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1.
Zhonghua Er Ke Za Zhi ; 59(4): 294-298, 2021 Apr 02.
Artigo em Chinês | MEDLINE | ID: mdl-33775048

RESUMO

Objective: To analyze the clinical characteristics and treatment of tricuspid valve prolapse caused by chordal rupture complicated with persistent pulmonary hypertension in neonates. Methods: The clinical data of a male neonate with tricuspid valve prolapse complicated with persistent pulmonary hypertension admitted to the Neonatal Intensive Care Unit of Children's Hospital of Hebei Province in November 2018 was analyzed retrospectively. Related literature up to September 2020 was searched with the strategy of "(neonate OR newborn) AND (tricuspid valve prolapse) AND (rupture OR necrosis) AND (papillary muscle OR chordae tendineae) AND (pulmonary hypertension)" in Wanfang, CNKI and PubMed database in Chinese and English. The characteristics of the disease were summarized. Results: A male full-term neonate was admitted due to presenting severe cyanosis for 9 hours. He was born by caesarean section and presented severe cyanosis and dyspnea at 10 min of ages, unresponsive to the positive airway pressure resuscitation. After 9 hours of mechanical ventilation, there was no improvement. Thus he was transferred to Children's Hospital of Hebei Province. On admission, the initial blood gas analysis showed an arterial partial pressure of oxygen of 22.5 mmHg (1 mmHg=0.133 kPa). The echocardiography revealed prolapsed anterior leaflet of tricuspid valve, severe tricuspid regurgitation (TR) and pulmonary artery hypertension, and right to left shunt via a patent foramen ovale. The arterial duct was closed. The chest X-ray was normal. The boy was treated with nitric oxide, milrinone, and continued mechanical ventilation initially. Addition of prostacyclin analog (treprostinil) on day 3 led to significant improvement of pulmonary blood flow, oxygenation, and stabilization, so that the extracorporeal membrane oxygenation therapy was avoided. At 11 months after birth, the boy underwent cardiac surgery. At surgery, the rupture of chordal tendineae in anterior leaflet of tricuspid valve was found. Tricuspid annuloplasty, valvuloplasty and repair of patent foramen ovale were successfully performed. The follow-up echocardiogram at postoperative 3 months showed only mild tricuspid insufficiency. The boy was well at last follow-up at 22 months of age with normal cognitive skill development. According to literature, 20 cases of papillary muscle or chordae tendineae rupture in neonates had been reported in 12 English papers. Among the total 21 neonates, there were 12 male infants and only one premature infant with gestational age of 33 weeks. They presented with profound cyanosis soon after birth. All of them received endotracheal intubation and mechanical ventilation. Other treatments included inhalation of nitric oxide, intravenous milrinone, vasoactive drugs, diuretics and prostacyclin, etc. Extracorporeal membrane oxygenation (ECMO) was used in 6 infants as a bridge to surgical treatment. Two cases reported earlier death of cardiopulmonary failure without operation and the rest 19 survived after surgery. The followed surgery or autopsy revealed that all of them had tricuspid valve prolapse, rupture of papillary muscle or chordae tendineae. Conclusions: The severe TR resulting from rupture of papillary muscle or chordate tendineae in neonates is rare and could cause severe hypoxemia. Early recognition, adequate cardiopulmonary support to stabilize the hemodynamic status and timely surgery can significantly reduce the mortality.


Assuntos
Hipertensão Pulmonar , Valva Tricúspide , Cesárea , Criança , Cordas Tendinosas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia
3.
Int Heart J ; 62(1): 57-64, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455981

RESUMO

Tricuspid valve (TV) surgery is associated with a high risk of postoperative pacemaker requirement. We set out to identify the incidence of atrioventricular block (AVB) after TV surgery and determine whether atrioventricular conduction recovers within time.We investigated pre/intra- and postoperative predictors of AVB in patients who underwent tricuspid valve surgery (not only isolated TV surgery) at our institution between 2004 and 2017. Patients who had pacemakers prior to surgery were excluded.One year after surgery, 5.8% of the surviving cohort had received a pacemaker due to AVB. In the complete follow-up time, 33 out of 505 patients required pacemaker implantation because of AVB. Of the 37 patients who presented to the intensive care unit postoperatively with AVB III, 14 (38%) underwent pacemaker implantation for AVB, and 20 (54%) did not require a pacemaker. AVB III at ICU admission was identified as a predictor of pacemaker implantation (OR: 9.7, CI: 3.8-24.5, P < 0.001). TV endocarditis was also identified as a predictor (OR: 12.4, CI: 3.3-46.3, P < 0.001). Eleven out of 32 patients (34%) with tricuspid endocarditis required a pacemaker for AVB. The mean ventricular pacing burden within the first 5 years after pacemaker implantation was 79%.The issue of AVB after TV surgery is significant. Both the initial rhythm after surgery and etiology of the tricuspid disease can help predict pacemaker requirement. Within the first 5 years after surgery, the ventricular pacing burden remains high without relevant rhythm recovery.


