Pulmonary Regurgitation Research Articles

Early postoperative tachyarrhythmias in adult congenital heart surgery: an eight-year review at a tertiary university hospital in Thailand.

Tachyarrhythmias are a common and significant complication following surgery for adult congenital heart disease (CHD), adversely affecting morbidity. This study aimed to assess the incidence, characteristics, and risk factors of early postoperative tachyarrhythmias in adults undergoing CHD surgery. We conducted a retrospective cohort study at Siriraj Hospital, Bangkok, Thailand, including 311 adult patients who underwent elective CHD surgeries from March 2013 to November 2020. We analyzed demographic and surgical data, focusing on new-onset tachyarrhythmias requiring interventions such as antiarrhythmic drugs or cardioversion. The patient cohort had a median age of 34 years (range, 18-78 years), with 34.7% male, predominantly diagnosed with atrial and ventricular septal defects (54.7%), and severe pulmonary regurgitation post-tetralogy of Fallot repair (22.2%). Postoperative tachyarrhythmias occurred in 12.9% of patients, with atrial fibrillation (AF; 67.5%) and atrial flutter (AFL; 14.5%) being the most frequent. Independent risk factors for tachyarrhythmias included older age [adjusted odds ratio (OR) =1.26 per 5-year increment; 95% confidence interval (CI): 1.12-1.42; P<0.001] and left atrial enlargement (adjusted OR=2.78; 95% CI: 1.31-5.85; P=0.007). Early postoperative tachyarrhythmias are prevalent in adults undergoing CHD surgery, with advanced age and left atrial enlargement as significant risk factors. These findings underscore the importance of early detection and management of septal defects and advocate for enhanced screening and healthcare strategies to reduce postoperative complications in this population.

Assessment of right ventricular function in significant pulmonary regurgitation by 2d echocardiography after repair of tetralogy of fallot

Assessment of right ventricular function in significant pulmonary regurgitation by 2d echocardiography after repair of tetralogy of fallot

Respiratory and haemodynamic effects of 6h-pronation in neonates recovering from respiratory distress syndrome, or affected by acute respiratory distress syndrome or evolving bronchopulmonary dysplasia: a prospective, physiological, crossover, controlled cohort study.

Pronation ameliorates oxygenation in adults with acute respiratory distress syndrome (ARDS); the effect in neonates with ARDS or other types of respiratory failure is unknown. We aimed to verify if pronation has similar respiratory and haemodynamic effects in three common types of neonatal respiratory failure. Prospective, physiologic, crossover, quasi-randomised, controlled cohort study performed in a tertiary academic neonatal intensive care unit. We enrolled neonates with: 1) recovering respiratory distress syndrome (RDS, mild restrictive pattern); 2) neonatal ARDS (NARDS, severe restrictive pattern); or 3) evolving bronchopulmonary dysplasia (BPD), that is chronic pulmonary insufficiency of prematurity (mixed restrictive/obstructive pattern). Neonates with other lung disorders, malformations or haemodynamic impairment were excluded. Patients were started prone or supine and then shifted to the alternate position for 6h; measurements were performed after 30' of "wash out" from the positioning and at the end of 6h period. Primary outcomes were respiratory (PtcCO2, modified ventilatory index, PtcO2/FiO2, SpO2/FiO2, oxygenation index, ultrasound-assessed lung aeration) and haemodynamic (perfusion index, heart rate, arterial pressure, cardiac output) parameters. Between May 1st, 2019, and May 31st, 2021, 161 participants were enrolled in this study, and included in the final analysis. Pronation improved gas exchange and lung aeration (p always <0.01) and these effects were overturned in the alternate position, except for lung aeration in NARDS where the improvement persisted. The effects were greater in patients recovering from RDS than in those with evolving BPD than in those with NARDS, in this order (palways <0.01). Pronation produced a net recruitment as lung ultrasound score decreased in patients shifted from supine (16.9 (standard deviation: 5.8)) to prone (14.1 (standard deviation: 3.3), p<0.01) and this reduction correlated with oxygenation improvement. Haemodynamic parameters remained within normal ranges. 6h-pronation can be used to improve gas exchange and lung aeration in neonates with recovering RDS, evolving BPD or NARDS without relevant haemodynamic effects. None.

