-
Multimedia Manual of Cardiothoracic... Oct 2023We present an isolated endoscopic tricuspid repair in an 85-year-old man who presented with progressive dyspnoea and pedal oedema. He had coronary artery bypass grafting...
We present an isolated endoscopic tricuspid repair in an 85-year-old man who presented with progressive dyspnoea and pedal oedema. He had coronary artery bypass grafting about 24 years ago and had significant comorbidities including atrial fibrillation, chronic obstructive pulmonary disease and upper gastrointestinal bleeding.
Topics: Male; Humans; Aged, 80 and over; Tricuspid Valve; Cardiac Surgical Procedures; Endoscopy; Tricuspid Valve Insufficiency; Coronary Artery Bypass; Treatment Outcome; Heart Valve Prosthesis Implantation
PubMed: 37861687
DOI: 10.1510/mmcts.2023.056 -
International Journal of Cardiology Feb 2024Epidemiology of tricuspid regurgitation (TR) is poorly known and its burden in the community is challenging to define. We aimed to evaluate the prevalence of TR in a...
BACKGROUND AND AIMS
Epidemiology of tricuspid regurgitation (TR) is poorly known and its burden in the community is challenging to define. We aimed to evaluate the prevalence of TR in a geographically defined area and its outcome, in particular overall survival and hospitalization, considering different clinical contexts.
METHODS
We retrospectively analyzed consecutive outpatients referred between 2006 and 2013 for echocardiography and clinical evaluation. Patients with at least moderate TR were included and five different clinical settings were defined: concomitant significant left-sided valvular heart disease (LVHD-TR), heart failure (HF-TR), previous open-heart valvular surgery (postop-TR), pulmonary hypertension (PHTN-TR) and isolated TR (isolated-TR). Primary endpoint was a composite outcome of all-cause mortality or first hospitalization for HF.
RESULTS
Of 6797 consecutive patients with a clinical visit and echocardiograms performed in routine practice in a geographically defined community, moderate or severe TR was found in 4.8% of patients (327) . During median follow-up of 6.1 years, TR severity was a determinant of event-free survival. Analyzed for each clinical subset, eight-year event-free survival was 87 ± 7% for postop-TR subgroup, 75 ± 7% for isolated-TR, 67 ± 6% for PHTN-TR, 58 ± 6% for LHVD -TR and 52 ± 11% for HF-TR.
CONCLUSION
Moderate or more TR is a notable finding in the community and has impact on event-free survival in all clinical settings, with the worst outcomes when associated with relevant left-sided valvular heart disease and HF.
Topics: Humans; Tricuspid Valve Insufficiency; Retrospective Studies; Outpatients; Heart Failure; Echocardiography; Treatment Outcome
PubMed: 37844668
DOI: 10.1016/j.ijcard.2023.131443 -
Cureus Oct 2023Background and objective Complex congenital heart diseases (CHDs), such as the tetralogy of Fallot (TOF), often warrant reconstruction and augmentation of the right...
The Utility of Invengenx® Bovine Patch for Right Ventricular Outflow Tract (RVOT) Reconstruction and Augmentation in the Surgical Management of Tetralogy of Fallot (TOF): A Contemporary Study and Review of the Literature.
Background and objective Complex congenital heart diseases (CHDs), such as the tetralogy of Fallot (TOF), often warrant reconstruction and augmentation of the right ventricular outflow tract (RVOT). This procedure requires the use of both synthetic and natural materials. However, finding the ideal material for tissue implants can be challenging. Biological materials often face issues such as tissue degeneration, calcium deposition, antigenicity, rejection, shrinkage, and fibrosis. These issues can lead to complications such as stenosis and insufficiency, potentially requiring early reoperations. In light of this, this study aimed to investigate the effectiveness of the Invengenx® bovine patch for RVOT reconstruction and augmentation. Methods This was a retrospective observational study conducted among eight children who underwent TOF correction cardiac surgery. Their demographic and clinical characteristics, intraoperative findings, and postoperative follow-up results at six months were collected from the hospital patient database. Results There were no deaths or complications in this study. We observed a significant reduction in the gradient across the pulmonary valve and the outflow tract at six months post-procedure. The analysis demonstrated that the Invengenx® bovine patch was successful and did not lead to any complications. Conclusions This study demonstrates the safety and efficacy of this engineered bovine pericardial patch (Invengenx®) as a cardiovascular substitute for surgical repair of both simple and more complex congenital cardiac defects.
PubMed: 37841993
DOI: 10.7759/cureus.46882 -
Journal of Veterinary Cardiology : the... Oct 2023Echocardiographic diagnosis of pulmonary hypertension (PH) in horses is usually based on Doppler interrogation of tricuspid (TR) or pulmonic regurgitation (PR). This...
