Rheumatic Tricuspid Valve Disease Research Articles

Clinical outcome of patients with rheumatic tricuspid valve disease: matched cohort study.

Rheumatic heart disease (RHD) is still a major health problem, especially in low- to mid-income countries, leading premature deaths owing to valvular disease. Although left-sided valvular involvement is most commonly seen in RHD, the tricuspid valve can also be affected. However, there is a lack of information about the prognostic value of primary tricuspid valve (TV) disease in RHD. This study aimed to determine the impact of TV disease on clinical outcome in RHD. This prospective study enrolled patients with rheumatic mitral valve disease (MVD) referred to a tertiary center for management of heart valve disease. Primary rheumatic TV disease was defined by echocardiographic features including thickening of leaflets associated with some degree of restricted mobility. Patients with rheumatic TV disease were matched to patients with MVD using 1:1 genetic matching algorithm that maximized balance of baseline covariates prior to exploring outcome differences. The main outcome was either need for MV replacement or death. Among 694 patients eligible for the study, age of 47 ± 13 years, 84% female, 39 patients (5.6%) had rheumatic TV disease. After excluding patients with incomplete data, 33 patients with TV disease were matched to 33 controls based on age, right-sided heart failure, atrial fibrillation, and MV area. During a mean follow-up of 42 months (median 28, IQR 8 to 71 months), 32 patients (48.5%) experienced adverse events, including 6 cardiovascular deaths and 26 patients who underwent surgery for mitral valve replacement. The adjusted analysis demonstrated a significant association between TV disease and the outcome, with a hazard ratio (HR) of 3.386 (95% CI 1.559-7.353; P = 0.002) in the genetic matched cohort with balance on baseline covariates of interest. The model exhibited good discriminative ability, as indicated by a C-statistic of 0.837. In patients with rheumatic mitral valve disease, rheumatic TV disease significantly increased risk of adverse events compared with matched controls. The involvement of TV may express overall disease severity that adversely affects clinical outcome.

Mixed rheumatic tricuspid valve disease: details of preoperative evaluation and surgical management.

Mixed rheumatic tricuspid valve disease: details of preoperative evaluation and surgical management.

Rheumatic tricuspid valve disease: Repair versus Replacement

Rheumatic tricuspid valve disease: Repair versus Replacement

Severe Rheumatic Tricuspid Valve Disease, to Repair or to Replace, Egyptian Experience.

Severe Rheumatic Tricuspid Valve Disease, to Repair or to Replace, Egyptian Experience.

Clinical Profile and Management of Rheumatic Heart Disease in Children and Young Adults at a Tertiary Cardiac Center in Indonesia.

Introduction: Rheumatic heart disease (RHD) remains a major public health issue affecting children and young adults in developing countries. This study aimed to evaluate the clinical characteristics, management, and reactivation of RHD among children and young adults.Patients and Methods: This was a hospital-based retrospective study conducted at the National Cardiovascular Center Harapan Kita, Indonesia; we retrieved relevant data from patients diagnosed with RHD between 2012 and 2018.Results: Two hundred and seventy-nine patients were diagnosed with rheumatic heart disease, of whom 108 were children (mean age of 12.02 ± 3.36 years) and 171 were young adults (mean age was 24.9 ± 3.84). RHD was more common in female than in male young adults (1.5:1). Hospitalization due to RHD complications such as congestive heart failure was seen in 11.11% of cases in children, while pulmonary hypertension was present in 19.95% young adult cases. Reactivation of RHD occurred in 17.2% (48/279) cases, significantly in children (p < 0.001). Overall, the mitral valve (either isolated or combined) was the organ most affected in children (39.13%) and young adults (44.81%). Isolated mitral regurgitation was more common in children (13/21, 61.9%), while isolated mitral stenosis was more common in young adults (19/47, 40.42%). There was a high rate of rheumatic tricuspid valve disease in all populations (193/279, 69.17%) and reported involvement of pulmonary regurgitation (46/279, 16.48%). Multivalve lesions were more common than single lesions in both groups, with a combination of mitral and tricuspid regurgitation the predominant type in children (32/43, 74.41%) and mixed mitral lesion and tricuspid regurgitation in young adults (22/72, 30.56%). We observed a significant occurrence of quadrivalve lesions in children (p = 0.039). Valve repair was more common in children (49.07%) and replacement in young adults (32.16%), with low in-hospital mortality. Compliance with secondary prophylaxis was a significant challenge.Conclusion: Chronic RHD often presented with complications of the disease or reactivation of rheumatic fever (RF). Inadequate treatment of RF/RHD leads to extensive valvular damage and consequent disabilities. Efforts toward active early diagnosis and prompt treatment of RF/RHD and effective preventive measures are essential.

