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3.
Rev Bras Ter Intensiva ; 31(2): 262-265, 2019 May 30.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31166560

RESUMO

Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.


Assuntos
Forame Oval Patente/etiologia , Átrios do Coração/cirurgia , Músculos Papilares/lesões , Valva Tricúspide/lesões , Acidentes de Trânsito , Anuloplastia da Valva Cardíaca/métodos , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/cirurgia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Músculos Papilares/cirurgia , Valva Tricúspide/cirurgia
4.
Rev. bras. ter. intensiva ; 31(2): 262-265, abr.-jun. 2019. graf
Artigo em Português | LILACS | ID: biblio-1013780

RESUMO

RESUMO O traumatismo cardíaco é comum em acidentes com veículos automotores. Uma mulher com 50 anos de idade foi transportada para nosso hospital após sofrer múltiplos traumatismos em um acidente de automóvel quando dirigia em alta velocidade. Após admissão à unidade de terapia intensiva, uma ultrassonografia cardíaca revelou ruptura traumática de músculo papilar da valva tricúspide e forame oval patente, enquanto se observou, no exame físico, o sinal de Lancisi. Foi realizado tratamento cirúrgico com anuloplastia da valva e fechamento do forame oval patente; durante o ato cirúrgico, diagnosticou-se ruptura oculta do átrio direito.


ABSTRACT Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.


Assuntos
Humanos , Feminino , Músculos Papilares/lesões , Valva Tricúspide/lesões , Forame Oval Patente/etiologia , Átrios do Coração/cirurgia , Músculos Papilares/cirurgia , Valva Tricúspide/cirurgia , Acidentes de Trânsito , Forame Oval Patente/cirurgia , Forame Oval Patente/diagnóstico , Anuloplastia da Valva Cardíaca/métodos , Átrios do Coração/lesões , Traumatismos Cardíacos/cirurgia , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Pessoa de Meia-Idade
5.
Zhonghua Wai Ke Za Zhi ; 57(2): 134-138, 2019 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-30704218

RESUMO

Objective: To investigate the indication and midterm outcomes of surgical treatment of traumatic tricuspid insufficiency. Methods: Totally 19 patients with traumatic tricuspid insufficiency who underwent surgical treatment at Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University from January 2002 to January 2018 were included in this retrospective study. There were 12 male and 7 female patients, aged (43.1±12.9) years (range: 17-68 years). The main causes of traumatic tricuspid insufficiency included blunt chest trauma following high-speed vehicle accidents (17 patients) and high-fall trauma (2 patients). The preoperative New York Heart Association functional class was class Ⅱ in 5 patients, class Ⅲ in 12 patients, and class Ⅳ in 2 patients. The mechanism of tricuspid insufficiency included anterior chordal rupture in 9 patients, anterior papillary muscle rupture in 3 patients, anterior and posterior chordal or papillary muscle rupture in 4 patients, laceration of leaflet combined with chordal rupture in 2 patients and infection combined with anterior papillary muscle rupture in 1 patient. Anular dilation and enlargement of the right ventricle were observed in all the patients. Paired t test was used to evaluate the echocardiogratic results at preoperation, postoperation and follow-up. Independent sample rank sum test was used to evaluate the intervals between trauma and surgery in tricuspid valve repair group and tricuspid valve replacement group. Results: Tricuspid valve repair was successful in 8 patients, and 11 patients underwent valve replacement. Among the patients who underwent valve replacement, 6 patients received mechanical valve and 5 received bioprosthetic valve. The interval from trauma to surgery of the valve repair group and valve replacement group were 8.5(10.0) months (range: 0.1-13.0 months) and 72.0 (108.0) months (range: 2.0-228.0 months), respectively. Concomitant procedures included debridement in scalp trauma (1 patient), internal fixation of femoral fracture (1 patient). One patient died from liver failure 10 days after operation and the remaining patients survived. Eighteen patients were followed up for (94±50) months, 15 patients were in New York Heart Association functional class Ⅰ and 3 patients in class Ⅱ. One patient received redo-tricuspid valve replacement because of mechanical valve failure at the 11 years of follow-up. Conclusions: The midterm outcomes of surgical treatment of severe traumatic tricuspid insufficiency were satisfactory. Early diagnosis and surgical invention were recommended to achieve successful valve repair.


