-
Journal of the American College of... Apr 2016Tricuspid valve (TV) disease has been relatively neglected, despite the known association between severe tricuspid regurgitation (TR) and mortality. Few patients undergo... (Review)
Review
Tricuspid valve (TV) disease has been relatively neglected, despite the known association between severe tricuspid regurgitation (TR) and mortality. Few patients undergo isolated tricuspid surgery, which remains associated with high in-hospital mortality rates, particularly in patients with prior left-sided valve surgery. Patients with severe TR are often managed medically for years before TV repair or replacement. Current guidelines recommend TV repair in the presence of a dilated tricuspid annulus at the time of a left-sided valve surgical intervention, even if regurgitation is mild. This proposed algorithm aims to prevent the inevitable progression to severe TR and the need for a second surgical intervention. Recently, novel transcatheter treatment options were developed for treating patients with severe TR and right heart failure with prohibitive surgical risk. Here we describe currently available transcatheter treatment options for severe TR implanted at different levels: the junction between vena cavae and right atrium; the tricuspid annulus; or between TV leaflets, improving coaptation.
Topics: Cardiac Catheterization; Disease Progression; Echocardiography; Heart Valve Prosthesis Implantation; Hospital Mortality; Humans; Risk Adjustment; Severity of Illness Index; Time-to-Treatment; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 27081024
DOI: 10.1016/j.jacc.2016.01.063 -
Archives of Cardiovascular Diseases Nov 2014Since the first transcatheter implantation of a pulmonary valve in 2000 in a twelve year-old boy with a dysfunctional right ventricle to pulmonary artery conduit by... (Review)
Review
Since the first transcatheter implantation of a pulmonary valve in 2000 in a twelve year-old boy with a dysfunctional right ventricle to pulmonary artery conduit by Philip Bonhoeffer and Younes Boudjemline, the Melody(®) valve has become worldwide used. It represents an efficient alternative to open-heart surgery. We aimed in this comprehensive review to describe the current indications of percutaneous pulmonary valve implantation, the devices currently used and the clinical results.
Topics: Bioprosthesis; Cardiac Catheterization; Heart Defects, Congenital; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Prosthesis Design; Prosthesis Failure; Pulmonary Valve; Pulmonary Valve Insufficiency; Pulmonary Valve Stenosis; Treatment Outcome
PubMed: 25444020
DOI: 10.1016/j.acvd.2014.07.048 -
World Journal of Cardiology May 2021Right ventricular outflow tract (RVOT) obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot, pulmonary atresia/stenosis... (Review)
Review
Right ventricular outflow tract (RVOT) obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot, pulmonary atresia/stenosis and other conotruncal abnormalities After surgical repair, these patients develop RVOT residual abnormalities of pulmonic stenosis and/or insufficiency of their native outflow tract or right ventricle to pulmonary artery conduit. There are also sequelae of other surgeries like the Ross operation for aortic valve disease that lead to right ventricle to pulmonary artery conduit dysfunction. Surgical pulmonic valve replacement (SPVR) has been the mainstay for these patients and is considered standard of care. Transcatheter pulmonic valve implantation (TPVI) was first reported in 2000 and has made strides as a comparable alternative to SPVR, being approved in the United States in 2010. We provide a comprehensive review in this space-indications for TPVI, detailed procedural facets and up-to-date review of the literature regarding outcomes of TPVI. TPVI has been shown to have favorable medium-term outcomes free of re-interventions especially after the adoption of the practice of pre-stenting the RVOT. Procedural mortality and complications are uncommon. With more experience, recognition of risk of dreaded outcomes like coronary compression has improved. Also, conduit rupture is increasingly being managed with transcatheter tools. Questions over endocarditis risk still prevail in the TPVI population. Head-to-head comparisons to SPVR are still limited but available data suggests equivalence. We also discuss newer valve technologies that have limited data currently and may have more applicability for treatment of native dysfunctional RVOT substrates.