Assuntos
Bloqueio Atrioventricular/etiologia , Endocardite/complicações , Marca-Passo Artificial/estatística & dados numéricos , Valva Tricúspide/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/cirurgia , Intervalo Livre de Doença , Endocardite/cirurgia , Feminino , Seguimentos , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/patologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Valva Tricúspide/patologia
4.
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
5.
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
6.
Pneumologie ; 74(10): 665-669, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-33059372

RESUMO

HISTORY AND CLINICAL FINDINGS: Emergency admission of a 66-years-old man with right-sided and partly breath-dependent chest pain in the interdisciplinary emergency room. The complaints existed for several days and had a progressive character. Purulent expectoration and fever were negated. There was a history of COPD with occasional pulmonary exacerbations. Several weeks before the current event, community-acquired pneumonia had been treated with antibiotics. Moreover, the patient reported on multiple spine surgery procedures performed in recent months. INVESTIGATIONS AND DIAGNOSIS: In transthoracic echocardiography (TTE), detection of a foreign body (Palacos) in the right ventricle, which was confirmed to be a toothpick-like structure in the supplementary CT scan of the thorax and the transoesophageal echocardiography (TOE). TREATMENT AND COURSE: Foreign body extraction using right anterior mini thoracotomy. Subsequently, iatrogenic pneumothorax with bilateral nosocomial pneumonia and drainage. After short-term convalescence, renewed admission with bilateral pulmonary infiltrates. Under invasive ventilation, new left-sided pneumothorax was diagnosed, which was supplied with a Bülau drainage. Due to the detection of positive blood cultures, re-conducting of a TOE examination. Now first diagnosis of tricuspid valve endocarditis. Despite successful surgical biologic tricuspid valve replacement with an epicardial pacemaker electrode placement, the patient died approximately three quarters of a year after he became an emergency patient due to dyspnoea. DISCUSSION: The present case shows that a typical clinical symptom, associated with a previously known chronic illness, has to be reminded again and again of other and less common diseases. Even everyday diagnostic and therapeutic procedures are associated with a residual risk of possible complications.


Assuntos
Dispneia/etiologia , Endocardite/cirurgia , Corpos Estranhos/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Toracotomia/efeitos adversos , Vertebroplastia/efeitos adversos , Idoso , Dispneia/mortalidade , Ecocardiografia , Endocardite/diagnóstico , Evolução Fatal , Humanos , Masculino , Complicações Pós-Operatórias , Embolia Pulmonar/diagnóstico , Valva Tricúspide/microbiologia , Valva Tricúspide/cirurgia
7.
Herzschrittmacherther Elektrophysiol ; 31(4): 437-440, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32989567

RESUMO

Mapping and ablation of atriofascicular fibers can be highly challenging due to the complex and dynamic anatomy of the tricuspid valve annulus. This case highlights the utility of a multi-electrode catheter three-dimensional mapping approach to localize the Mahaim pathway along the tricuspid annulus in order to guide catheter ablation.


Assuntos
Ablação por Cateter , Pré-Excitação Tipo Mahaim , Eletrocardiografia , Eletrodos , Humanos , Pré-Excitação Tipo Mahaim/cirurgia , Valva Tricúspide/cirurgia
8.
J Vis Exp ; (161)2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32804160

RESUMO

Heart conditions in which the tricuspid valve (TV) faces either increased volume or pressure stressors are associated with premature valve failure. Mechanistic studies to improve our understanding of the underlying pathophysiology responsible for the development of premature TV failure are lacking. Due to the inability to conduct these studies in humans, an animal model is required. In this manuscript, we describe the protocols for a novel chronic recovery infant piglet heart model for the study of changes in the TV when placed under combined volume and pressure stress. In this model, volume loading of the right ventricle and the TV is achieved through the disruption of the pulmonary valve. Then pressure loading is accomplished through the placement of a pulmonary artery band. The success of this model is assessed at four weeks post intervention surgery through echocardiography, intracardiac pressure measurement, and pathologic examination of the heart specimens.