Very rare Image for Rheumatoid tricuspid valve changes

Rheumatic tricuspid valve disease occurs in association with rheumatic involvement of the mitral aortic valves combined. The third world still have a significant prevalence of rheumatic tricuspid valvular disease. The preponderance of cases is in young women. Rheumatic tricuspid disease usually results in a regurgitant valve with variable amounts of stenosis, Borders of the stenotic tricuspid orifice are usually fibrous and thickened, although peripheral portions of the leaflets remain thin. The hallmark of organic tricuspid stenosis is commissural fusion. All commissures are usually equally fused, but occasionally fusion is limited to the anteroseptal commissure. Chordal thickening and fusion are usually mild, and calcification is usually absent. Case of 30 years old lady who underwent cardiac surgery for mitral, Aortic, tricuspid valve replacement. Keywords: Valvular disease; Rheumatismal changes; Tricuspid valve disease

How rare is isolated rheumatic tricuspid valve disease?

The incidence of rheumatic fever (RF) has markedly decreased in Europe since the beginning of the 20th century due to improved living conditions, early antibiotic therapy in streptococcal pharyngitis, and changes in serotypes of circulating streptococci. Isolated outbreaks of RF are still found in various parts of the world and the disease has changed its presentation with milder joint symptoms and subclinical carditis that make the correct diagnosis more difficult. Patients can present many years later with severe valve disease and significant disability. This article presents a case of isolated rheumatic tricuspid valve disease that presented with signs and symptoms of right heart failure and severe valve damage. Isolated involvement of the tricuspid valve is rarely found in rheumatic fever and a thorough differential diagnosis is needed.

Prevalence of organic tricuspid valve disease and pattern of valvular involvement in rheumatic heart disease: An echocardiographic study

Background: Rheumatic fever and rheumatic heart disease are still a major public health problem in developing countries. There is a growing interest in tricuspid valve disease because of its clinical outcome, difficulty in treating it, and upcoming interventional therapeutic options. The aim of the present study is to assess the organic involvement of tricuspid valve and echocardiographic pattern of other valvular involvement in rheumatic heart disease in a tertiary care center located in South India. Materials and Methods: This is a prospective observational study which was carried out over a period of 1 year. Transthoracic echocardiography data of patients, diagnosed with rheumatic heart disease during the study period, were reviewed for type and degree of valvular involvement. Results: During the study period, a total of 6612 patients were found to have rheumatic heart disease, and 4129 (62.45%) were female. The average age was 33.96 ± 12.21 years. On echocardiography, organic tricuspid valve involvement was seen in 684 (10.34%) patients. Mitral valve is the most common valve involved, both in isolation and in totality. Five thousand and thirty (76.07%) patients were diagnosed with mitral regurgitation, and 4497 (68.01%) patients were diagnosed with mitral stenosis. Two thousand nine hundred and ninety-three (45.27%) patients were diagnosed with aortic regurgitation, and 1085 (16.41%) patients were diagnosed with aortic stenosis. Conclusion: Mitral valve was most commonly affected, whereas isolated aortic valve was least commonly affected valve. A considerable number of patients showed involvement of organic rheumatic tricuspid valve disease. With the growing awareness of tricuspid valve disease causing significant morbidity and mortality, and therapeutic options under research, identifying organic tricuspid valve disease is of foremost important.

