De Vega Tricuspid Annuloplasty Research Articles

De Vega Tricuspid Annuloplasty for Pediatric Patients: Growth Potential of the Plicated Annulus.

Although De Vega annuloplasty is an important option for pediatric patients with functional tricuspid regurgitation (TR), little is known about its long-term results, including the future of the plicated annulus. We retrospectively reviewed our experience with pediatric patients who underwent the De Vega annuloplasty between 2005 and 2020. Tricuspid valve assessments were performed by transthoracic echocardiography. The targeted diameter of annular plication was 80 to 90% of normal tricuspid diameter, according to the patient's condition. The study included 55 patients (41 with biventricular physiology (group B), 14 with univentricular physiology (group U)) with a median follow-up of 5.0years. Median age at operation was 5.0years. There was one late death due to severe mitral regurgitation. Tricuspid valve reoperation was required in five patients and the 10-year freedom from reoperation was 91.9% for the entire cohort. The 10-year freedom from the composite adverse outcome of death, reoperation, and significant TR was 79.2% in group B versus 56.6% in group U (p = 0.034). TR grade significantly decreased after surgery (p < 0.001), without significant aggravation during the postoperative follow-up. No patients presented tricuspid stenosis. Mean Z-scores of annular diameter immediately after operation and at the latest follow-up were - 0.65 ± 0.56 versus - 0.47 ± 0.65 (p = 0.57). De Vega annuloplasty is a safe, efficient, and durable procedure for functional TR in pediatric patients including those with univentricular physiology, allowing adequate growth of the plicated annulus without the progression of tricuspid stenosis.

Conduction Abnormalities Associated with Tricuspid Annuloplasty in Cardiac Transplantation.

Prophylactic DeVega tricuspid annuloplasty (DVA) of the donor heart has been reported to improve tricuspid regurgitation (TR), renal dysfunction, and mortality in cardiac transplant recipients. This is the first study to investigate the electrical, as well as, hemodynamic effects of DVA during orthotopic heart transplantation (OHT). Electrocardiographic, echocardiographic, and hemodynamic data of 76 patients with DVA and 104 patients without DVA who underwent OHT between 2013 and 2017 at Columbia University Medical Center (New York, NY) were studied. Patients with DVA were older (56.5 ± 1.2 vs. 52.4 ± 1.0 years of age; p = 0.017) and predominantly men (78% vs. 68%; p = 0.02). There were no significant differences in right ventricular function and TR. Patients with DVA had increased incidence of right bundle branch block compared with without DVA (37% ± 5.9% vs. 9% ± 2.9%; p < 0.001). Three patients with DVA developed complete heart block (CHB), whereas no patients without DVA developed CHB (p = 0.04). Four patients with DVA received a pacemaker (PPM), whereas only one patient in the without DVA group received a PPM. Complete heart block was significantly increased in patients who received prophylactic DVA. Possible risk of conduction abnormalities should be considered with performance of DVA annuloplasty in cardiac transplant recipients.

Total Anomalous Pulmonary Venous Connection in a Teenage Patient

Total anomalous pulmonary venous connection is usually seen and treated in childhood or in neonatal period in his obstructive type. Sometime it can be detected beyond the first decade. The objective of this case report is to give prove of the fact that it can be seen and treated in a teenager. We present a rare case of 15 years old boy who was admitted for supraventricular tachycardia with hypotension. Emergency electrocardiography showed atrial Flutter with a frequency of 225 beats/min. He complained from dyspnea state 2 at New York Heart Association functional classification before. The echocardiography showed a dilated coronary sinus in cardiac-type total anomalous pulmonary venous connection associated with a large atrial septal defect. Cardiac rhythm was normal after administration of Amiodarone. In cardiopulmonary bypass, an incision was made from the atrial septal defect to unroof the coronary sinus; a large pericardial patch was put to close the unroofing coronary sinus and let it in the left atrium. A De Vega tricuspid annuloplasty was done to reduce the tricuspid valve leak. The patient’s postoperative course was uneventful and was discharged in day 9 after operation. Total pulmonary venous return can evolve until teenage if the atrial septal defect is large. Evolution is good after a complete repair.