Assuntos
Ventrículos do Coração/fisiopatologia , Valva Tricúspide/fisiopatologia , Anestesia , Animais , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Hemodinâmica , Imageamento Tridimensional , Masculino , Modelos Animais , Tamanho do Órgão , Pressão , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/cirurgia , Valva Pulmonar/fisiopatologia , Valva Pulmonar/cirurgia , Suínos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia
10.
Kyobu Geka ; 73(7): 498-502, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32641668

RESUMO

Right minithoracotomy has become the standard approach along with sternotomy in mitral and tricuspid valve surgery. Transareolar incision, compared with submammary incision, is advantageous in that it often allows better angle for antegrade cardioplegia cannulation through the main wound. It also provides a better cosmesis. In this retrospective study, we reviewed the 11 patients who underwent mini-mally invasive tricuspid valve repair through transareolar approach from 2016 to 2019. Mean age was 58 years, 8 ware female, mean body weight was 53 kg, and mean body surface area was 1.47 m2. Causative pathology was atrial septal defect in 8, trauma in 1, tumor in 1 and pacemaker lead infection in 1. Homologous blood transfusion was performed in 1. Hospital mortality occurred in 1;a patient on dialysis who underwent tricuspid valve repair with removal of vegetation for pacemaker lead infection died of uncontrollable acidosis. There was no late death. Transareolar approach was considered a feasible option for tricuspid valve surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Valva Tricúspide/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Diálise Renal , Estudos Retrospectivos , Toracotomia , Resultado do Tratamento
11.
J Card Surg ; 35(10): 2567-2573, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32667082

RESUMO

OBJECTIVE: Minimally invasive surgery is a widely accepted surgical treatment for valve disease, however triple valve surgery (TVS) is a complex and challenging procedure. The objective of this study was to describe the morbidity and mortality related to minimally invasive TVS at our institution. METHODS: This was a retrospective review of all minimally invasive TVS performed between 2012 and 2019. Baseline and perioperative characteristics were reviewed, as were postoperative outcomes. RESULTS: Eighteen patients underwent TVS; 12 patients underwent additional procedures at the time of TVS. Median time to initial extubation was 11.5 hours (interquartile range [IQR] 9.8-13.3). Intensive care unit and total length of stay were 1.22 (IQR, 1.16-1.31) and 9 (IQR, 6-17) days, respectively. No hospital deaths occurred; 30-, 90-, and 365-day mortality were 0%. Two postoperative neurologic complications occurred, two patients had acute kidney injuries. The most common complication was rhythm disturbance with five patients requiring permanent pacemaker implantation. Mean follow-up was 39.9 months (252-2642 days). CONCLUSIONS: Our findings demonstrate that minimally invasive TVS utilizing femoral cannulation results in an acceptable risk of complication. Short and intermediate term survival were excellent.


Assuntos
Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Valva Tricúspide/cirurgia , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Doenças das Valvas Cardíacas/mortalidade , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
12.
J Card Surg ; 35(8): 1848-1855, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652650

RESUMO

BACKGROUND: The data on readmissions following tricuspid valve repair/replacement (TVR) are scarce. We examined rates, predictors, causes, and outcomes of readmissions after TVR, using the National Readmission Database. METHODS: The International Classification of Diseases-9th version was used to identify the patients who underwent isolated TVR or concomitant aortic, mitral, and coronary bypass surgeries. Rates, causes, and outcomes were assessed using the analysis of variance and the χ2 test, and predictors of readmissions were evaluated using multivariate analysis. RESULTS: A total of 8254 patients who underwent TVR during 2013 to 2014 were included, of whom 1994 (24.16%) were isolated, and 6260 (75.84%) were performed concomitantly with other heart valve or coronary bypass surgery. A total of 1720 (20.84%) patients were readmitted within 30 days. The readmission rates were 448 (22.46%) after isolated TVR and similar after concomitant TVR (TVR + aortic valve replacement, TVR + mitral valve repair, TVR + coronary artery bypass graft, and TVR + multiple) (P = .194); whereas 1305 (20.11%) and 414 (23.45%) were after tricuspid valve repair and replacement (P = .080), respectively. The independent predictors of readmission were acute kidney injury during index visit and Charlson comorbidity index of more than 2. Mean time to readmission and median length of stay during readmission were 13.02 (±7.93) and 5 (interquartile range: 3-9) days, respectively. Total mortality during rehospitalization was 105 (6.1%), a very high (26.86%) number of patients were discharged to skilled facilities after readmission. CONCLUSIONS: One out of five patients were readmitted within 30 days after the TVR, associated with 6.1% mortality during rehospitalization, and very high need for skilled facility placement.