Post Rheumatic Tricuspid Valve Disease Associated to a Left Atrial Mass in a Young Female: a Case Report

Primary lesions of the tricuspid valve are rare Tricuspid disease is an uncommon valvular abnormality that most commonly occurs in association with other valvular lesions particularly in patients with rheumatic heart disease For many years surgical commissurotomy and valvuloplasty were the only available methods to correct tricuspid disease We present a case of post rheumatic disease of the tricuspid valve in a young girl associated to a left atrial mass nbsp

Echo Diagnosis of Rheumatic Tricuspid Valve Disease

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Repair of Rheumatic Tricuspid Valve Disease: Predictors of Very Long-Term Mortality and Reoperation

We examined predictors of reoperation and late mortality in patients undergoing tricuspid valve repair for rheumatic disease. Between 1997 and 2007, 299 consecutive patients (mean age 50.8 + or - 13.7 years) underwent surgical repair of the tricuspid valve for multivalvular organic rheumatic disease. A total of 184 patients was found to have mitral and tricuspid valve disease, 108 triple valve disease, 5 isolated tricuspid lesion, and 2 aortic and tricuspid valve disease. Prosthetic ring annuloplasty was performed in 78 patients, commissurotomy and ring annuloplasty in 82, isolated commissurotomy in 10, suture annuloplasty in 105, and commissurotomy and suture annuloplasty in 24. Thirty-day mortality was 7.4%. Previous valve surgery and reoperation for bleeding were risk factors for early death. Late mortality was 51.2%, in the majority of patients due to cardiac causes. There was a median follow-up of 16.4 years (range, 6 months to 34 years) and cumulative follow-up of 5,432 patients per year (96.7% complete). Age, New York Heart Association functional class IV and postclamping time were predictive factors for late mortality. At 25 years, the Kaplan-Meier survival was 26.6% + or - 4.2%. A total of 106 patients required valve reoperation. Age older than 40 years was a protective factor for reoperation. At 25 years, Kaplan-Meier freedom from reoperation was 35.0% + or - 5.3%. Repair of the tricuspid valve in patients with rheumatic valve disease can be performed with acceptable early results, but progression of rheumatic disease is associated with a high incidence of valve dysfunction and mortality in the long term.

Valve Repair With Autologous Pericardium for Organic Lesions in Rheumatic Tricuspid Valve Disease

Surgical repair of pathologic tricuspid valve disease often fails because of severe anatomic distortion of the valve apparatus, particularly in patients with rheumatic heart disease. This usually leads to tricuspid valve replacement despite the associated prosthesis-related complications. This study examines our experience of tricuspid valve repair with autologous pericardium for organic rheumatic tricuspid valve disease. From 1996 to 2007, 31 patients underwent repairs for rheumatic tricuspid valve disease characterized by retracted leaflets and inadequate leaflet area. The patients, aged 14 to 56 years, had a mean New York Heart Association (NYHA) class of 2.9 +/- 0.6. All patients presented with severe tricuspid regurgitation and coexisting left-sided heart valve disease. Glutaraldehyde-treated autologous pericardial patch was used to augment tricuspid valve leaflets. Other techniques were applied as needed, including commissurotomy, leaflet mobilization, annuloplasty, and prosthetic ring implantation. Concomitant operations included left-sided valve replacement in all, and left atrial thrombus removal in 3 patients. Follow-up duration was 4 to 126 months. No deaths or late reoperations occurred. All patients demonstrated clinical improvements on follow-up. Echocardiographic studies before hospital discharge showed less than mild tricuspid regurgitation in all patients. The most recent echocardiographic follow-up showed no tricuspid regurgitation in 10 patients (32.3%), trivial regurgitation in 12 (38.7%), mild regurgitation in 8 (25.8%), and moderate regurgitation in 1 (3.2%). In selected patients, organic rheumatic tricuspid valve disease can be treated with pericardial patch to augment the retracted leaflets in combination with other techniques. Follow-up reveals excellent tricuspid valve function.