Assuntos
Traumatismos Cardíacos/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Ferimentos não Penetrantes/cirurgia , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Seguimentos , Traumatismos Cardíacos/etiologia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/lesões , Insuficiência da Valva Tricúspide/etiologia , Ferimentos não Penetrantes/complicações , Adulto Jovem
9.
PLoS One ; 13(11): e0206744, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30408050

RESUMO

PURPOSE: Chordae rupture is one of the main lesions observed in traumatic heart events that might lead to severe tricuspid valve (TV) regurgitation. TV regurgitation following chordae rupture is often well tolerated with few or no symptoms for most patients. However, early repair of the TV is of great importance, as it might prevent further exacerbation of the regurgitation due to remodeling responses. To understand how TV regurgitation develops following this acute event, we investigated the changes on TV geometry, mechanics, and function of ex-vivo porcine hearts following chordae rupture. METHODS: Sonomicrometry techniques were employed in an ex-vivo heart apparatus to identify how the annulus geometry alters throughout the cardiac cycle after chordae rupture, leading to the development of TV regurgitation. RESULTS: We observed that the TV annulus significantly dilated (~9% in area) immediately after chordae rupture. The annulus area and circumference ranged from 11.4 ± 2.8 to 13.3 ± 2.9 cm2 and from 12.5 ± 1.5 to 13.5 ± 1.3 cm, respectively, during the cardiac cycle for the intact heart. After chordae rupture, the annulus area and circumference were larger and ranged from 12.3 ± 3.0 to 14.4 ± 2.9 cm2 and from 13.0 ± 1.5 to 14.0 ± 1.2 cm, respectively. CONCLUSIONS: In our ex-vivo study, we showed for the first time that the TV annulus dilates immediately after chordae rupture. Consequently, secondary TV regurgitation may be developed because of such changes in the annulus geometry. In addition, the TV leaflet and the right ventricle myocardium are subjected to a different mechanical environment, potentially causing further negative remodeling responses and exacerbating the detrimental outcomes of chordae rupture.


Assuntos
Cordas Tendinosas/lesões , Traumatismos Cardíacos/patologia , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/lesões , Animais , Fenômenos Biomecânicos , Cordas Tendinosas/fisiopatologia , Cordas Tendinosas/cirurgia , Dilatação , Modelos Animais de Doenças , Traumatismos Cardíacos/fisiopatologia , Traumatismos Cardíacos/cirurgia , Hemodinâmica , Técnicas In Vitro , Modelos Cardiovasculares , Sus scrofa , Valva Tricúspide/fisiopatologia , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/fisiopatologia
10.
Pacing Clin Electrophysiol ; 41(12): 1606-1610, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30341813

RESUMO

BACKGROUND: Today, there is no manufacturer-supplied retrieval tool for the Micra™ pacemaker (Medtronic, Minneapolis, MN, USA); therefore, off-the-shelf catheters have been employed for retrievals. The proximal retrieval feature of the Micra™ can be snared and the device is then retracted from the myocardium, pulling the device through the tricuspid valve. This study characterizes the potential risks of Micra™ nitinol tine engagement with the tricuspid sub-valvular apparatus. METHODS: Fresh human hearts nonviable for transplant (n = 10) were obtained from our regional organ procurement agency (LifeSource, Minneapolis, MN, USA). Micra™ fixation tines were affixed to a linear force transducer. Tines were then engaged in tricuspid chordae tendineae to conduct a constant velocity tensile test. Each test was run until tines disengaged from the chordae tendineae or until they released from the valve apparatus. Subsequently, biomechanical failure properties of the valve apparatus and isolated chordae tendineae were determined using a series of uniaxial tensile tests. RESULTS: There were no chordal ruptures observed during our Micra™ tine extraction testing. Chordal failure required 15.0 times the force of extracting a single engaged tine, and 9.0 times the force of extracting two engaged tines. The uniaxial stresses required for isolated chordal failure averaged 17.4 N/mm2 ; failure strains exceeded 150% resting chordal length. CONCLUSIONS: The forces required to rupture tricuspid chordae tendineae significantly exceeded the forces potentially imposed on the chordae during Micra™ device retrievals. We conclude that the fixation tines of the Micra™ device are unlikely to damage the tricuspid apparatus during either implant or retrieval.