Diagnostic value of two-dimensional echocardiographic measurements of the pulmonary artery diameter and the pulmonary artery distensibility index to detect pulmonary hypertension in horses.
INTRODUCTION/OBJECTIVES
Echocardiographic diagnosis of pulmonary hypertension (PH) in horses is usually based on Doppler interrogation of tricuspid (TR) or pulmonic regurgitation (PR). This study aimed at investigating two-dimensional echocardiographic (2DE) variables, including pulmonary artery diameter (PAD) and pulmonary artery distensibility index (PADI), to diagnose PH.
ANIMALS, MATERIALS AND METHODS
41 healthy horses; 82 horses with TR or PR and normal intracardiac pressure gradients; and 35 horses with TR or PR velocities indicating PH. The 2DE variables were compared between groups, cut-offs for the diagnosis of PH were determined, and conditional inference trees served to identify the variable best predicting PH in the absence of TR or PR.
RESULTS
Horses with PH had larger end-diastolic cross-sectional (short-axis) PAD (PAD) (5.8 ± 1.0 cm; mean ± SD) and smaller PADI (15.4 ± 7.7%) than healthy horses (5.0 ± 0.6 cm, P<0.0001; 20.5 ± 4.4%, P<0.001) and horses with TR or PR but no PH (5.3 ± 0.6 cm, P=0.003; 18.8 ± 4.2%, P=0.005). PAD predicted PH with sensitivity (Se) = 36% and specificity (Sp) = 94% (cut-off 6.0 cm, AUC = 0.668, P=0.002), while PADI predicted PH with Se = 43% and Sp = 92% (cut-off 13.7%, AUC = 0.662, P=0.004). In the absence of TR, PAD and the end-diastolic long-axis aortic diameter-to-PAD ratio (AoD/PAD) were most suitable to diagnose PH.
CONCLUSION
Pulmonary artery crosssectional (short-axis) diameter at end-diastole measured in a right-parasternal long axis view of the left ventricular outflow tract and Pulmonary artery distensibility index were moderately specific but not very sensitive to diagnosing PH. Nonetheless, they may be used as complementary indices suggesting PH in the absence of TR or PR.
Topics: Animals; Horses; Hypertension, Pulmonary; Pulmonary Artery; Cross-Sectional Studies; Echocardiography; Pulmonary Valve Insufficiency; Horse Diseases
PubMed: 37832424
DOI: 10.1016/j.jvc.2023.08.001 -
Journal of Cardiothoracic Surgery Oct 2023Limited data on the prognostic value of periprocedural changes of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) after transcatheter aortic valve...
BACKGROUND
Limited data on the prognostic value of periprocedural changes of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) after transcatheter aortic valve replacement (TAVR).
METHODS
Data of plasma NT-proBNP were retrospectively collected in 357 patients before TAVR procedure and at discharge from January 1, 2018 to December 31, 2021 in our single center. Patients were grouped as responders and non-responders according to the NT-proBNP ratio (postprocedural NT-proBNP at discharge/ preprocedural NT-proBNP). Responders were defined as NT-proBNP ratio < 1 and non-responders were defined as NT-proBNP ratio ≥ 1. Outcomes were defined according to the Valve Academy Research Consortium (VARC)-3 criteria.
RESULTS
A total of 234 patients (65.5%) and 123 patients (34.5%) were grouped as the responders and the non-responders, respectively. Responders and non-responders were significantly different in both median preprocedural (2103.5 vs. 421.0 pg/ml, p < 0.001) and postprocedural (707.6 vs. 1009.0, p < 0.001) NT-proBNP levels. Patients in the non-responder group were more inclined to have comorbidities of hypertension (73.2% vs. 51.7%, p < 0.001), hyperlipidaemia (46.3% vs. 34.6%, p = 0.031), peripheral vascular disease (20.3% vs. 8.5%, p = 0.001) and pure aortic insufficiency (15.4% vs. 4.3%, p < 0.001). In the contrast, patients in the responder group had higher prevalence of maximum transvalvular velocity (4.6 vs. 4.2 m/s, p < 0.001), reduced left ventricular ejection fraction (58.0% vs. 63.0%, p < 0.001), heart failure (9.4% vs. 2.4%, p = 0.014), mitral regurgitation ≥ moderate (13.7% vs. 4.9%, p = 0.010), tricuspid regurgitation ≥ moderate (12.0% vs. 2.4%, p = 0.002), and pulmonary hypertension (32.9% vs. 13.0%, p < 0.001). Patients in the non-responder group were moderately longer than the responder group in total hospitalization length (14 vs. 12 days, p < 0.001). The non-responder group were significantly associated with cumulative all-cause mortality (p = 0.009) and cardiac mortality (p < 0.001) during the follow-up period.
CONCLUSIONS
Periprocedural changes of NT-proBNP is clinically useful for the risk stratification of survival in patients after TAVR.