Comprehensive outcomes after primary arterial switch operation.

To report the long-term outcomes of the arterial switch operation for transposition of the great arteries. The data of 35 patients who underwent an arterial switch operation between April 2006 and May 2021 were retrospectively examined; five had double-outlet right ventricles, three had side-by-side transposition, and 27 had d-transposition. The punch-out technique was the basic method for coronary transplantation; however, if coronary artery kinking after additional peeling was a concern, the trap-door technique was used. In aortic reconstruction, the caliber difference between the neoascending aorta and the native pulmonary artery was fixed using the pulmonary artery flap. In pulmonary reconstruction, the pulmonary artery was bilaterally exposed over the second branch. The median age at operation and follow-up duration were 10.0 (8.0-12.5) days and 72.9 (40.7-139.5) months, respectively. Thirty-four patients survived, and one was lost to follow-up ([coronary transplantation]: right coronary artery, punch-out = 31, trap-door = 2; left coronary artery, punch-out = 28, trap-door = 7; [aortic regurgitation]: no-slight = 27, mild = 6, moderate = 1; [pulmonary regurgitation]: no-slight = 22, mild = 11, moderate = 1). Slight coronary bending occurred in two patients; ischemia was not observed. Catheter stent placement was performed in one of three patients with stenosis at the pulmonary artery bifurcation. Catheter balloon dilation was performed in one patient with supravalvular pulmonary stenosis. There were no cases of coronary, aortic, or pulmonary artery reoperations. The 15-year cumulative reintervention avoidance rate was 91.0%. There were no deaths or reoperations during the long-term follow-up period, and arterial switch operation outcomes at our hospital were satisfactory.

Experimental Cardiac Toxicity Induced by the Injection of Uracoan Rattlesnake (Crotalus vegrandis) and the Black Rattlesnake (Crotalus pifanorum) Venoms

Background Snakebite is a collective health problem that afflicts areas with poor healthcare coverage. Venezuela has an important population of snakes, including the endemic species Crotalus vegrandis and Crotalus pifanorum, whose venom has not been fully characterized, especially of those aspects related to cardiac electrophysiology. Aims In this sense, this work aims to characterize the electrocardiographic and histopathological effect of crude venom of C. vegrandis and C. pifanorum on albino Naval Medical Research Institute (NMRI) mice. Results For this, mice were gathered in C. pifanorum and C. vegrandis experimental groups, including normal controls and envenomed mice injected with commercial antivenom. C. vegrandis venom showed a significant T and S wave flattening and pulmonic (pulmonary) regurgitation (PR) enlargement, in addition to atrial ectopic activity, notched R wave, triggered activity, and T wave inversion. C. pifanorum was the only group that registered triggered activity. Antivenom was able to revert conduction disorders showing a statistical increase in arrhythmogenic compared by χ2 . The multidimensional comparison confirmed the statistical differences between C. vegrandis and C. pifanorum venoms and between antivenom vs non-antivenom groups, detecting variables associated with cardiac conduction, as the most important variables. Conclusion In conclusion, this work demonstrated, as far as we know, for the first time the cardiotoxic effects associated with C. vegrandis and C. pifanorum venom injection, subsequently suggesting the duty of including an electrocardiogram in the consultation of any accident caused by these species.

