Native Tricuspid Valve Research Articles

Tricuspid Anterior and Posterior Patch (TRAPP) Repair of Functional Tricuspid Regurgitation

Objective: Annuloplasty is the most common strategy for repair of functional tricuspid regurgitation (FTR) but is not effective in patients with massive/torrential FTR or leaflet tethering. To address the deficits of tricuspid annuloplasty, TRicuspid Anterior and Posterior Patch (TRAPP) repair was developed, which is a pericardial patch augmentation of the anterior and posterior leaflets. Methods: To test this repair, a previously validated ex vivo model in an explanted porcine heart was used, wherein annular and leaflet geometry were evaluated using a 3-dimensional structured light scanner at 4 time points: (1) baseline, (2) induction of FTR, (3) annuloplasty repair, and (4) patch repair. Results: Compared with the regurgitant tricuspid valve, annuloplasty reduced annular circumference (13.7 to 9.5 cm) and area (13.7 vs 6.1 cm2), whereas TRAPP repair did not alter annular dimensions (circumference: 13.7 vs 13.5 cm; area: 13.7 vs 13.6 cm2). Annuloplasty increased leaflet tenting angles (anterior: 53.5° vs 41.0°; posterior: 59.7° vs 48.2°; septal: 38.9° vs 31.4°) whereas TRAPP repair relieved anterior and posterior leaflet tenting (anterior: 28.9° vs 41.0°; posterior: 34.9° vs 48.2°; septal: 33.2° vs 31.4°) and restored geometry comparable to the native tricuspid valve. Central coaptation lengths were greater with TRAPP repair than with annuloplasty for all 3 leaflets (anterior: 12.7 vs 9.5 mm; posterior: 12.2 vs 8.2 mm; septal: 7.4 vs 4.6 mm). Conclusions: Compared with annuloplasty, TRAPP repair yielded greater coaptation length, resolved leaflet tethering, and resulted in a larger annular area that may facilitate durable repair of advanced FTR, which previously would have required replacement.

Development and validation of an ex vivo porcine model of functional tricuspid regurgitation

Background and Aim: Ex vivo models of functional tricuspid regurgitation (FTR) are needed for pre-clinical testing of novel surgical and interventional repair strategies, but current options are costly or have not been formally validated. The objective of this research was to create and validate an ex vivo model to test novel repair methods for FTR. Methods: In explanted porcine hearts, the right atrium was excised to visualize the tricuspid valve. The pulmonary artery and aorta were clamped and cannulated, the coronary arteries ligated, and the right and left ventricles statically pressurized with air to 30 mmHg and 120 mmHg, respectively. FTR was induced by increasing right ventricular pressure to 80 mmHg for 3 h, which resulted in progressive tricuspid annular enlargement, right ventricular dilation, papillary muscle displacement, and central tricuspid malcoaptation. A structured light scanner was used to image the 3D topography of the tricuspid valve in both the native and FTR state, and images were exported into scan-to-computer-aided design software, which allowed for high-resolution 3D computational reconstruction. Relevant geometric measurements were sampled including annular circumference and area, major and minor axis diameter, and tenting height, angle, and area. Geometric measurements from the ex vivo model were compared to clinical transthoracic echocardiographic (TTE) measurements using two-sample t-tests. Results: A total of 12 porcine hearts were included in the study. Annular measurements of the native valve were comparable to published TTE data, except for the minor axis diameter, which was shorter in the ex vivo model (2.5 vs. 3.1 cm, P = 0.007). Induction of FTR in the ex vivo model resulted in annular enlargement (FTR vs. native: circumference 13.7 vs.11.8 cm, P = 0.012; area 14 vs. 11 cm2, P = 0.011). Ex vivo leaflet measurements in both the native and FTR model differed from published TTE data, but demonstrated comparable directional changes between the native and regurgitant states, including increased tenting height, area, and volume. Conclusion: The ex vivo pneumatically-pressurized porcine model closely recapitulates the geometry of both the native and regurgitant tricuspid valve complex in humans and holds promise for testing novel FTR repair strategies. Relevance for Patients: Currently available interventions for the tricuspid valve have a risk of permanent conduction abnormalities and are insufficient in addressing tricuspid disease for a subset of patients. This ex vivo model provides a platform for testing of novel interventions that address the deficiencies of current tricuspid therapies.

Tricuspid valve repair for infective endocarditis.