Topics: Humans; Transcatheter Aortic Valve Replacement; Natriuretic Peptide, Brain; Stroke Volume; Retrospective Studies; Aortic Valve Stenosis; Biomarkers; Ventricular Function, Left; Peptide Fragments; Prognosis; Aortic Valve
PubMed: 37817246
DOI: 10.1186/s13019-023-02391-2 -
Journal of Cardiothoracic Surgery Oct 2023Pulmonary hypertension (PH)-associated with left heart disease (Nice PH classification group II) improves when the latter is treated; however, the treatment of PH...
Redo mitral valve replacement in an adult with severe pulmonary hypertension resulting from structural valve deterioration and left ventricular outflow tract obstruction and a history of atrioventricular septal defect repair: a case report.
BACKGROUND
Pulmonary hypertension (PH)-associated with left heart disease (Nice PH classification group II) improves when the latter is treated; however, the treatment of PH concomitant with group I PH due to congenital heart disease is difficult, and the optimal pharmacotherapy is controversial. Intervention strategies for the left-sided atrioventricular valve in partial atrioventricular septal defect (AVSD) are problematic.
CASE PRESENTATION
A 37-year-old woman who had undergone patch closure for a partial AVSD and mitral valve replacement with a rather large bioprosthesis at the juxta-annular position for mitral regurgitation 12 years earlier was referred to our institute because of severe PH. Echocardiography revealed calcification resulting in severe stenosis of the bioprosthesis and protrusion of its stent post into the left ventricular outflow tract; therefore, redo mitral valve replacement at the supra-annular position was performed using a mechanical valve. Combined group I and II PH gradually improved with meticulous postoperative medical management.
CONCLUSIONS
Severe PH due to stent post protrusion and structural valve deterioration in AVSD was successfully treated with redo mitral valve replacement. The present case was complicated with group I and II PH, for which medical therapy in conjunction with surgical treatment yielded an optimal therapeutic effect.
Topics: Female; Humans; Adult; Ventricular Outflow Obstruction, Left; Mitral Valve; Hypertension, Pulmonary; Ventricular Outflow Obstruction; Mitral Valve Insufficiency; Reoperation; Treatment Outcome
PubMed: 37794522
DOI: 10.1186/s13019-023-02371-6 -
Clinical Research in Cardiology :... Jan 2024Obesity and underweight represent classical risk factors for outcome in patients treated for cardiovascular disease. This study describes the impact of different body...
BACKGROUND
Obesity and underweight represent classical risk factors for outcome in patients treated for cardiovascular disease. This study describes the impact of different body mass index (BMI) categories on 1-year clinical outcome in patients with tricuspid regurgitation (TR) undergoing transcatheter-edge-to-edge repair (TEER).
METHODS
We analyzed 211 consecutive patients (age 78.3 ± 7.2 years, 55.5% female, median EuroSCORE II 9.6 ± 6.7) with tricuspid regurgitation undergoing TEER from June 2015 until May 2021. Patients were prospectively enrolled in our single center registry and were retrospectively analyzed. Patients were stratified according to body mass index (BMI) into 4 groups: BMI < 20 kg/m (underweight), BMI 20.0 to < 25.0 kg/m (normal weight), BMI 25.0 to > 30.0 kg/m (overweight) and BMI ≥ 30 kg/m (obese).
RESULTS
Kaplan-Meier survival curves demonstrated inferior survival for underweight and obese patients, but comparable outcomes for normal and overweight patients (global log rank test, p < 0.01). Cardiovascular death was significantly higher in underweight patients compared to the other groups (24.1% vs. 7.0% vs. 6.3% vs. 6.4%; p < 0.01). Over all, there were comparable rates of bleeding, stroke and myocardial infarction. Multivariable Cox regression analysis (adjusted for age, gender, coronary artery disease, chronic obstructive pulmonary disease, tricuspid annular plane systolic excursion, left-ventricular ejection fraction) confirmed underweight (HR 3.88; 95% CI 1.64-7.66; p < 0.01) and obesity (HR 3.24; 95% CI 1.37-9.16; p < 0.01) as independent risk factors for 1-year all-cause mortality.
CONCLUSIONS
Compared to normal weight and overweight patients, obesity and underweight patients undergoing TEER display significant higher 1-year all-cause mortality.
Topics: Humans; Female; Aged; Aged, 80 and over; Male; Tricuspid Valve Insufficiency; Body Mass Index; Overweight; Stroke Volume; Retrospective Studies; Thinness; Treatment Outcome; Heart Valve Prosthesis Implantation; Ventricular Function, Left; Obesity
PubMed: 37792020
DOI: 10.1007/s00392-023-02312-2 -
Archivos Peruanos de Cardiologia Y... 2023Aneurysm of the Sinus of Valsalva (ASV) is a rare abnormality and affects less than 0.1% of the general population. We describe the case of a 37-year-old woman with a...