Machine Learning-Based Scoring System for Early Prognosis Evaluation of Patients with Coronavirus Disease 2019

Abstract Background The global spread of coronavirus disease 2019 (COVID-19) continues to threaten human health security, exerting considerable pressure on healthcare systems worldwide. While prognostic models for COVID-19 hospitalized or intensive care patients are currently available, prognostic models developed for large cohorts of thousands of individuals are still lacking. Methods Between February 4 and April 16, 2020, we enrolled 3,974 patients admitted with COVID-19 disease in the Wuhan Huo-Shen-Shan Hospital and the Maternal and Child Hospital, Hubei Province, China. (1) Screening of key prognostic factors: A univariate Cox regression analysis was performed on 2,649 patients in the training set, and factors affecting prognosis were initially screened. Subsequently, a random survival forest model was established through machine analysis to further screen for factors that are important for prognosis. Finally, multivariate Cox regression analysis was used to determine the synergy among various factors related to prognosis. (2) Establishment of a scoring system: The nomogram algorithm established a COVID-19 patient death risk assessment scoring system for the nine selected key prognostic factors, calculated the C index, drew calibration curves and drew training set patient survival curves. (3) Verification of the scoring system: The scoring system assessed 1,325 patients in the test set, splitting them into high- and low-risk groups, calculated the C-index, and drew calibration and survival curves. Results The cross-sectional study found that age, clinical classification, sex, pulmonary insufficiency, hypoproteinemia, and four other factors (underlying diseases: blood diseases, malignant tumor; complications: digestive tract bleeding, heart dysfunction) have important significance for the prognosis of the enrolled patients with COVID-19. Herein, we report the discovery of the effects of hypoproteinemia and hematological diseases on the prognosis of COVID-19. Meanwhile, the scoring system established here can effectively evaluate objective scores for the early prognoses of patients with COVID-19 and can divide them into high- and low-risk groups (using a scoring threshold of 117.77, a score below which is considered low risk). The efficacy of the system was better than that of clinical classification using the current COVID-19 guidelines (C indexes, 0.95 vs. 0.89). Conclusions Age, clinical typing, sex, pulmonary insufficiency, hypoproteinemia, and four other factors were important for COVID-19 survival. Compared with general statistical methods, this method can quickly and accurately screen out the relevant factors affecting prognosis, provide an order of importance, and establish a scoring system based on the nomogram model, which is of great clinical significance.

Left ventricle dysfunction in patients with critical neonatal pulmonary stenosis: echocardiographic predictors. A single-center retrospective study.

The aim of this study is to identify echocardiographic predictors of transient left ventricle dysfunction after pulmonary valve balloon dilatation (PVBD), in neonates with pulmonary valve stenosis (PVS) and atresia with intact septum (PAIVS) at birth. The study includes patients admitted at the Bambino Gesù Children Hospital from January 2012 to January 2017. Clinical, echocardiographic and cardiac catheterization data before and after PVBD were retrospectively analyzed. Twenty-nine infants were included in the study (21 male and eight female). The median age was 5.8 ± 7.1 days. Eight patients developed transient LV dysfunction (three PAIVS and five PVS) and comparing data before and after the procedure, there was no difference in right ventricle geometrical and functional parameters except for evidence of at least moderate pulmonary valve regurgitation after PVBD. Moderate to severe degree pulmonary valve regurgitation was significant associated to LV dysfunction (p < 0.05) in PVS and PAIVS patients.

Echocardiography protocol: A tool for infrequently used parameters in mice.

Echocardiography is frequently used to evaluate cardiac function in rodent models of cardiovascular disease. Whereas methods to acquire the commonly used echocardiography parameters are well-described in published protocols or manuals, many important parameters are ill-defined and often open to subjective interpretation. Such lack of uniformity has engendered conflicting interpretations of the same parameters in published literature. In particular, parameters such as mitral regurgitation, mitral stenosis, pulmonary regurgitation, and aortic regurgitation that are required to define more esoteric etiologies in rarer mouse models often remain equivocal. The aim of this methods paper is to provide a practical guide to the acquisition and interpretation of infrequently used echocardiography parameters and set a framework for comprehensive analyses of right ventricle (RV), pulmonary artery (PA) pulmonary valve (PV), left atrium (LA), mitral valve (MV), and aortic valve (AoV) structure and function.