The progressive increase in the use of implantable electronic devices, vascular access for dialysis and the increased life expectancy of patients with congenital heart diseases has led in recent years to a considerable number of right-side infective endocarditis, especially of the tricuspid valve (TV). Although current guidelines recommend TV repair for native tricuspid valve endocarditis (TVE), the percentage of valve replacements remains very high in numerous studies. The aim of our study is to analyse our experience in the treatment of TVE with a reparative approach. This case series includes all the patients who underwent surgery for acute or healed infective endocarditis on the native TV, at the Cliniques Universitaires Saint-Luc (Bruxelles, Belgium) between February 2001 and December 2020. Thirty-one patients were included in the study. Twenty-eight (90.3%) underwent TV repair and 3 (9.7%) had a TV replacement with a mitral homograft. The repair group was divided into 2 subgroups, according to whether a patch was used during surgery or not. Hospital mortality was 33.3% (n = 1) for the replacement group and 7.1% (n = 2) for repair (P = 0.25). Overall survival at 10 years was 75.6% [95% confidence interval (CI): 52-89%]. Further, freedom from reoperation on the TV at 10 years was 59.3% (95% CI: 7.6-89%) vs 93.7% (95% CI: 63-99%) (P = 0.4) for patch repair and no patch use respectively. Freedom from recurrent endocarditis at 10 years was 87% (95% CI: 51-97%). Considering that TVE is more common in young patients, a repair-oriented approach should be considered as the first choice. In the case of extremely damaged valves, the use of pericardial patch is a valid option. If repair is not feasible, the use of a mitral homograft is an additional useful solution to reduce the prosthetic material.

Haemophilus influenzae endocarditis: a case report and literature review.

Haemophilus influenzae (HI) is an exceedingly rare cause of infective endocarditis (IE). We present a case of a 90-year-old female diagnosed with HI-IE involving the native tricuspid valve in the absence of traditional risk factors for right-sided endocarditis. She was treated with a 5-week course of IV Ampicillin from negative cultures and suffered no complications. We also conducted a thorough literature review through PubMed and Google Scholar, which yielded a mere 15 reported cases of HI-IE. Fourteen of the reported HI-IE cases included epidemiological data, showing no gender predominance. The mean age of the subjects was 39.5, with the mitral valve being the most implicated (64%) and tricuspid valve involvement being rare (21%). Native tricuspid valve IE is an uncommon entity, especially in the absence of IV drug use. Haemophilus influenzae is an extremely rare cause of IE, with a literature review showing merely 15 reported cases. This article cites the 16th case of HI-IE published in the literature.

Management of isolated native tricuspid valve infective endocarditis by a multidisciplinary program: a single-center retrospective cohort study.

Isolated native tricuspid valve infective endocarditis remains a challenging disease to treat given the large number of patients with substance use disorder. There is limited data on the optimal treatment strategy and the impact of a multidisciplinary endocarditis program on outcomes for this population. To assess the clinical outcomes associated with management of native tricuspid valve infective endocarditis by a multidisciplinary team. Single-center, retrospective cohort study. Patient cases were identified from the registry of the institutional multidisciplinary endocarditis team. Patients with left-sided endocarditis, multivalvular endocarditis, prosthetic tricuspid valves and cardiac implantable electronic devices were excluded. Between September 7th, 2021 and February 1st, 2024 72 consecutive patients with isolated native tricuspid valve infective endocarditis were identified. Sixty-six (91.7%) patients were managed medically. Five patients underwent percutaneous mechanical aspiration of tricuspid valve vegetations and one patient underwent tricuspid valve replacement during the index hospitalization. In-hospital mortality was 1.4% and 90-day mortality was 2.8%. Nineteen (26.4%) patients discharged before medically advised and 25% were re-admitted within 30 days. Ten (13.9%) patients underwent elective tricuspid valve replacements after outpatient follow-up. Among 72 patients with isolated native tricuspid valve infective endocarditis managed by a multidisciplinary endocarditis program over a 2.5-year period, in-hospital, 90-day mortality and 1-year mortality were very low despite low rates of percutaneous mechanical aspiration and tricuspid valve surgery. Multidisciplinary follow-up can lead to elective tricuspid valve surgery in a delayed fashion.

Acute drug-use-related native tricuspid valve infective endocarditis: a non-surgical disease.

As a result of the ongoing opioid epidemic, physicians have encountered increasing rates of drug-use-related native tricuspid valve infective endocarditis (DU-TVIE), a complex multi-faceted disease that is best managed by interdisciplinary teams. Despite the large number of patients with DU-TVIE, there is little data to support the optimal treatment strategy with respect to medical and surgical therapy. The recent introduction of percutaneous mechanical aspiration of tricuspid valve vegetations has added another treatment modality that is also of uncertain benefit. Here we review the literature on the management of DU-TVIE and highlight the multi-step treatment approach developed by the multidisciplinary endocarditis team at the University of Kentucky.