Aneurysm of the Sinus of Valsalva (ASV) is a rare abnormality and affects less than 0.1% of the general population. We describe the case of a 37-year-old woman with a clinical picture characterized by dyspnea, palpitations, and syncope of 6 years of evolution. The echocardiographic study revealed a right ASV with a sub pulmonary interventricular perforation of 8mm and producing a regurgitant jet into the right ventricle, causing dilatation of the right ventricular outflow tract, pulmonary artery, and severe aortic insufficiency Carpentier DI. The patient underwent successful repair of the defect and interventricular perforation, and valve replacement was not necessary. Timely echocardiographic diagnosis and early surgery are the main predictors that make the difference between an excellent outcome and certain death.
PubMed: 37780949
DOI: 10.47487/apcyccv.v4i1.284. -
Cardiology Journal Sep 2023The aim of the study was to assess some parameters of right ventricle (RV) function as predictors of short-term mortality in patients with severe secondary mitral...
BACKGROUND
The aim of the study was to assess some parameters of right ventricle (RV) function as predictors of short-term mortality in patients with severe secondary mitral regurgitation (SMR) after mitral valve surgery.
METHODS
We conducted a retrospective analysis of 112 consecutive patients with severe SMR who had undergone mitral valve repair or replacement with or without concomitant coronary artery bypass surgery. We assessed RV to pulmonary artery coupling by calculating the ratio of tricuspid annular plane systolic excursion (TAPSE) to non-invasively estimated RV systolic pressure (RVSP). The study endpoint was 30 days post-procedural mortality.
RESULTS
Overall, the 30-day mortality was 6%. TAPSE/RVSP ratio < 0.42 mm/mmHg was a significant predictor of mortality and remained so after adjusting for age and sex. The Kaplan-Meier survival analysis showed that patients with RVSP > 55 mmHg and those with TAPSE/RVSP ratio < 0.42 mm/mmHg had a lower survival probability.
CONCLUSIONS
TAPSE/RVSP < 0.42 mm/mmHg is a strong predictor of short-term mortality in patients with SMR when considered for valve surgery.
PubMed: 37772356
DOI: 10.5603/cj.92559 -
European Review For Medical and... Sep 2023The objective of this study was to investigate the role of echocardiographic parameters in diagnosing bronchopulmonary dysplasia (BPD) in preterm infants.
OBJECTIVE
The objective of this study was to investigate the role of echocardiographic parameters in diagnosing bronchopulmonary dysplasia (BPD) in preterm infants.
PATIENTS AND METHODS
Ninety preterm infants with a gestational age of less than 32 weeks and a weight less than 1.5 kg, admitted to the neonatal intensive care unit of the hospital between January 2020 and January 2021, were selected for the study. The study subjects were divided into two groups: a BPD group (54 cases, observation group) and a non-BPD group (36 cases, control group). The correlation between tricuspid regurgitation (TR) velocity and BPD was investigated by detecting the cardiac function of preterm infants in both groups using a color Doppler ultrasound diagnostic instrument and analyzing the cardiac ultrasound results. The early prediction efficiency of TR velocity (m/s) for BPD was evaluated using the receiver operator characteristic (ROC) curve.
RESULTS
The incidence of patent ductus arteriosus (PDA) and pulmonary hypertension (PH) in the observation group was significantly higher than that in the control group. The levels of left ventricular ejection fraction (LVEF) and left ventricular shorting fraction (LVFS) were significantly lower than those in the control group (p < 0.05). The incidence of patent foramen ovale (PFO), atrial septal defect (ASD), and ventricular septal defect (VSD) in the observation group were not significantly different from the control group (p > 0.05). The proportion of tricuspid regurgitation in the observation group was significantly higher than that in the control group, and the TR velocity was significantly higher than that in the control group. The Spearman correlation analysis showed that TR velocity (m/s) was positively correlated to BPD severity (r = 0.379, p < 0.05). The area under the curve (AUC) for predicting BPD with TR velocity was 0.735. The sensitivity and specificity were 88.0% and 62.6%, respectively, when the TR velocity was 1.45 m/s.
CONCLUSIONS
Echocardiography is useful for understanding the degree of impaired cardiac function in preterm infants and for early detection of PH, which may reduce the mortality rate to a certain extent. The risk of BPD is significantly increased when TR velocity is higher than 1.45 m/s.
Topics: Infant; Humans; Infant, Newborn; Infant, Premature; Bronchopulmonary Dysplasia; Stroke Volume; Tricuspid Valve Insufficiency; Ventricular Function, Left; Echocardiography; Early Diagnosis
PubMed: 37750627
DOI: 10.26355/eurrev_202309_33558