Assuntos
Remoção de Dispositivo , Marca-Passo Artificial , Ligas , Cordas Tendinosas/lesões , Desenho de Equipamento , Humanos , Técnicas In Vitro , Valva Tricúspide/lesões
11.
Pediatr Transplant ; 22(7): e13275, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30076684

RESUMO

Per protocol, our institution obtains echocardiograms immediately after each EMB to rule out procedural complication. We sought to determine the incidence of echocardiogram-detected cardiac perforation and TV injury and to evaluate the utility of routine screening echocardiogram after each EMB in the current era. At a single center, 99% (1917/1942) EMB performed in 162 patients were immediately followed by an echocardiogram per protocol. There were five newly diagnosed pericardial effusions, and only one required pericardiocentesis. In the three echocardiograms demonstrating new flail TV, only one patient underwent surgical repair 2 months later. This study demonstrates the very low incidence of significant hemopericardium and TV injury after EMB in pediatric heart transplant recipients and argues against the utility of post-EMB echocardiograms to screen solely for procedural complications.


Assuntos
Ecocardiografia , Traumatismos Cardíacos/diagnóstico por imagem , Transplante de Coração , Miocárdio/patologia , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Valva Tricúspide/lesões , Adolescente , Biópsia/efeitos adversos , Criança , Pré-Escolar , Feminino , Seguimentos , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/patologia , Traumatismos Cardíacos/epidemiologia , Traumatismos Cardíacos/etiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/epidemiologia , Derrame Pericárdico/etiologia , Cuidados Pós-Operatórios/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Valva Tricúspide/diagnóstico por imagem , Adulto Jovem
12.
Intern Med ; 57(20): 2963-2968, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-29780143

RESUMO

Traumatic tricuspid regurgitation (TR) is a rare cardiovascular complication in chest trauma. Changes in the left ventricle (LV) function after operation are unclear. A 61-year-old woman who had been involved in a traffic accident 1 month earlier presented with exertional dyspnea. Transthoracic echocardiography (TTE) showed severe tricuspid regurgitation (TR) accompanied by LV dysfunction due to anterior leaflet prolapse with papillary muscle rupture. After tricuspid plasty, the LV function improved, as evidenced by TTE and speckle tracking echocardiography. In conclusion, the early diagnosis of traumatic TR is important, and early surgical intervention might be effective for achieving ventricular function improvement.


Assuntos
Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/lesões , Valva Tricúspide/cirurgia , Função Ventricular Esquerda/fisiologia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgia , Acidentes de Trânsito , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem
14.
Catheter Cardiovasc Interv ; 91(5): 927-931, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29405557

RESUMO

Nowadays, percutaneous pulmonary valve implantation (PPVI) is a suitable alternative to surgical procedure in patients with right ventricle outflow tract dysfunction. Two valves are currently available for PPVI: the Melody valve and the Edwards Sapien valve. The following complications may occur: coronary artery compression, deformation of the aortic root, stent or valve embolization, damage of distal pulmonary arteries, access site injuries. Here, we report on three cases of severe tricuspid regurgitation due to valvular and subvalvular apparatus damage during Edwards Sapien XT valve implantation.