Tétralogie de Fallot réparée au long terme : paramètres échographiques en corrélation avec l'IRM cardiaque

IntroductionTetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease. After surgical repair, the excellent survival rate has led to long-term complications dominated by pulmonary regurgitation (PR). Our study aimed to identify echocardiographic criteria for assessment of right ventricular (RV) function and quantification of PR correlated with cardiac MRI indices. MethodsWe conducted a descriptive study between June 2021 and March 2022 including patients followed for repaired ToF since 2016 or earlier. All patients were seen for clinical, electrocardiographic, and ultrasound evaluation. Cardiac MRI was performed with a maximum delay of 1 month from Doppler echocardiography. Results38 patients were included, with a mean age at imaging of 18 ± 9 years. Our study showed that the echocardiographic parameters of PR quantification correlated with a pulmonary regurgitation fraction on MRI greater than 40% were: the PHT value (p = 0.005) and the ratio of PR jet width to pulmonary valve annulus diameter (p = 0.032). The only ultrasound parameter estimating RV systolic function correlated with RVEF on cardiac MRI was FAC, with p = 0.007. ConclusionQuantitative assessment of RV parameters in patients followed for repaired ToF, as well as the assessment of the severity of PR, is feasible with a standardized ultrasound examination, with good correlation with cardiac MRI.

Immediate and Intermediate Term Outcome of Percutaneous Balloon Pulmonary Valvuloplasty

Background: Pulmonary stenosis (PS) is one of the common congenital heart diseases (CHD) with the incidence of 8-10% of all CHD. Percutaneous balloon pulmonary valvuloplasty (PBPV) is considered as the treatment of choice for these purposes. It is a safe, effective and less time-consuming procedure. But in Bangladesh, we have very limited research-based data regarding the effectiveness of percutaneous balloon pulmonary valvuloplasty in treating pulmonary stenosis. Aim of the Study: The aim of this study was to evaluate the immediate and intermediate term outcome of percutaneous balloon pulmonary valvuloplasty in treating pulmonary stenosis. Methods: This was a hospital based prospective observational study conducted from January 2021 to December 2021 at Combined Military Hospital (CMH) Dhaka, Bangladesh. Interventional work was completed during the first 06 months and follow up was completed during the remaining 06months. A total of 50 patients were evaluated who had undergone PBPV by detailed clinical history, thorough physical examination and relevant investigations, like- CXR, ECG and Echocardiography. All data were processed, analyzed and disseminated by using MS Excel and SPSS version 24 program as per necessity. Results: In this study, two cases were undergone double intervention. During the procedure all cases developed bradycardia and 5(10%) developed cardiac arrest. Immediately after the procedure RV pressure was reduced and PA pressure was increased and PS gradient was reduced dramatically. The peak-to-peak pressure gradient across pulmonary valve reduced from pre-procedure value of 76.8± 5.41mmHg to post procedure value of 18.14±6.88 mmHg which is statistically significant (P&lt;.00001). On D1 Echocardiographic follow up, 13 cases developed trivial pulmonary regurgitation (PR) and after that at D30 follow up, 1 patient developed mild PR out of these 13. In our study 46(92%) cases were successful and 4(8%) and procedure failed; out of these 04 procedures failed cases 3(6%) cases developed restenosis, one patient on D30 Echo and two cases on D90 Echo, D180 Echo do not develop any complications. Other than 3 restenosed cases all 47(94%) cases were leading healthy life without any unwanted events. All the restenosed cases had dysplastic pulmonary valve (PV). RV function of 50(100%) cases was good both in pre and post procedure as evidenced by normal TAPSE ranges from 15-22. Chest X- Ray (CXR) and Electrocardiography was found normal in 180 days follow up. Conclusion: Percutaneous balloon pulmonary valvuloplasty (PBPV) is already considered as the gold standard in the treatment of valvular pulmonary stenosis. This patient friendly procedure should be taken as a first line interventional treatment for congenital as well as post-operative valvular pulmonary stenosis. This study showed excellent outcome among study population without major complications and mortality and recommend PBPV as the first-choice therapy in our setup.