Assuntos
Implante de Prótese de Valva Cardíaca , Readmissão do Paciente/estatística & dados numéricos , Valva Tricúspide/cirurgia , Previsões , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Fatores de Tempo , Resultado do Tratamento
13.
J Card Surg ; 35(8): 1891-1900, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652675

RESUMO

BACKGROUND: The aim of the present retrospective study was to evaluate the influence of preoperative right ventricular (RV) and tricuspid valve (TV) remodeling on the fate of tricuspid annuloplasty (TA) and right ventricle. METHODS: From May 2009 to December 2015, 423 patients who had undergone TA for functional tricuspid regurgitation (TR) were included in the study. Residual and recurrent TR were defined as moderate or more TR at discharge and follow-up, respectively. RV remodeling was defined as RV dysfunction and/or dilation. RESULTS: Residual TR after TA was recorded in 54 patients (13%). Five-year freedom from TR recurrence was 81% ± 3% in patients without residual TR and 41 ± 8 in patients with residual TR (P < .001). In patients without residual TR, the following risk factors for recurrent TR and late RV remodeling were identified: preoperative systolic pulmonary artery pressure, preoperative RV remodeling, severe preoperative TR or less than severe TR but with TV apparatus remodeling, and etiology of mitral regurgitation. Cox analysis with time-dependent variables confirmed TR recurrence (hazard ratio [HR]: 3.1) and late RV remodeling (HR: 6.5) as risk factors for lower survival. No protective effect of either flexible band or rigid ring TA compared with DeVega procedure was found. Similarly, preoperative atrial fibrillation and pacemaker dependency, late failure of mitral valve surgery did not affect the fate of TR. CONCLUSIONS: Prophylactic TA should be encouraged among surgeons. TA at the time of left-sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.


Assuntos
Anuloplastia da Valva Cardíaca , Insuficiência da Valva Tricúspide , Valva Tricúspide/cirurgia , Remodelação Ventricular , Ventrículos do Coração , Humanos , Complicações Pós-Operatórias , Período Pré-Operatório , Estudos Retrospectivos , Valva Tricúspide/fisiopatologia
14.
J Card Surg ; 35(8): 1901-1904, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652779

RESUMO

BACKGROUND: Significant secondary tricuspid regurgitation, often accompanied by right ventricular dilation and dysfunction, occurs in a significant proportion of patients submitted to surgery for severe mitral valve disease. It appears a vicious circle that is not interrupted by the treatment of the left heart valve alone, hence it requires concomitant intervention on the tricuspid valve. AIMS: In this commentary I will discuss a paper published in this issue of the Journal by Calafiore et al from Riyadh - Saudi Arabia, reporting a retrospective study that evaluated the influence of preoperative right ventricular and tricuspid valve (TV) remodeling on the fate of tricuspid annuloplasty (TA) and RV in 423 patients undergoing TA for functional TR operated on from May 2009 to December 2015 at their institution. MATERIALS & METHODS: Current guidelines and other consensus documents recommend that tricuspid valve surgeryshould be considered (class IIa) in patients with mild/moderate secondary regurgitation and/or significant annular dilatation. However, rates of tricuspid annuloplasty performed during operations to left-heart valves are very variable, depending also on the etiology of the mitral disease. RESULTS & DISCUSSION: Different methods of annuloplasty are used by the surgical community - suture, rings, bands - with widely variable results with regard to the recurrence of regurgitation and long-term survival. Not all these techniques are standardised and this may also be a cause for the disparate results. CONCLUSION: In the absence of randomized studies, which are highly unlikely to be undertaken in this situation, more information is required from large series with longer follow-ups.