The Minimally Invasive Right Vertical Infra-axillary Lateral Minithoracotomy Approach For The Heart Valve Surgery: Report of 115 Cases

Objective: We have developed a minimally invasive technique for heart valve replacements through a lateral mini-thoracotomy via a small right infra-axillary skin incision, and have evaluated its initial results. Methods: Through right vertical infra-axillary lateral minithoracotomy incision (by third intercostal space), 106 patients with rheumatic heart valve disease underwent heart valve surgery, 4 patients with left atrial myxsoma and 5 patient with large atrial septal defect underwent open heart operation are included in this study from July 2012 to December 2015. Results: 42 isolated mitral valve replacements, 7 mitral valve replacements and DeVega tricuspid annuloplasty, 3 mitral and tricuspid valve replacement, 2 mitral valve replacement and right coronary artery bypass graft, 1 reoperative mitral valve replacement due to dejeneration of the bioprothesis of the mitral valve, 6 mitral valve repair, 1 mitral valve repair and aortic valve replacement; 33 isolated aortic valve replacements, 9 aortic and mitral double valve replacements, 2 triple valve replacements, 4 excision of the left atrial myxsoma and 5 surgical closure of the large atrial septal defect were performed. There were 52 women (45%) and 63 men (55%). The mean and range of age was 48±9 (14-91). The length of the incision averaged 8.5±0.5 cm, There were 4 operative mortalities, one patient from infective endocarditis and multisystem organ failure, the other patients from cardiac failure in the hospital. The results of follow up for other patients were fine. Conclusions: This minimally invasive right vertical infra-axillary lateral minithoracotomy approach is safely, practicable, useful, economic, small wounded, cosmetic, contemporary and modern approach for the heart valve surgery

The Mid-Term Results of Patients who Underwent Radiofrequency Atrial Fibrillation Ablation Together with Mitral Valve Surgery.

ObjetiveSaline-irrigated radiofrequency ablation, which has been widely used for surgical treatment of atrial fibrillation in recent years, is 80-90% successful in achieving sinus rhythm. In our study, our surgical experience and mid-term results in patients who underwent mitral valve surgery and left atrial radiofrequency ablation were analyzed.MethodsForty patients (15 males, 25 females; mean age 52.05±9.9 years; range 32-74) underwent surgery for atrial fibrillation associated with mitral valvular disease. All patients manifested atrial fibrillation, which started at least six months before the surgical intervention. The majority of patients (36 patients, 90%) were in NYHA class III; 34 (85%) patients had rheumatic heart disease. In addition to mitral valve surgery and radiofrequency ablation, coronary artery bypass, DeVega tricuspid annuloplasty, left ventricular aneurysm repair, and left atrial thrombus excision were performed. Following discharge from the hospital, patients' follow-up was performed as outpatient clinic examinations and the average follow-up period of patients was 18±3 months.ResultsWhile the incidence of sinus rhythm was 85.3% on the first postoperative day, it was 80% during discharge and 71% in the 1st year follow-up examination.ConclusionRadiofrequency ablation is an effective method when it is performed by appropriate surgical technique. Its rate for returning to sinus rhythm is as high as the rate of conventional surgical procedure.

Repair of Functional Tricuspid Regurgitation: Comparison Between Suture Annuloplasty and Rings Annuloplasty

The purpose of this study was to review our experience with modified De Vega tricuspid annuloplasty versus ring annuloplasty for treating functional tricuspid regurgitation (TR). In all, 448 consecutive patients undergoing tricuspid annuloplasty with concomitant procedures between 2000 and 2012 were included. Modified De Vega annuloplasty was performed in 216 patients (group 1) and ring annuloplasty in 232 patients (group 2). Clinical and echocardiographic follow-up results were used to assess TR grade. Recurrent TR was defined as grade 2 or greater at echocardiography. Preoperative clinical and echocardiographic characteristics were comparable in the two groups. Early mortality was similar (group 1, 0.9%, versus group 2, 1.3%; p<0.67). Follow-up was available for 97%; New York Heart Association class and symptoms of right-side heart failure were significantly improved. Survival rates at 1 and 5 years were comparable (97% and 84% for group 1, and 96% and 82% for group 2, respectively). Postoperative echocardiography showed significant improvement in tricuspid valve function, with reduction in TR grade from 3.4 to 0.6, and no differences between groups. However, recurrence-free survival was better for group 2 than for group 1 (78.8% versus 74.5%; p<0.62). Risk factors for recurrent TR included severity of preoperative TR, atrial fibrillation, and pulmonary hypertension. The modified De Vega tricuspid annuloplasty is acceptable for repair of functional TR and improvements in clinical and echocardiographic status on a long-term basis, although the long-term recurrence-free survival appeared to be lower than that for ring annuloplasty.

