Tricuspid Failure Research Articles

Postoperatif Fallot Tetralojili Çocuklarda Aort Kökü Dilatasyonu, Kısa ve Orta Dönem Sonuçlarımız

Amaç: Tam düzeltme ameliyatı yapılmış Fallot tetralojili hastalarımızın klinik durumlarının değerlendirilmesi, ritim bozukluklarının araştırılması, ekokardiyografi ile ventrikül fonksiyonlarının ve aort kökü dilatasyonunun değerlendirilmesidir. Gereç ve Yöntemler: İstanbul Üniversitesi, İstanbul Tıp Fakültesi Çocuk Kardiyoloji bölümünde izlenen, düzeltme operasyonu uygulanmış Fallot tetralojili 50 çocuk çalışmaya dahil edildi. Düzeltilmiş Fallot tetralojili olgular aort kökü dilate olanlar ve dilate olmayanlar diye iki guruba ayrıldı. Her iki gurup arasında cinsiyet, tam düzeltme operasyonu yaşı, aort yetersizliği, triküspit yetersizliği, pulmoner yetersizlik, palyatif tedavi ve transanüler yama kullanımı açısından farklar değerlendirildi. Pulmoner kapak yetmezliği, tam düzeltme ameliyatı sırasında uygulanan transanüler yama yapılanlar ve yapılmayanlar olarak karşılaştırıldı. Düzeltilmiş Fallot tetralojili olguların ekokardiyografik olarak ölçülen aort kökü ve asendan aort çapları yaş, cinsiyet ve vücut yüzey alanlarına göre normal dağılımları ile değerlendirildi. Bulgular: Çalışmaya 24 Ocak-15 Mayıs 2014 tarihleri arasında 50 olgu alındı. Çalışmaya katılan olguların yaşları 2-21 yıl arasında değişmekte olup, ortalama 9.9 ±4.5 yıldır. Çalışmaya katılanların %52’si (n=26) erkek, %48’i (n=24) kızdır. Olguların total düzeltme yaşları 6 (0.5 yıl) ile 190 (15.8 yıl) ay arasında değişmekte olup, ortalama 28.3 ± 28.3 (2.3 ± 2.3 yıl) aydır. Postoperatif süreleri 1.3-17.8 yıl arasında değişmekte olup, ortalama 8.0 ± 4.1 yıldır. Olguların %28’ine (n=14) palyatif tedavi uygulanmıştır. Olguların aort kök ölçümleri 18.0 ile 42.5 mm arasında değişmekte olup, ortalama 27.9 ±5.3 mm’dir. Olguların %12’sinin (n=6) aort kökü dilatasyonu yok iken, %88’inin (n=44) aort kökü dilatasyonu vardır. Olguların tamamında (%100) sağ ventrikül dilatasyonu ve asendan aort dilatasyonu vardır. Transanüler yama uygulananlarda, orta ve ağır pulmoner yetmezlik daha az saptandı (p: 0.02). Sonuç: Olguların %88’inde (n: 44) aort kökü dilatasyonu saptandı. Yıllık aort kökü çapı ölçümlerinin verilmesi, Fallot tetralojili hastalarda ilerleyici aort kökü dilatasyonunun tedavisinde daha etkili bir stratejisinin planlanmasına yardımcı olacaktır.

Right atrial pseudomyxoma originated from junction between right atrial wall and tricuspid ring annuloplasty

We present diagnostic echocardiography results of a patient with intracardiac mass who had undergone primary ASD closure and tricuspid valve annuloplasty after being diagnosed with atrial septal defect and tricuspid failure. The atrial mass originated from free right atrial wall junction and tricuspid ring annuloplasty. Typical morphology of intracardiac mass which was considered to be myxoma during preoperative period was found to be an organized thrombus.

Detection of Atrial Septal Defect by Heart Sound Signal Analysis and its Relation with Tricuspid Failure

Atrial Septal Defect (ASD) takes an important place in pediatric heart diseases. In ASD there is an opening in the wall between left and right atriums. This study addresses three heart sound signals obtained from two patients by the implementation of time amplitude analysis. In the said examination, a murmur that developed due to fixed pairing at S2 and tricuspid failure was observed in diastole, and in addition, its significance in detecting the disease in the auscultation region was established.

Endocardial and myocardial involvement in systemic sclerosis – is there a relevant inflammatory component?