Assuntos
Anuloplastia da Valva Cardíaca , Valva Tricúspide/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Humanos
15.
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
16.
Artigo em Inglês | MEDLINE | ID: mdl-32520450

RESUMO

The Melody valve (Medtronic, Minneapolis, MN, USA) is a stented bovine jugular vein graft that was primarily approved for transcatheter implantation in a pulmonary valve position. The prosthetic valve can also be implanted in an atrioventricular position in infants and young children, and in these cases it must be modified appropriately.  In this tutorial we demonstrate the surgical preparation of a stented transcatheter Melody valve for implantation in the atrioventricular position. Additionally, we present a safe and effective method for surgical valve-in-valve implantation in a 3-year-old patient with hypoplastic left heart syndrome.


Assuntos
Bioprótese , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Stents , Animais , Bovinos , Humanos , Lactente , Veias Jugulares/cirurgia , Valva Tricúspide/cirurgia
17.
Pediatr Cardiol ; 41(6): 1244-1247, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32572547

RESUMO

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles address the following: (1) transcatheter closure of sinus venous atrial septal defect which is feasible in adults with careful planning, (2) exercise echocardiography in children with hypertrophic cardiomyopathy which was found to be very helpful to identify low-risk patients when there is no gradient at rest or during exercise, (3) features of Fontan patients with normal exercise capacity who typically report more active life style and have less complications during the post-Fontan admissions, (4) the natural history of Anderson-Tawil syndrome which is characterized by high incidence of life-threatening arrhythmogenic events especially when there is history of syncope, ventricular tachycardia, or the use of amiodarone, (5) pulmonary artery banding in complete atrioventricular septal defects which were found to be a safe alternative to early complete repair and served as a bridge to biventricular repair with variable effect on common atrioventricular valve regurgitation and (6) tricuspid valve interventions (TVI) in patients undergoing pulmonary valve replacement (PVR) which further reduce tricuspid regurgitation beyond what is expected in PVR alone without increasing early complications or hospital length of stay.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias/terapia , Publicações Periódicas como Assunto , Adolescente , Adulto , Cardiologia , Cardiomiopatia Hipertrófica/terapia , Criança , Ecocardiografia , Exercício Físico , Feminino , Técnica de Fontan/métodos , Cardiopatias/cirurgia , Defeitos dos Septos Cardíacos/cirurgia , Comunicação Interatrial/cirurgia , Humanos , Masculino , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/epidemiologia
18.
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
19.
J Cardiothorac Surg ; 15(1): 122, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493495

RESUMO

PURPOSE: To analyze the efficacy of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle. METHODS: Eighty cardiac patients with previous sternotomy and giant left ventricle according to the diagnostic criteria that left ventricular end diastolic diameter (LVEDD) was ≥70 mm, who underwent mitral valve surgery at our center from January 2006 to January 2019 were analyzed. We divided all patients into minimally invasive beating heart technique group (n = 30) and conventional median resternotomy arrested heart technique group (n = 50) according to the surgical methods. Preoperative, intraoperative, and postoperative variables were compared between two groups. RESULTS: Minimally invasive beating heart technique compared to the conventional median resternotomy arrested heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle had significant differences in operation time(P = 0.002), cardiopulmonary bypass (CPB) time(P < 0.001), intraoperative blood loss(P < 0.001), postoperative transfusion ratio(P = 0.01), postoperative transfusion amount(P < 0.001), postoperative drainage volume(P = 0.001), extubation time(P = 0.04), intensive care unit (ICU) stay time(P = 0.04) and postoperative hospital stay time(P < 0.001), but no significant differences in re-exploration for bleeding, postoperative 30-day mortality, postoperative complications and 6 months postoperative echocardiographic parameters. CONCLUSIONS: Using the method of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle is effective and reliable, meanwhile reduce the operation time and CPB time, decrease the transfusion ratio and transfusion amount, shorten postoperative ICU stay and hospital stay time, promote the early extubation so that accelerate the patients' early recovery. All of these show a benefit of minimally invasive beating heart technique compared to conventional median resternotomy arrested heart technique.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Anuloplastia da Valva Mitral/métodos , Valva Mitral/cirurgia , Idoso , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Procedimentos Cirúrgicos Cardíacos/métodos , Anuloplastia da Valva Cardíaca/métodos , Feminino , Ventrículos do Coração , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Esternotomia/métodos , Valva Tricúspide/cirurgia
20.
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
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