Pulmonary Hypertension in Mitral Valve Disease-Rheumatic Mitral Stenosis versus Organic Mitral Regurgitation: The Doppler-Echocardiographic Study Revisited

Background: Pulmonary hypertension (PH) is common in patients with mitral valve disease. Objective: To determine the factors associated with PH among patients with mitral valve disease, and the similarities and differences in the subgroups of mitral stenosis (MS) and mitral regurgitation (MR). Materials and Methods: Patients with isolated moderate to severe organic mitral valve disease were prospectively enrolled. PH was defined echocardiographically as pulmonary artery systolic pressure of more than 50 mmHg. Patients with MS who had mitral valve area of more than 1.5 cm² and patients with MR who had effective regurgitant orifice area of less than 20 mm² were excluded. Results: Three hundred eighteen patients with a mean age of 54.3±15.5 years including 57.6% female and 66.7% MR were included in this study. PH was present in 119 patients (37.4%), including 48.1% in MS and 31.8% in MR. Severe mitral valve disease was reported in 245 patients (77.0%). Left atrial (LA) diameter and pulmonary artery pressure were significantly higher in patients with MS. Dyspnea, LA volume index, significant tricuspid and pulmonary regurgitation, severe mitral valve disease, and the presence of MS were independently associated with PH. Among patients with MS, LA volume index and severe disease were independently associated with PH. Significant tricuspid and pulmonary regurgitation, LA volume index and severe disease were independently associated with PH in patients with MR. Conclusion: PH is common in patients with mitral valve disease. LA volume index and severe disease were, in common, independently associated with PH in patients with mitral valve disease and in the subgroups of MS and MR. Keywords: Mitral regurgitation; Mitral stenosis; Pulmonary hypertension; Rheumatic heart disease

1038 RIGHT VENTRICULAR-PULMONARY ARTERIAL (UN)COUPLING ESTIMATION IN PATIENTS WITH TRICUSPID REGURGITATION

Abstract Background right-ventricular (RV)-pulmonary arterial (PA) uncoupling expressed by Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Artery Systolic Pressure (PAPs) ratio is associated with poor outcomes in patients with heart failure (HF). TAPSE/PAPs ratio has been poorly investigated in patients with tricuspid regurgitation (TR) with related volume overload and progressive right chambers remodeling. Purpose to assess the effectiveness of other estimation methods of RV-PA coupling in different TR severity groups compared to the classic TAPSE/PAPs ratio. Material and Methods 116 stable patients with TR were enrolled at the time of echocardiography (43 men, 37%; mean age 74±13 years). TR severity was quantified by means of proximal isovelocity surface area (PISA) derived effective regurgitant orifice area (EROA) and regurgitant volume (RVol). RV function was assessed by RV Free Wall Longitudinal Strain (FWLS). PAPs was obtained using the following formula: 4*(peak tricuspid regurgitation velocity)2 + right atrial pressure (RAP); meanPAP was estimated using TR continuous wave signal mean gradient (PAPmIT) and pulmonary artery regurgitation peak gradient (PAPmIP), adding RAP for both. RV-PA coupling was evaluated by TAPSE/PAPs ratio, TAPSE/PAPmIT and TAPSE/PAPmIP ratios. Result TR was quantified mild in 23 patients, moderate in 49, severe and torrential in 29 and 15 patients respectively. Mean RV-FWLS was -26.4±6.9% in mild, -21.8±7.4% in moderate, -18±7% and -18.3±4.2% in severe and torrential TR respectively (p&amp;lt;0.0001). Mean TAPSE/PAPs ratio was 0.6±0.23 mm/mmHg, 0.44±0.19, 0.38±0.19 and 0.37±0.12 mm/mmHg in mild, moderate, severe and torrential TR respectively, with a statistically significant difference between the 4 groups (p&amp;lt;0.0001). Mean TAPSE/PAPmIP ratio was 1.08±0.5 mm/mmHg in mild TR, 0.68±0.34 in moderate, 0.67±0.5 in severe TR and 0.47±0.13 mm/mmHg in torrential TR with a statistically significant difference between distinct TR grades (p=0.004). Mean TAPSE/PAPmIT in mild TR was 0.92±0.5 mm/mmHg, 0.63±0.29 in moderate, 0.53±0.29 and 0.51±0.16 mm/mmHg in severe and torrential TR respectively with a statistically significant difference between the groups (p&amp;lt;0.0001). Finally, an analysis of covariance with RV-FWLS as potential confounder was performed: only the adjusted means of TAPSE/PAPmIP and TAPSE/PAPmIT ratios preserved a statistically significant difference between distinct TR groups (p=0.01 and p=0.019 respectively). Conclusion TAPSE/PAPmIP and TAPSE/PAPmIT ratios seem to preserve a stronger relation with increasing TR grade and worsening of RV disfunction, suggesting it as a more powerful index in this subset of patients. The progression of TR grade leading to a right chamber remodeling could influence the reliability of RV-PA uncoupling expressed by standard TAPSE/PAPs ratio.