Midterm Clinical and Echocardiographic Results of a Modified De Vega Tricuspid Annuloplasty for Repair of Functional Tricuspid Regurgitation

BackgroundThere is an ongoing debate whether the tricuspid valve (TV) should be repaired with a suture annuloplasty or a prosthetic ring. MethodsTwo hundred thirty-seven patients underwent a modified De Vega tricuspid annuloplasty for tricuspid regurgitation (TR) as part of the cardiac surgical procedure. Follow-up information was obtained for 230 patients, with a mean follow-up time of 6.5 ± 3.2 years. Analysis is based on Doppler echocardiographic evaluation. Survival and development of recurrent TR were evaluated by Kaplan-Meier analysis. Risk factors for recurrent TR were identified and analyzed by multivariable ordinal longitudinal methods. ResultsNo deaths had occurred at the time of follow-up. Early predischarge echocardiography quantified TR as 1+ in 227 patients (95.8%), 2+ in 8 patients (3.4%), and 3+ in 2 patients (0.8%). No patients had TR classified as 4+. The mean TR grade decreased from 3.4 ± 0.2 preoperatively to 1.6 ± 0.6 on predischarge echocardiography (P < 0.01). During follow-up, the most recent echocardiogram showed TR was 1+ in 88.3% of patients, 2+ in 10.4% of patients, 3+ in 1.3% of patients, and 4+ in 0% of patients, with a small increase in mean TR compared with predischarge echocardiography. No patient required TV reoperation. Risk factor analysis revealed that higher preoperative regurgitation grade, higher systolic pulmonary arterial pressure (sPAP), and preoperative New York Heart Association (NYHA) grade IV were independent predictors of recurrent TR. Five-year actuarial freedom from congestive heart failure (CHF) and late TR were 86.7% ± 2.4% and 88.5% ± 0.2%, respectively. ConclusionsA modified De Vega suture annuloplasty was effective at eliminating TR and producing right ventricular (RV) reverse remodelling at 5-year follow-up, although TR tends to increase with time.

ADJUSTED DE VEGA TRICUSPID ANNULOPLASTY GUIDED BY INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAM

Functional tricuspid regurge (FTR) is an important dilemma in cardiac surgery, and tricuspid annular dilation is a reliable indicator of the degree of FTR. Many methods are available for repair: Ring repair is believed to be more durable than suture annuloplasty, however the suture repair still holds a place. This work was conducted over 60 patients with history of rheumatic heart disease with predominance mitral valve diseases, pulmonary hypertension (PH) and FTR.Group I : 30 patients had ADVTA using intraoperative TEE. Group II: 30 patients had conventional De Vega tricuspid annuloplasty(CDVTA). The two groups were assessed immediately and six months later by TTE. There was a significant relation between PH and tricuspid valve annulus diameter (TVAD) in Group I (mean TVAD in PH grade 2 is 38.0+6.5 mm, while in PH grade 3 mean TVAD is 41.1+4.6). Also PH correlates significantly with TVAD in Group II. Results showed advantage of ADVTA in avoiding postoperative residual TR due to accurate application of tension(Preoperative FTR grade 2 in 12 patients and FTR grade 3 in 18 patients, immediate postoperative TR grade 2 in 4 patients and no patient in TRgrade 3,late postoperative TR grade 2 in 6 patients and TR grade 3 in one patient). Results demonstrated superiority of ADVTA in decreasing postoperative diastolic gradient(PODG) on tricuspid valve and in avoiding tricuspid stenosis (immediate PODG in Group I is 5.4+3.2 mmHg and 9.1+3.3mmHg in Group II, late PODG in Group I is 5.9+3.3 mmHg and 9.9+3.5 mmHg in Group II). ADVTA guided by TEE still holds a place as it is quick, inexpensive, devoid of use of foreign body especially in the presence of infection, and showed durability.