PubMed: 34131475
DOI: 10.4330/wjc.v13.i5.117 -
Arquivos Brasileiros de Cardiologia Oct 2021
Topics: Echocardiography; Heart Ventricles; Humans; Pulmonary Valve Insufficiency
PubMed: 34709297
DOI: 10.36660/abc.20210744 -
Journal of the American College of... Oct 2016
Topics: Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 27687195
DOI: 10.1016/j.jacc.2016.08.001 -
JACC. Cardiovascular Interventions May 2022
Topics: Cardiac Catheterization; Coronary Vessels; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Treatment Outcome
PubMed: 35512923
DOI: 10.1016/j.jcin.2022.03.031 -
Nature Reviews. Cardiology Apr 2015Mitral regurgitation (MR) is a common, progressive, and difficult-to-manage disease. MR is dynamic in nature, with physiological fluctuations occurring in response to... (Review)
Review
Mitral regurgitation (MR) is a common, progressive, and difficult-to-manage disease. MR is dynamic in nature, with physiological fluctuations occurring in response to various stimuli such as exercise and ischaemia, which can precipitate the development of symptoms and subsequent cardiac events. In both chronic primary and secondary MR, the dynamic behaviour of MR can be reliably examined during stress echocardiography. Dynamic fluctuation of MR can also have prognostic value; patients with a marked increase in regurgitant volume or who exhibit increased systolic pulmonary artery pressure during exercise have lower symptom-free survival than those who do not experience significant changes in MR and systolic pulmonary artery pressure during exercise. Identifying patients who have dynamic MR, and understanding the mechanisms underlying the condition, can potentially influence revascularization strategies (such as the surgical restoration of coronary blood flow) and interventional treatment (including cardiac resynchronization therapy and new approaches targeted to the mitral valve).
Topics: Cardiac Resynchronization Therapy; Clinical Decision-Making; Echocardiography, Doppler; Echocardiography, Stress; Exercise; Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency
PubMed: 25666403
DOI: 10.1038/nrcardio.2015.16 -
JACC. Cardiovascular Interventions Sep 2017
Topics: Heart Valve Prosthesis; Humans; Prospective Studies; Pulmonary Valve; Pulmonary Valve Insufficiency; Stents; United States
PubMed: 28823779
DOI: 10.1016/j.jcin.2017.06.008 -
The Journal of Thoracic and... Apr 2018
Topics: Bioprosthesis; Heart Valve Prosthesis; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency
PubMed: 29395196
DOI: 10.1016/j.jtcvs.2017.12.092 -
Multimedia Manual of Cardiothoracic... Nov 2023The Ross-Personalized External Aortic Root Support procedure is a surgical aortic valve replacement technique in which the autologous pulmonary valve is transposed in...
The Ross-Personalized External Aortic Root Support procedure is a surgical aortic valve replacement technique in which the autologous pulmonary valve is transposed in the aortic position to replace the malfunctioning aortic valve and a homograft is implanted in the pulmonary position. To prevent autograft dilatation, a Personalized External Aortic Root Support prosthesis is included in the proximal autograft anastomosis and wrapped around the ascending aorta. The aorta is transected transversely, the aortic valve is resected, and the coronary arteries are mobilized and cut out of the sinuses, leaving a rim. The pulmonary autograft is harvested by transecting the pulmonary artery and part of the right ventricular outflow tract. The autograft is approximated to the aortic root and inverted inside the ventricle. The proximal anastomosis is performed including the prosthesis between the aortic root and the autograft. The coronary buttons are threaded through appropriately positioned and sized holes in the prosthesis and reimplanted into the autograft. The ascending aorta is appropriately adapted and anastomosed with the distal autograft. When the patient is off cardiopulmonary bypass, the prosthesis can be closed longitudinally and is anchored to the distal aortic adventitia.
Topics: Humans; Autografts; Aorta, Thoracic; Transplantation, Autologous; Aortic Valve; Aorta; Aortic Valve Stenosis; Aortic Valve Insufficiency; Pulmonary Valve; Heart Valve Prosthesis Implantation; Reoperation
PubMed: 37942704
DOI: 10.1510/mmcts.2023.077