366 RIGHT HEART FAILURE IN CARCINOID HEART DISEASE: A MULTIDISCIPLINARY APPROACH

Abstract Introduction Carcinoid heart disease occurs in more than 50% of patients with neuroendocrine gastrointestinal tumors, and it is the initial presentation of carcinoid syndrome in up to 20% of patients. The disease is characterized by pathognomonic plaque-like deposits of fibrous tissue in the endocardium of valvular cusps, cardiac chambers, and occasionally, the intima of the pulmonary arteries or aorta. The tricuspid and the pulmonary valve are most often affected by carcinoid disease, with several combinations of valve dysfunction (usually pulmonic stenosis + tricuspid regurgitation). Valvular dysfunction can lead to peripheral edema, ascites and right-sided heart failure, extreme cases may present with low cardiac output syndrome. Valve surgery may relieve symptoms and it should be considered in patients with controlled neoplasia. Case report a 47-years-old man with a history of operated neuroendocrine gastrointestinal tumor (ileal resection+right hemicolectomy+mesenteric lymphadenectomy) was admitted to our department for right heart failure. His clinical examination was remarkable for ankle swelling, flushing, liver congestion, ascites; moreover the patient reported progressive compromise of functional capacity and weight loss due to anorexia. Laboratory findings were in the normal range except for BNP 184 pg/ml (UNL &amp;lt;100 pg/dl). ECG: sinus rhythm 80 bpm, diffuse repolarization abnomarlities. Transthoracic echocardiography showed: severe right chambers remodeling with RV+RA dilatation associated with systo-diastolic septal bulge (pressure + volume overload), torrential tricuspid regurgitation (secondary to fibrotic retraction of valve leaflets and severe coaptation deficiency with apical tethering), moderate-to-severe pulmonic regurgitation associated with valve stenosis; on the left side: mitral and aortic valves were normal, there was mild reduction of left ventricle ejection fraction secondary to ventricular interdipendence. The patient was discussed in Heart Team: right sided valves were both considered responsible for patient's symptoms, so he was scheduled for surgical intervention after achieving adeguate haemodinamic stability. Pre-surgery right catetherization showed normal pulmonary pressures. Coronary arteries were normal. Before, during and after surgery he was treated with octreotide to reduce the risk of Carcinoid Crisis in the perioperative period. The patient underwent surgical replacement of tricuspid and pulmonary valves with biological prosthesis Mosaic n°33 and Avalus n°23 respectively. Histological examination of the valves showed extensive deposits of fibrous tissue in the valvular endocardium. Post-surgical hospital stay was uneventful, the patient was discharged 14 days after surgery on normal sinus rhythm and in good clinical conditions. In order to prevent thromboembolic events anticoagulant therapy with Warfarin was introduced. Conclusion this is the report of a rare cardiac condition responsible for right heart failure symptoms. Heart Team discussion and multidisciplinary approach involving surgeons and oncologist are mandatory in order to establish the best treatment strategy and timing for interventions. However, since this is a rare condition, more evidence is needed to better understand long term clinical outcomes and treatment options (including future percutaneous perspectives).

