Filtros de Veia Cava/efeitos adversos , Adulto , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/cirurgia , Veia Cava Inferior , Trombose Venosa/complicações
17.
Ann Thorac Surg ; 110(3): 918-924, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32035052

RESUMO

BACKGROUND: Tricuspid regurgitation (TR) is common in advanced heart failure (HF) patients. However, the effect of concomitant tricuspid valve repair or replacement (tricuspid valve intervention [TVI]) with left ventricular assist device (LVAD) implantation is controversial. The aim of this study was to investigate the longitudinal trend of TR after LVAD implantation and the effect of TVI on the TR trend and clinical outcomes. METHODS: We retrospectively reviewed patients at our institution who underwent LVAD implantation between April 2014 and August 2018. We evaluated the grade of TR by echocardiography before and after LVAD implantation. Moderate or greater TR was defined as significant. RESULTS: Among 199 consecutive patients, 194 had at least 2 echocardiographic TR assessments before and after LVAD implantation. Of these patients, 108 were included in the TVI-positive (TVI+) group and 86 in the TVI-negative (TVI-) group. In the TVI+ group, the prevalence of significant TR decreased from 52% to about 20% in the first 6 months after implantation (P < .01). Overall survival and HF readmission-free survival were comparable between the TVI+ and TVI- patients. In contrast, patients in both groups who had significant postoperative TR during early follow-up had worse 2-year HF readmission-free survival (36% in patients with significant postoperative TR vs 55% in those without significant postoperative TR; P = .028). CONCLUSIONS: Concomitant TVI with LVAD implantation improved TR in most patients but did not have an impact on clinical outcomes. Significant postoperative TR after LVAD implantation, in patients with and without TVI, was associated with worse HF-free outcomes.


Assuntos
Insuficiência Cardíaca/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Coração Auxiliar , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Idoso , Ecocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/etiologia
18.
J Card Surg ; 35(4): 950-951, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32107792

RESUMO

Traumatic tricuspid regurgitation (TR) is a rare cause of acute right ventricular dysfunction. The surgical technique could be complex and the reparative gesture has a lower success rate when compared with functional TR. We present the case of a 26-year-old male patient with traumatic TR who underwent tricuspid valve repair, with an initial satisfactory result. Later, the onset of acute severe residual TR was observed and the valve needed to be replaced. Surgery is the mainstay of treatment for traumatic TR, either in the form of repair or replacement. It requires an early diagnosis and concomitant treatment of injuries.


Assuntos
Anuloplastia da Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Ferimentos e Lesões/complicações , Acidentes por Quedas , Adulto , Diagnóstico Precoce , Humanos , Masculino , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico
19.
Catheter Cardiovasc Interv ; 95(5): 950-953, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31912986

RESUMO

Trans-apical approach has been proved successful in failing surgical bio-prosthesis in both mitral and aortic position in adult patients. Recently, valve-in-valve treatments have been applied even in patients with complex congenital heart disease. Here, we report the case of a 32 years old lady with left atrial isomerism, complete AV septal defect, interrupted inferior vena cava with azygos continuation who underwent Kawashima procedure with atrial Fontan. Severe systemic atrioventricular valve regurgitation necessitated a 33 mm Perimount valve implantation and conversion to lateral tunnel Fontan. After only 4 years there was severe valve stenosis and the patient underwent successful trans-apical transcatheter implantation of a 29 mm Sapien valve.


Assuntos
Cateterismo Cardíaco/instrumentação , Técnica de Fontan , Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Tricúspide/cirurgia , Estenose da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Feminino , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Desenho de Prótese , Recuperação de Função Fisiológica , 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/fisiopatologia , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/fisiopatologia
20.
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
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