Surgical Outcome of Isolated Total Anomalous Pulmonary Venous Connection in Adults: A 14-Year Experience

To investigate the surgical result of adult total anomalous pulmonary venous connection (TAPVC). From March 1997 to March 2011, 12 adult cases of isolated TAPVC, with an average age of 24.9 ± 6.7 years (from 18 to 41 years), underwent surgical repair in our department. All patients suffered from right-sided volume overload with clinical manifestations varying from mild cyanosis to severe heart failure. According to Darling's classification, eight cases were classified as supracardiac type, four as cardiac type. Unobstructed connections were established between the left atrium and the pulmonary common vein in all patients with external cardiac approach in four supracardiac cases, and internal cardiac approach in four cardiac and three supracardiac cases, and Warden technique in one supracardiac patient. Concomitant operations included De Vega's tricuspid annuloplasty in six patients, patent arteriosus ductus closure in two. All patients survived the operation, and postoperative follow-up was 100% complete with a period ranging from 10 months to 14 years. NYHA grade decreased from 2.33 ± 0.49 to 1.08 ± 0.29 (p < 0.01). Three patients had postoperative tricuspid insufficiency. Five patients had cardiac arrhythmia, among two symptomatic cases; one controlled with medication, another received a successful radiofrequency ablation for incision-related atrial flutter. Surgical correction of isolated adult TAPVC can be carried out safely with acceptable long-term outcome. Postoperative tricuspid insufficiency and cardiac arrhythmias may have a negative long-term impact, which should be evaluated preoperatively and managed individually during surgery.

La visión global de la anuloplastia de De Vega

AbstractThe world view on De Vega annuloplastyThe De Vega tricuspid annuloplasty was first published in 1972. after its description it became a well-known surgical technique whose use quickly spread all over the world. Due to its conceptual and practical simplicity, this technique has been easily reproduced with good results in terms of valve functionality and clinical impact. The development of different types of rings allowed for different views of tricuspid valve disease and some reports described the superiority of prosthetic devices for repair compared to suture annuloplasty. however, at the moment, de Vega annuloplasty is still a popular and widely used technique and the proof of superiority of rings over suture annuloplasty is still debatable. the de Vega annuloplasty has stood the test of time and offers consistent results over time.

Echocardiographic Predictors of Adverse Short-term Outcomes after Heart Surgery in Patients with Mitral Regurgitation and Pulmonary Hypertension

Pulmonary hypertension (PH) is a frequent occurrence and a negative prognostic indicator in patients with mitral regurgitation. Preoperative PH causes higher early and late mortality rates after heart surgery, adverse cardiac events, and postoperative systolic dysfunction in the left ventricle (LV). The research consisted of a retrospective study of a group of 171 consecutive patients with mitral regurgitation and preoperative PH who had undergone mitral valve surgery between January 2008 and October 2011. The PH diagnosis was based on echocardiographic evidence (systolic pulmonary artery pressure [sPAP] >35 mm Hg). The echocardiographic examination included assessment of the following: LV volume, LV ejection fraction (LVEF), sPAP, right ventricular end-diastolic diameter, right atrium area indexed to the body surface area, the ratio of the pulmonary acceleration time to the pulmonary ejection time (PAT/PET), tricuspid annular plane systolic excursion (TAPSE), determination of the severity of the associated tricuspid regurgitation, and presence of pericardial fluid. Surgical procedures consisted of mitral valve repair in 55% of the cases and mitral valve replacement in the remaining 45%. Concomitant coronary artery bypass grafting (CABG) surgery was carried out in 52 patients (30.41%), and De Vega tricuspid annuloplasty was performed in 29 patients (16.95%). The primary end point was perioperative mortality. The secondary end points included the following: pericardial, pleural, hepatic, or renal complications; the need for a new surgical procedure; postoperative mechanical ventilation >24 hours; length of stay in the intensive care unit; duration of postoperative inotropic support; need for an intra-aortic balloon pump; and need for pulmonary vasodilator drugs. The mortality rate was 2.34%. In the univariate analysis, the clinical and echocardiographic parameters associated with mortality were preoperative New York Heart Association (NYHA) class IV, the PAT/PET ratio, TAPSE, the indexed area of the right atrium, and concomitant CABG surgery. In the multivariate analysis, the indexed area of the right atrium and concomitant CABG surgery remained statistically significant. The multivariate analysis also showed the indexed area of the right atrium, LVEF, presence of pericardial fluid, preoperative NYHA class, and concomitant CABG surgery as statistically significant for the secondary end point. The receiver operating characteristic (ROC) curves identified an sPAP value >65 mm Hg to have the highest specificity and sensitivity for the risk of perioperative death in mitral regurgitation patients (area under the ROC curve [AUC], 0.782; P < .001) and identified an sPAP value of 60 mm Hg as the secondary end point (AUC, 0.82; P < .001). Severe PH (sPAP >60 mm Hg) is associated with a significant increase in the mortality rate; a longer stay in the intensive care unit; a mechanical ventilation duration >24 hours; lengthy inotropic support; renal, hepatic, and pericardial complications; and a need for endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, and/or prostanoids, both in the general group and in patients with preserved systolic functioning of the left ventricle. PH is a strong short-term negative prognostic factor for patients with mitral regurgitation. The surgical procedure should be performed in the early stages of PH. Echocardiographic examination has useful, simple, and reproducible tools for classifying operative risks. An ischemic etiology and a need for concomitant CABG surgery are additional risk factors for patients with mitral regurgitation and PH.