Reversal of Right Ventricular Remodeling After Correction of Pulmonary Regurgitation in Tetralogy of Fallot

In the sheep model with pathophysiologic changes similar to patients with repaired TOF, severe PR leads to fibrotic changes in the RV. Pulmonary valve replacement reverses these fibrotic changes. Early valve replacement led to a quick RV recovery, and in time there was no difference in outcome between early and late valve replacement. These data support the benefit of valve replacement for RV function and suggest that there is a margin in the timing of the surgery. The fibrotic changes correlated well with the circulating biomarker PICP, which can have an added value in the clinical follow-up of patients with repaired TOF.

Valvular and aortic surgery in an adult patient late after repaired tetralogy of Fallot

BackgroundThe most common complication after tetralogy of Fallot repair is pulmonary valve regurgitation. However, concomitant surgery for tricuspid valve regurgitation and/or aortic dilatation is occasionally required.Case presentationA 56-year-old woman who underwent surgery for tetralogy of Fallot at age 29 years was diagnosed with progressive tricuspid valve regurgitation, hepatosplenomegaly, and thrombocytopenia. Moreover, computed tomography and transesophageal echocardiography revealed regurgitation in pulmonary and mitral valves and dilatation of the ascending aorta. One month after splenectomy for increasing platelet count, she underwent pulmonary valve replacement, tricuspid and mitral valve annuloplasty, and ascending aortic replacement. Postoperatively, the intensive care stay was complicated because of ventricular dysfunction and long-term ventilation. After 1 week, the patient was disconnected from the respirator, and she was transferred on the 55th postoperative day to another hospital for rehabilitation, without permanent disabilities.ConclusionWe herein reported a patient with repaired TOF who successfully underwent PVR, tricuspid and mitral valve annuloplasty, and ascending aortic replacement.

Transcatheter pulmonary valve replacement in congenital heart diseases.

Surgical repair of a variety of congenital heart diseases involves repair of the right ventricular outflow tract (RVOT) with valved or non-valved conduit to connect the right ventricle (RV) to the pulmonary artery (PA) or just patch enlargement of the native RVOT. With time, this RV-PA conduit will degenerate with deterioration of function, either causing pulmonary stenosis or pulmonary regurgitation. This RVOT dysfunction may result in RV dilation, RV dysfunction, and eventual RV failure and arrhythmias. Multiple surgical pulmonary valve replacement (PVR) is often required throughout the patient's lifetime. Patients are subjected to increased risks with each additional cardiac operation. Transcatheter PVR (TPVR) has been developed over the past two decades as a valuable non-surgical alternative to restore the RVOT and RV function, and hence reduce patients' lifetime risks related to surgery. This article will discuss the long-term results of TPVR which are demonstrated to be comparable to surgical results and the latest development of large pulmonary valves which will allow TPVR to be performed on native or larger RVOT.

Relationship of Balloon Size in Pulmonary Valvuloplasty Outcome

Objective: To evaluate the relation between balloon size and outcome of patients undergoing pulmonary valvuloplasty. Study Design: A quasi-experimental study. Place and Duration: Pediatric Cardiology Department of Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan from January 2021 to June 2022. Methodology: Children of both genders aged less than 15 years having severe pulmonary stenosis and who underwent pulmonary valvuloplasty during the study period were analyzed. After 24 hours post procedure, echocardiography was done to see echo gradient across pulmonary valve, tricuspid regurgitation, pulmonary regurgitation, right ventricular dysfunction or pericardial effusion. Procedure was considered successful if the residual gradient across pulmonary valve was &lt; 40 mmHg, pulmonary regurgitation &lt; moderate and patients had no major complications. Results: In a total of 75 children, 42 (56.3%) were male. The mean age was 6.24 ± 4.81 years. Cyanosis was observed in 10 (13.3%) children while there was right ventricular dysfunction in 6 (8.0%) children. The pulmonary valvuloplasty procedure was successful in 53 (70.6%) cases while in remaining 22 (29.4%) cases, the procedure was partially successful because of infundibular obstruction. We observed that the degree of pulmonary regurgitation was greater when annulus- balloon ratio was 1.3 or more than that (p&lt;0.0001). Practical Implications: Large balloons do not impart advantages beyond that produced by balloons between 1.2-1.4 times of the annular size but further research is required to ascertain these findings Conclusion: Signification relation exists regarding balloon size and outcome of children undergoing pulmonary valvuloplasty as the degree of pulmonary regurgitation was greater when annulus- balloon ratio was 1.3 or more. Keywords: Cyanosis, pulmonary regurgitation, pulmonary valvuloplasty, right ventricular dysfunction.