Surgery for rheumatic tricuspid valve disease: A 30-year experience

This study was undertaken to assess factors influencing short- and long-term outcomes of surgery for rheumatic disease of the tricuspid valve. Between 1974 and 2005, a total of 328 consecutive patients (mean age 51.3 +/- 13.6 years) underwent tricuspid valve surgery for rheumatic disease. There were 12 cases of isolated tricuspid lesion, 199 of triple-valve disease, 114 of tricuspid and mitral valve disease, and 3 of aortic and tricuspid valve disease. Most patients (72%) had predominantly tricuspid regurgitation. Tricuspid valve prosthetic replacement was performed in 31 cases and valve repair in 297. In-hospital mortality was 7.6%. Late mortality was 52.1%, whereas the expected mortality of the Spanish population of the same age was 24.2%. Predictors of in-hospital mortality were male sex, isolated tricuspid lesion, moderate aortic insufficiency, postclamping time, and tricuspid valve replacement. Mean follow-up was 8.7 years (range 1-31 years). Follow-up was 98.9% complete. Predictors of late mortality were age, New York Heart Association functional class IV, postclamping time, and mitral valve replacement. In total, 114 patients required valve reoperation, but only 4 (3.5%) for isolated tricuspid valve dysfunction. At 30 years, actuarial survival was 12.1% +/- 4.4%, actuarial freedom from reoperation was 27.5% +/- 5.8%, and actuarial freedom from valve-related complications was 2.0% +/- 1.3%. Organic tricuspid valve disease associated with rheumatic mitral or aortic lesions increases hospital and late mortality, but valve repair compared favorably with valve replacement. Long-term results may be considered acceptable for otherwise incurable valve disease.

Tricuspid valve replacement with a mitral homograft in children with rheumatic tricuspid valvulopathy

Objective Tricuspid valve replacement in children is associated with a nonnegligible complication rate because of specific disadvantages of mechanical or biologic prostheses. The objective of this study was to examine the midterm clinical outcomes of tricuspid valve replacement with a mitral homograft in 8 children with unreparable rheumatic tricuspid valve involvement. Methods Between 1993 and 2003, tricuspid valve replacement with a mitral homograft was performed in 8 patients (2 male and 6 female patients; mean age, 14.2 years) with rheumatic tricuspid valve disease. All patients were in New York Heart Association class III or IV. In all patients with rheumatic valve disease, conservative operations had previously been performed on the tricuspid valve during concomitant left-sided surgical intervention. Mean follow-up was 56 ± 12 months and was complete. Results There were no operative or late deaths. All patients were alive at the most recent follow-up contact and were in New York Heart Association functional class I or II. None of the patients required homograft-related reoperation. At the most recent echocardiograhic examination, 6 patients had trivial residual tricuspid regurgitation, and 2 had mild tricuspid regurgitation. None of the patients had maximal transvalvular tricuspid gradients greater than 2 mm Hg during their yearly follow-up visits. Conclusion On the basis of our midterm results, tricuspid valve replacement with a mitral homograft in children seems to be a valuable alternative surgical option.

Juvenile tricuspid stenosis and rheumatic tricuspid valve disease: an echocardiographic study

Tricuspid valve involvement is not uncommon in patients with rheumatic heart disease and is frequently missed on routine clinical examination. We prospectively studied the echocardiographic profile of tricuspid valve disease in 788 consecutive patients with rheumatic heart disease. Out of these patients 9% (70) had tricuspid valve disease and 55.7% (39) of these were of ≤20 years of age. Of these 60% were females and 40% were males. Their ages ranged from 9 to 64 years (mean 24.2±13.6 years). Of these patients, 50% had tricuspid stenosis with or without tricuspid regurgitation whereas 50% had isolated tricuspid regurgitation. Isolated tricuspid stenosis was present in 7.4% of these cases. All patients had associated mitral stenosis. Severe mitral stenosis was present more commonly in patients with juvenile tricuspid stenosis compared to older patients (94.1% vs. 55.6%, P<0.005). Mitral regurgitation was present more commonly in juvenile age group patients compared to older patients (53.8% vs. 25.8%, P<0.01). A combination of mitral, aortic and tricuspid stenosis was present in five cases and four of these were in the juvenile age group. Left ventricular enlargement and dysfunction were present in 28.6 and 14.3% patients, respectively, and the majority of these patients were in the juvenile age group ( P<0.05). We conclude that rheumatic tricuspid valve disease occurs early in the course of the disease and progresses faster in India and is always associated with mitral stenosis. Juvenile tricuspid stenosis is more commonly associated with severe mitral stenosis, mitral regurgitation, left ventricular enlargement and dysfunction as compared with older patients.