Assuntos
Traumatismos Cardíacos/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valva Pulmonar/cirurgia , Insuficiência da Valva Tricúspide/etiologia , Valva Tricúspide/lesões , Adolescente , Angiografia , Anuloplastia da Valva Cardíaca , Ecocardiografia Doppler em Cores , Feminino , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Masculino , Desenho de Prótese , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Índice de Gravidade de Doença , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/cirurgia
15.
Gen Thorac Cardiovasc Surg ; 66(8): 480-483, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29177987

RESUMO

Several cases of traumatic ventricular septal defect (VSD) have been reported. However, traumatic VSD complicated by tricuspid rupture is rare. We report a case of traumatic VSD with tricuspid rupture who required repeated repair of both conditions. A 69-year-old man was transferred to our hospital for emergent surgical repair of traumatic VSD and tricuspid rupture. Although emergent repair was performed, a new left-to-right shunt and moderate tricuspid regurgitation appeared during his postoperative course. A reoperation was performed 4 months after the first operation. The borders of the defect were very fibrotic and strong compared with those in the first operation. Surgical treatment of traumatic VSD should be postponed in hemodynamically stable patients. When emergent repair is performed, careful follow-up is necessary to diagnose new VSD.


Assuntos
Comunicação Interventricular/cirurgia , Traumatismos Torácicos/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/lesões , Ferimentos não Penetrantes/cirurgia , Idoso , Traumatismos Cardíacos/cirurgia , Comunicação Interventricular/etiologia , Humanos , Masculino , Reoperação , Ruptura , Insuficiência da Valva Tricúspide/etiologia
16.
Innovations (Phila) ; 12(6): 479-482, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29194099

RESUMO

Totally endoscopic robotic surgery is a safe approach to atrial septal defect closure in adults. Robotic approach can be an alternative to traditional incisions in the management of concomitant tricuspid valve regurgitation with ruptured chordae tendineae. Herein, we describe a woman who presented with atrial septal defect and tricuspid insufficiency after an unsuccessful percutaneous intervention with device removal from the right ventricle. Concomitant closure of septal defect and tricuspid valve repair with artificial chords was successfully performed using robot assistance.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Endoscopia/métodos , Comunicação Interatrial/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/lesões , Adulto , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Humanos , Falha de Tratamento , Insuficiência da Valva Tricúspide/etiologia
17.
Int Heart J ; 58(3): 451-453, 2017 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-28539566

RESUMO

Traumatic tricuspid regurgitation is a rare and progressive disease. Early diagnosis and surgical valve repair are very important. A 57-year-old male was referred to our hospital with a history of blunt chest trauma. Three-dimensional echocardiography showed severe tricuspid regurgitation and demonstrated two main anterior leaflet chordaes of the tricuspid valve rupture and the whole anterior leaflet prolapsed. The diagnosis was severe tricuspid regurgitation due to leaflet chordae rupture secondary to blunt chest trauma. Surgical repair of the tricuspid valve was performed in this patient. At 3-month follow-up, the right ventricle was decreased in size with significantly improved right ventricular function. The signs and symptoms of right heart failure were relieved. In this case, 3-dimensional transthoracic echocardiography enabled fast and non-invasive evaluation of the spatial destruction of the tricuspid valve and subvalvular apparatus to assist in the planning of valve repair.


Assuntos
Traumatismos Torácicos/complicações , Insuficiência da Valva Tricúspide/etiologia , Ferimentos não Penetrantes/complicações , Procedimentos Cirúrgicos Cardíacos/métodos , Cordas Tendinosas/diagnóstico por imagem , Cordas Tendinosas/lesões , Cordas Tendinosas/cirurgia , Ecocardiografia , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Torácicos/diagnóstico , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/lesões , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/cirurgia , Ferimentos não Penetrantes/diagnóstico
18.
Ann Thorac Surg ; 103(2): e207-e208, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28109394

RESUMO

Permanent pacemaker lead may damage the tricuspid valve in various ways, causing severe tricuspid valve regurgitation. The perforation of posterior papillary muscle is an uncommon complication caused by the lead. We describe a lead-sparing tricuspid valve repair in which the lead extraction was not an option. The papillary muscle containing the lead was fully mobilized to release the adherent leaflets. The repair was completed by commissuroplasty as well as ring annuloplasty, leaving the lead inside the implanted ring.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Marca-Passo Artificial/efeitos adversos , Músculos Papilares/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Idoso , Ecocardiografia , Feminino , Humanos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/lesões , Insuficiência da Valva Tricúspide/diagnóstico
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