Successful Use of Fondaparinux for Bridging Early After Aortic and Mitral Mechanical Heart Valve Replacement

To report a case of successful use of fondaparinux for bridging early after aortic and mitral mechanical heart valve replacement (MHVR). A 71-year-old female underwent aortic and mitral valve replacements with St. Jude medical bileaflet prostheses, as well as DeVega tricuspid annuloplasty and coronary artery bypass graft. Anticoagulation was initially withheld following the procedure because of thrombocytopenia, large amount of chest tube drainage (~1 L/day), and concerns regarding postoperative bleeding. The thrombocytopenia (baseline platelet count 183 x 10(3)/μL; postoperative platelet count 44 × 10(3)/μL) was thought to be a consequence of the cardiopulmonary bypass; there was a low probability of heparin-induced thrombocytopenia. However, the care team preferred to avoid heparin products and initiated fondaparinux 7.5 mg subcutaneously once daily on postoperative day 8 once the patient's platelet count had recovered to >100 x 10(3)/μL. The treatment was bridged to warfarin on postoperative day 13 and the patient was discharged home after receiving 8 days of fondaparinux. Throughout the patient's hospitalization and upon follow-up on postoperative day 31, there were no signs or symptoms of thromboembolic events or bleeding. Unfractionated heparin and low-molecular-weight heparins are the standard of care for bridging to warfarin in patients with MHVR. The use of fondaparinux following MHVR has not been studied in randomized controlled trials. In vitro studies support the effectiveness of fondaparinux in preventing thrombus formation on mechanical heart valves. However, the only data available in humans as of December 2011 are 3 case reports. Two of these case reports described the successful use of fondaparinux for anticoagulation in a patient with an aortic valve replacement. In the third case report, the patient had an aortic and mitral valve replacement. Our case report is novel because it describes the use of fondaparinux early after MHVR, which is the most critical time period for effective thromboprophylaxis. The use of fondaparinux for postoperative bridging in our patient early after combined aortic and mitral MHVR was effective. However, until studies evaluate the efficacy and safety of fondaparinux in patients with MHVR, its use should be considered only when heparin products are contraindicated.

328 Early postoperative results of De Vega tricuspid annuloplasty for tricuspid regurgitation in rheumatic Mitral disease

Tricuspid regurgitation (TR) in patients with mitral valve (MV) disease is associated with poor outcome and predicts poor survival, heart failure, and reduced functional capacity. We review our early results in patients who required surgical correction of tricuspid valve disease with concomitant rheumatic disease of the mitral valve operated on between 2005 and 2008. We studied 68 consecutive patients (mean age, 32 years). All patients were investigated perioperatively by Doppler echocardiography. Echocardiographic assessment of tricuspid incompetence was on the basis of gradation of tricuspid regurgitation severity according to color Doppler flow criteria, the flow convergence region proximal to the regurgitant orifice (PISA), the size of the tricuspid annulus, and estimation of the pulmonary artery systolic pressure by continuous Doppler. Median tricuspid insufficiency was 3+. Tricuspid lesions were functional in 59 patients and organic in 9 patients. The cause was rheumatic mitral valve disease in all patients. Any patient has an aortic surgical dlession. All patients underwent De Vega tricuspid annuloplasty at the time of mitral surgery. There was one operative death. Prosthetic mitral replacement was performed in 57 patients (83.82%) and a mitral valve repair in 11 patients (16.17%). There was 1+ or less TR in 59 patients (86.7%), moderate TR 2+ in 7 patients (10.2%) and severe TR 3+ in two patients how had a severe pulmonary hypertension. Aggressive repair of accompanying TR should be undertaken at the time of initial mitral surgery. Tricuspid valve repair, described by De Vega, is a simple, short, and inexpensive procedure with few complications.