Contemporary profile of infective endocarditis in young patients in the era of ageing population: a comparative study

Abstract Aim The aim of the study is to describe the main differences in epidemiological characteristics, clinical features and prognosis between IE patients aged <50 and ≥50 years. Methods A total of 1935 episodes of IE were prospectively recruited at three tertiary centres from 1996 to 2022. Patients were classified into two groups: <50 years (n=333, median age 40 [IQR 33-45] and ≥50 years (n=1602, median age 71 [IQR 64-78]). Variables related to epidemiology, microbiology, echocardiography and outcomes among both groups were analysed. Results The proportion of male patients was higher in those <50 years (73.9% vs 64%; p<0.001). Patients aged ≥50 years had more comorbidities. Time to diagnosis was longer in this group of patients (6.2 ± 1.5 vs 21.7 ± 14.12 days; p<0.001). Proportion of community-acquired IE was higher in <50-year episodes (64.4% vs 81%; p<0.001). Intravenous drug use (IVU) was significantly more frequent in younger patients (22.6% vs 0.5%; p<0.001). Likewise, tricuspid native valve IE was more common in patients <50 years old (16.6% vs 4%; p<0.001). Congenital heart disease (17.2% vs 2.7%; p<0.001) and mitral valve prolapse (6.3% vs 3.8%; p=0.041) were more frequent in patients aged<50 years. Conversely, prosthetic valve IE (38.4% vs 20.7%; p<0.001) was more common in patients >50 years. Streptococcus bovis (0.9% vs 5.6%; p<0.001), enterococci (3% vs 12.6%; p=0.000), coagulase-negative staphylococci (9.9% vs 18.4%; p<0.001) and gram-negative bacilli (1.2% vs 3.5%; p=0.028) infections were more frequent in ≥50-year adults, while the incidence of Streptococcus viridans (21.9% vs 10.7%; p<0.001) and HACEK (1.2% vs 0.3%; p=0.03) infections was higher in the <50-year group. Staphylococcus aureus IE was similar between the two groups (23.7% vs 19.4%; p=0.074). The presence of vegetations (87.4% vs 80.9%; p=0.005), as well as severe new valve regurgitation (42% vs 30.8%; p<0.001) were more often found in <50-year patients. Acute heart failure (44.1% vs 59.5%; p<0.001), acute kidney failure (27.3% vs 47.5%; p<0.001) and septic shock (15.3% vs 20.9%; p=0.02) were more frequent in >50-year group. No differences in frequency of cardiac surgery among both groups were found (61.9% vs 57.6%; p=0.147). In-hospital mortality was significantly higher in ≥50-year patients (15.6% vs 29.2%; p<0.001). Mortality remained higher in ≥50-year adults who underwent cardiac surgery (12.4% vs 23.3%; p=0.001) as well as those who did not undergo surgery (20.5% vs 37.2%; p<0.001). Conclusions Patients aged <50 years diagnosed with IE were more frequently male, and had a higher proportion of community-acquired infections. Congenital heart disease, mitral valve prolapse and IVU were more frequent in <50-year adults. Streptococcus viridans infections were more frequent in this group of patients. In-hospital complications and mortality were lower compared to older patients, regardless of whether they underwent cardiac surgery.

Heart Transplantation in a Patient With a Heterotopic Percutaneous Tricuspid Valve Prosthesis: A Case Report

The bicaval transcatheter prosthesis (TricValve) allows the treatment of cava reflux in patients with severe tricuspid regurgitation and high surgical risk. It consists of the implantation of 2 self-expanding valves in both vena cava without directly approaching the native tricuspid valve. Heart transplantation in this setting may require some modifications compared with the conventional bicaval technique. We describe the clinical case of a 69-year-old woman with a background of rheumatic mitral valve disease who required a mitral valve replacement a few decades before. Ongoing clinical deterioration with biventricular dysfunction and severe tricuspid regurgitation was treated with a percutaneous bicaval heterotopic self-expanding valve system, with no clinical benefit. The patient underwent an elective heart transplantation. For the surgical approach, venous cannulation was performed percutaneously for both the right internal jugular and right femoral vein. Due to the impossibility of extracting percutaneous caval valves, the biatrial technique was selected for heart implantation. The postoperative course was difficult, but the patient was successfully discharged home 2 months postoperatively. She remains in good clinical condition with normal heart function 1 year after the transplant. To our knowledge, this is the first report describing a heart transplant in a patient with a bicaval transcatheter prosthesis.