Rheumatic tricuspid valve disease: Two-dimensional echocardiographic, hemodynamic, and angiographic correlations

From March 1977 through April 1982, 2-dimensional echocardiography detected 372 patients with rheumatic mitral valve disease. Of these patients, 23 (6%) had tricuspid valve involvement. Two-dimensional echocardiographic criteria of rheumatic tricuspid valve disease included thickened leaflets with restriction in motion, diastolic doming, and encroachment of the leaflet tips on the ventricular inlet. These criteria provided a sensitivity of 100%, a specificity of 90%, a predictive accuracy of 21%, and a negative predictive value of 100% in diagnosing hemodynamically significant tricuspid stenosis. Hemodynamic variables in patients with rheumatic tricuspid valve disease (Group I) were compared with those in patients with no rheumatic tricuspid disease (Group II). The only significant difference was mean right atrial pressure (15 +/- 7 mm Hg versus 11 +/- 5 mm Hg, p less than 0.02). Both groups were classified into patients with (A) and without (B) significant tricuspid regurgitation (TR). There was no significant difference in any hemodynamic variable when Group IA was compared with Group IIA. In addition, there was no difference in any hemodynamic variable when patients with functional TR (Group IIA) were compared with those with rheumatic mitral valvular disease without TR (Group IIB). Two-dimensional echocardiography and cardiac catheterization provide complementary diagnostic information in these patients.

Early risks of open heart surgery for mitral valve disease

During 1972 and 1973, a total of 235 patients had open heart surgery for mitral valve disease unassociated with significant aortic or rheumatic tricuspid valve disease. Thirty-one underwent closed heart mitral commissurotomy, without mortality. Of the 204 patients undergoing open operation, 125 had sequential measurement of cardiac output and mixed venous oxygen pressure. The hospital mortality rate was 6.4 percent in the larger group of 204 patients and in the 125 with cardiac output measurements. The rate was greater in those with class IV disability (New York Heart Association criteria) preoperatively than in those with class III or II disability. The mean ± standard deviation of the average cardiac index early postoperatively was 2.05 ± 0.579 liters ·min −1·m −2. Cardiac index was lower in the patients who died early postoperatively than in those who did not. The probability of hospital death was a significant function of cardiac index. The predicted probability of death was 10 percent with an average cardiac index of 1.42 liters·min −1·m −2 and increased sharply with lower indexes. Cardiac index was lower early postoperatively than preoperatively, and was lower in patients in class IV than in those in class III. There was no significant difference in cardiac index between patients with mitral valve replacement and those with repair. A history of closed commissurotomy, age, duration of cardiopulmonary bypass, duration of cardiac ischemia and method of myocardial preservation did not significantly influence cardiac index or hospital mortality rate. There was no significant relation between mixed venous oxygen pressure and hospital death. Further improvement in results of mitral valve surgery requires adequate preservation of left ventricular performance before, during and after operation.

The development of mitral stenosis in young people: With a disoussion of the frequent misinterpretation of a middiastolic murmur at the cardiac apex

From March 1977 through April 1982, 2-dimensional echocardiography detected 372 patients with rheumatic mitral valve disease. Of these patients, 23 (6%) had tricuspid valve involvement. Two-dimensional echocardiographic criteria of rheumatic tricuspid valve disease included thickened leaflets with restriction in motion, diastolic doming, and encroachment of the leaflet tips on the ventricular inlet. These criteria provided a sensitivity of 100%, a specificity of 90%, a predictive accuracy of 21%, and a negative predictive value of 100% in diagnosing hemodynamically significant tricuspid stenosis.Hemodynamic variables in patients with rheumatic tricuspid valve disease (Group I) were compared with those in patients with no rheumatic tricuspid disease (Group II). The only significant difference was mean right atrial pressure (15 ± 7 mm Hg versus 11 ± 5 mm Hg, p <0.02). Both groups were classified into patients with (A) and without (B) significant tricuspid regurgitation (TR). There was no significant difference in any hemodynamic variable when Group IA was compared with Group IIA. In addition, there was no difference in any hemodynamic variable when patients with functional TR (Group IIA) were compared with those with rheumatic mitral valvular disease without TR (Group IIB). Two-dimensional echocardiography and cardiac catheterization provide complementary diagnostic information in these patients.