Complete Surgical Correction for Impending Paradoxical Embolism with Pulmonary Embolism, Tricuspid Regurgitation, and Atrial Flutter

Impending paradoxical embolism through a patent foramen ovale with concomitant pulmonary embolism is a rare entity that requires urgent treatment. We present the case of a 74-year-old woman with acute pulmonary embolism and atrial flutter and with echocardiographic features of impending paradoxical embolism through the patent foramen ovale and tricuspid regurgitation. We performed an open pulmonary embolectomy with removal of thrombus from both atria, closure of the patent foramen ovale, a right-sided modified Maze procedure, and De Vega's tricuspid annuloplasty. The patient made a satisfactory recovery. Surgical management is preferable in this setting because it provides the opportunity to correct any associated cardiac abnormalities.

Predictors of secondary tricuspid regurgitation after left-sided valve replacement

To evaluate the risk factors of tricuspid regurgitation (TR) after left-sided valve replacement (LSVR) and plan the initial surgical treatment of TR. Two hundred and forty-eight patients, including 217 patients in the LSVR group and 31 patients in the LSVR+DeVega group, were followed up. A retrospective analysis was performed on 14 characteristics in the LSVR group. Variables were used to evaluate predictors of TR progression after single LSVR by either a univariate or multivariate analysis. DeVega's tricuspid annuloplasty was evaluated on progress of TR by univariate analysis. The mean follow-up was 5.2 +/- 2.9 (range, 3-16) years after surgery. In a univariate analysis, atrial fibrillation, huge left atrium, long time from onset to surgery, tricuspid rheumatic changes, preoperative +2 or +3 TR, the degradation of left ventricular ejection fraction, augmented right atrium, and single mitral valvular disease were significant risk factors for TR development. A multivariate analysis indicated that the four items mentioned above were statistically significant predictors of TR after surgery. The progress of TR in the LSVR+DeVega group was significantly less than in the LSVR group. An aggressive repair of accompanying TR should be performed at the time of initial surgery in patients with a huge left atrium, atrial fibrillation, long time from onset to surgery, or tricuspid rheumatic changes. DeVega's tricuspid annuloplasty therefore helps prevent a progression of TR.

De Vega annuloplasty for tricuspid valve repair in posttraumatic tricuspid insufficiency — 16 years experience

Posttraumatic tricuspid insufficiency (PTI) is an uncommon clinical condition and frequently difficult to diagnose due to latent development of cardiac symptoms. The selection of an appropriate surgical treatment for PTI has been controversial. A simple and effective method of choice is De Vega tricuspid annuloplasty. We report here the excellent surgical result of a tricuspid valve repair using De Vega annuloplasty at a 16-year follow-up in a patient who developed PTI as a complication of blunt chest trauma. In conclusion De Vega tricuspid annuloplasty can be recommended for tricuspid reconstruction.

Systematic Reductive Annuloplasty of the Mitral and Tricuspid Valves in Patients With End-Stage Ischemic Dilated Cardiomyopathy

Patients with ischemic dilated cardiomyopathy exhibit extensive remodeling of the left ventricle, annular dilation, and significant mitral and tricuspid regurgitation. These changes increase per operative morbidity and mortality, and emphasize patient candidacy for heart transplantation. The aim of this study is to show immediate and long-term results after reductive annuloplasty of double (mitral and tricuspid) orifices, performed at the time of coronary artery bypass grafting, as an alternative to heart transplantation. There were 226 consecutive patients (205 males, 21 females) with ischemic dilated cardiomyopathy, mean ejection fraction below 30% [(26.6 +/- 3.1)%], and mean left ventricle end-diastolic internal diameter greater than 7.0 cm (7.3 +/- 0.3 cm). In addition to myocardial revascularization, Carpentier's mitral annuloplasty and posterior semicircular reductive annuloplasty were performed in 37 and 189 patients, respectively. In all 226 patients, a modified De Vega's tricuspid annuloplasty was performed. Postoperative 30-day mortality was 7.5% (17 patients). Survival rates after 5 and 10 years were (61.5 +/- 4.0)% and (38.05 +/- 8.0)%, respectively. Reductive annuloplasty of mitral and tricuspid orifices performed at the time of myocardial revascularization could be beneficial in selective patients with ischemic dilated cardiomyopathy. Results indicate that this method should not be recognized as a valve repair, but ventricular repair procedure also.