Right ventricular echocardiographic remodeling after pulmonary valve replacement in repaired Tetralogy of Fallot

BackgroundMany patients with repaired tetralogy of Fallot require reoperation in the medium to long-term for residual pulmonary valve regurgitation. Best timing for pulmonary valve replacement remains controversial. A balance needs to be found between protecting the patients from permanent right ventricular damage and insertion of a prosthetic valve with its inherent issues. In the current study we sought to investigate the right and left ventricular functional recovery following valve replacement in our tertiary care institution. ResultsIn a retrospective cross-sectional study patients with history of total correction of tetralogy of Fallot who had undergone pulmonary valve replacement due to severe pulmonary regurgitation between 2003–2018 were evaluated for post intervention right and left ventricular functional recovery. Clinical and full echocardiographic data before and after the surgery were recorded and compared. There was statistically significant improvement in RV size and function post pulmonary valve replacement. There was no statistically significant improvement in left ventricular systolic function. Twenty percent of patient had persisting severe right ventricular enlargement at least twelve months post-surgery. No patient had fully normalized right ventricular size and function in follow-up. ConclusionsPulmonary valve replacement leads to improvement in right ventricular size and function in patients with repaired tetralogy of Fallot. However normalization of functional parameters did not occur and the majority of the patients have residual right and left ventricular dysfunction following redo valve replacement surgery.

Sequential percutaneous tricuspid and pulmonary valve implantation in a young child operated previously for Ebstein Anomaly.

We report a successful percutaneous tricuspid valve implantation followed by a percutaneous pulmonary valve implantation in a young child with Ebstein's anomaly of tricuspid valve and pulmonary stenosis who was previously treated surgically at 1 year of age with tricuspid ring annuloplasty and a transannular outflow patch. This article shows the feasibility of sequential implantation of two valves in young patients with severe tricuspid and pulmonary valve insufficiency.

Early results of Pulsta® transcatheter heart valve in patients with enlarged right ventricular outflow tract and severe pulmonary regurgitation due to transannular patch.

The purpose of this study is to assess the feasibility, effectivity, and safety of a novel self-expandable valve system, Pulsta® transcatheter heart valve in patients with tetralogy of fallot and severe pulmonary regurgitation after transannular patch repair. Severe pulmonary regurgitation after tetralogy of fallot repair is a life-threatening problem and should be treated by pulmonary valve implantation. Although percutaneous pulmonary valve implantation has been ever increasingly used for this purpose, available balloon-expandable valves have limitations and cannot be used by most patients. Pulsta® transcatheter heart valve is a new self-expandable valve system and offers a new solution to be used in patients with different types of native right ventricular outflow tract geometry. Ten patients with severe regurgitation after tetralogy of fallot repair with a transannular patch have been enrolled in the study according to echocardiographic examination. MRI was used in asymptomatic patients to delineate the indication and the right ventricular outflow tract geometry. Pulsta® transcatheter heart valve implantation was performed in ten patients, and preprocedural, procedure, and 6 months follow-up findings of the patients were evaluated. Pulsta® pulmonary valve implantation was performed in ten patients successfully without any severe complications. Valve functions were perfect in six of ten patients, while the others had insignificant regurgitation by echocardiographic examination at the end of 6 months follow-up. This study showed that Pulsta® transcatheter heart valve is a feasible, effective, and safe method in the treatment of severe pulmonary regurgitation due to transannular patch repair in patients with tetralogy of fallot.