ObjectivesMyocardial manifestations of systemic sclerosis are mainly due to fibrotic remodeling. We report on two cases, where an endocardial and myocardial inflammation may be a relevant component of cardiac disease. Case seriesCase 1 presented with fulminant tricuspid failure in the absence of pulmonary hypertension and with newly developing systemic sclerosis. Myocardial biopsy and MRI supported endocardial and myocardial inflammation. Treatment with cyclophosphamide resulted in stabilization of cardiac function and normalization of cardiac enzymes. The patient died due to infectious complications. Case 2, also newly developed systemic sclerosis, presented with renal crisis and pulmonary alveolitis. Elevated cardiac troponin T persisted in the presence of cyclophosphamide treatment, subsequent MRI suggested myocardial inflammation. After stepping up treatment by addition of rituximab cardiac enzymes normalized and cardiac function stabilized. ConclusionWe hypothesize that low-grade endocardial and myocardial inflammation may be more relevant in systemic sclerosis than appreciated previously.

Un volumineux myxome de l’oreillette droite révélé par une insuffisance cardiaque droite

Right atrial myxoma is a heart benignant tumor characterized by an important clinical polymorphism. We report a case of a 30-year-old female with a diagnosis of a big right atrial myxoma. The diagnosis has been done by transthoracic echocardiography which showed an important tumorous mass in the right atrium. It was moving, inhomogeneous and takes over the whole of right atrium cavity. The surgical excision of the tumor has been done under extracorporal circulation. The patient died after a second intervention for tricuspid failure.

Endocarditis due to Neisseria subflava biovar perflava

Clinical Case The subject was a 30-year-old male addict with a history of intravenous substance abuse. In 2002, he had infectious endocarditis caused by methicillin-resistant Staphylococcus aureus, which displayed a good response to antibiotic treatment. In April 2003, he suffered a motor vehicle accident that produced a femoral fracture requiring the insertion of an intramedullary spike. A week before hospitalization, he showed symptoms of general weakness, fever, and chills, and during an examination, a 2 to 3/6 systolic murmur was detected. Because of the physical results and his previous history, which included tricuspid valve endocarditis, infectious endocarditis was suspected. Blood was drawn for culture and treatment was started empirically with 500 mg of vancomycin plus 400 mg of ciprofloxacin i.v. twice a day. A transthoracic echocardiogram showed normal movement of the intraventricular septum but a lack of movement in the medial and apical septa, with a slight deterioration of systolic function and no vegetative growths. It also showed an irregular surface on the tricuspid valve, a serious level of insufficiency, and dilated right-side cavities. Initial laboratory results were as follows: erythrocyte sedimentation rate, 52 mm/h, and white blood cell count, 9,400/mm. The HIV serology was negative. Despite antibiotic treatment, after 1 week of hospitalization, the patient was still febrile with chills. A week from the date of hospitalization, a transesophageal echocardiogram showed a rounded and irregularly edged vegetative growth with a small pedicle on the left auricle, over the interauricular septum. Diagnosis was a suspected rupture of the interauricular septum and moderate tricuspid failure. Because of the persistence of fever and the fact that the patient had a compromised immune system and a history of hospitalization, ciprofloxacin was replaced with 500 mg of imipenem every 6 h in addition to the twice-daily dose of 500 mg of vancomycin. After a clear and rapid clinical recovery, the patient again became febrile. In four blood culture samples (Laboratorios Britania, Argentina), processed by a standard methodology, gram-negative diplococci were observed, which after 24 h of cultivation on blood agar, developed into small, regular, convex, and

Simultaneous Repair of Mitral and Tricuspid Valves Through Right Atrium and Interatrial Septum

Secondary tricuspid regurgitation is frequently responsible for serious downgrading of the clinical status of patients whose only primary rheumatic valvular lesion is of the mitral valve. In some instances the signs of tricuspid insufficiency disappear during the period of medical preparation for standard mitral commissurotomy. In others the disturbed dynamics which result from the tricuspid failure cannot be reversed and the patient must be operated upon for the mitral lesion in spite of the defect. If sufficient benefit accrues from the surgery to diminish right-heart work load, the tricuspid ring shrinks as right ventricular distention disappears. Tricuspid valvular sufficiency then results as a more or less delayed benefit of mitral valve commissurotomy or repair. The question arises as to whether repair of the tricuspid regurgitation accomplished at the same time as repair or commissurotomy of the mitral valve would be beneficial in terms of providing more rapid and certain improvement