Fatal early acute thrombosis of mechanical mitral prosthesis

To report a rare case of fatal early acute thrombosis of mechanical mitral prosthesis. A 62-year-old lady, who underwent closed mitral valvotomy for rheumatic heart disease 19 years ago, presented with Canadian Cardiovascular Society Class II angina and New York Heart Association Class III dyspnoea. Investigations including echocardiogram and cardiac catheterisation revealed mixed mitral valve disease. She had severe pulmonary artery hypertension with pulmonary artery wedge pressure of 35 mm of mercury. Significant stenosis in the midportion of dominant right coronary artery was also demonstrated. She underwent mitral valve replacement using mechanical tilting disc prosthesis, DeVega tricuspid annuloplasty and saphenous vein bypass graft to the distal right coronary artery. After having made satisfactory early postoperative progress, she suffered an asystolic cardiac arrest about 26 h postoperatively. The patient succumbed despite all resuscitative measures. Autopsy revealed an adherent thrombus occluding the atrial surface of the minor orifice of mechanical prosthesis, which prevented the valve from functioning. To the best of our knowledge, this is the first case of prosthetic valve thrombosis (PVT) occurring on the first postoperative day in a patient with a mechanical valve prosthesis, without any circulatory assist device.

Primary Cardiac Sarcoma in Pregnancy: A Case Report

Primary cardiac sarcoma is a rare disease in adults. It is also associated with poor prognoses, due to diagnostic delay, therapeutic difficulty, and high metastatic potential. The coincidence of pregnancy and a primary cardiac intimal sarcoma is extremely rare. We report a pregnant woman at 27+5 weeks gestation who was admitted to the hospital with acute-onset dyspnea. A mass was found on the left atrium by transthoracic echocardiography. Subsequently, the intracardiac mass was removed, and mitral valve replacement and modified DeVega tricuspid annuloplasty were performed. The patient was diagnosed with a undifferentiated sarcoma, and gave birth to a 1,230 g living baby boy by Caesarean section from preterm contraction at 29+5 weeks gestation. The patient then received systemic chemotherapy. However, 10 months after the initial clinical onset, the patient suddenly died. Surgery is the standard treatment for cardiac tumors, and their removal should always be attempted, even in pregnant women. Although the overall survival rates of the patients are rather poor, palliative cardiac surgery allows the prolonging of pregnancy, until an acceptable fetal viability level is reached.

De Vega tricuspid annuloplasty for tricuspid regurgitation in children

Background. Significant tricuspid valve regurgitation (TR) occurs with other congenital heart defects, typically after repair of right-sided obstructive lesions. Since 1991, we applied the De Vega tricuspid annuloplasty technique for TR in children. Methods. Forty-one children, aged 5 months to 22.7 years (mean, 9.9 years) underwent 42 De Vega tricuspid annuloplasties for moderate or severe TR during correction of other heart defects. One child had a De Vega during primary ventricular septal defect repair. The remaining patients had prior repair of tetralogy of Fallot or pulmonary atresia, or both (19 patients), double-outlet right ventricle (6 patients), pulmonary stenosis (4 patients), pulmonary atresia and intact ventricular septum (3 patients), complete atrioventricular septal defect (3 patients), and other diagnoses (6 patients). At the time of the De Vega, 37 patients (88%) had pulmonary valve replacement or right ventricular to pulmonary artery conduit replacement. Other procedures included aortic or mitral repair or replacement (6 patients), atrial septal defect and ventricular septal defect closure (5 patients), pulmonary arterioplasty (6 patients), and tracheoplasty (1 patient). Results. There were no deaths at follow-up of 3.4 ± 2.1 years; 1 child required cardiac transplantation 17 months postoperatively. Early postrepair echocardiography quantified TR as absent or mild (34 patients; 81%), mild-to-moderate (4 patients), moderate (3 patients), and severe (1 patient). The most recent echocardiogram showed moderate TR in 11 patients and severe TR in 2 patients (both with recurrent right ventricular hypertension). One child required tricuspid valve replacement 3 years later and 1 child had redo De Vega at the time of conduit re-replacement. No other child has symptomatic TR, significant tricuspid stenosis, or De Vega-related pacemaker implantation. Conclusions. The De Vega tricuspid annuloplasty safely provides excellent relief of TR, usually in children undergoing pulmonary valve replacement or conduit replacement. Although echocardiographic TR tends to increase with time (especially with right ventricular hypertension), it rarely requires reintervention or causes symptoms.