A Rare Case of Postpartum Native Tricuspid Valve Infective Endocarditis with Septic Pulmonary Embolization

Infective endocarditis (IE) is a rare life-threatening infection in pregnancy and postpartum period. In 90% of cases, right-sided IE involves the tricuspid valve. This case report illustrates acute IE with native tricuspid valve vegetation with septic pulmonary embolization in immediate postpartum period.

PO-03-084 EFFECT OF RIGHT VENTRICULAR ENDOCARDIAL VS EPICARDIAL LEADS ON CLINICAL OUTCOMES IN PATIENTS WITH TRICUSPID VALVE PROSTHESIS

Endocardial right ventricular (EnRV) leads are described as potential cause of native tricuspid valve regurgitation (TR). Need for cardiac pacing by EnRV or epicardial (EpiRV) lead after tricuspid valve repair (TVr) or bioprosthetic replacement (bTVR) is common, but little is known about their effects post-operatively. Assess clinical outcomes, such as TR, lead function, and risk of infection in patients with TV prosthesis followed by EnRV vs EpiRV lead implant. We retrospectively reviewed all patients with RV lead post-TVr or bTVR at our hospital between 1/2000-11/2022. These were divided in 2 groups: Grp 1 (patients with EnRV lead) and Grp 2 (patients with EpiRV lead). Primary outcome was change in TR and RV lead function at follow up. Level of TR was scored as 0 = none/trivial, 1 = mild, 2 = moderate, 3 = moderate-severe or severe. Pacing threshold change (Δ +/- SD V), need for revision/extraction, and death at follow up were noted. 64 patients were identified [Grp 1: n = 52 (56% female, 79% atrial fibrillation, 94% TVr, 6% bTVR) vs Grp 2: n = 12 (67% female, 42% atrial fibrillation, 42% TVr, 58% bTVR)]. In Grp 2, 58% had prior RV lead extracted intraoperatively due to lead-related TR vs 0% in Grp 1. In Grp 1, mean time from surgery to RV lead implant, last ECHO, and last device interrogation were 24, 77, and 83 months vs 0, 10.6, and 9 months for Grp2, respectively. TR worsened in Grp 1 only in 55% of TVr patients (mean 0.9 level). When compared to Grp 2, TR was significantly worse in Grp 1 vs Grp 2 (p = 0.029, FigA). This was particularly the case after TVr (FigB) and not bTVR (FigC). RV lead threshold significantly worsened in Grp 2 vs Grp 1 (55.5% vs 3.7%, p = 0.003); threshold increased significantly by Δ 1.18 +/- 2.05 V vs Δ 0.11 +/- 0.34 V (p = 0.026). Average threshold at follow up in Grp 2 was 2.02 +/- 2.13 V vs 0.737 +/- 0.27 V for Grp 1 (p = 0.05). Lead extraction occurred in 8% of patients in Grp 1 (25% endocarditis, 75% lead failure/malfunction) and 17% in Grp 2 (100% endocarditis). There were 28 deaths (Grp 1: 42%, mean follow up 97.9 months vs Grp2: 50%, mean follow up 14 months). In our study, presence of EnRV lead after TV surgery correlated with mild increase in TR after TVr but not bTVR. On the other hand, EpiRV lead threshold increased significantly over time compared to EnRV leads. EnRV lead is a suitable approach after TVr or bTVR.

A Case Study of Tricuspid Endocarditis in Post-Partum Female

Tricuspid valve endocarditis is uncommon thing compared to left-sided endocarditis which accounts for approximately 5-10 % of all cases of infective endocarditis. Tricuspid valve endocarditis is most commonly seen in patients who are addicted to intravenous drugs. Patients may present with symptoms like right- sided heart failure. Tricuspid endocarditis during pregnancy or peri-partum period is a rare entity with significant morbidity and mortality. Rheumatic heart disease was considered a significant risk factor previously which has changed over to intravenous drug abuse in recent decades. We hereby report a case of tricuspid native valve endocarditis complicating the post-partum period in a young female without underlying traditional risk factors, who improved with medical therapy alone.

Cryptococcus neoformans endocarditis in an immunocompetentpatient a case report

BackgroundCryptococcus neoformans is an invasive fungal infection commonly affecting immunocompromised patients as pneumonia or meningitis. More rarely, case reports describe Cryptococcus neoformans endocarditis, though nearly exclusively among patients with active immunosuppression, implanted cardiac devices or prosthetic valves.Case presentationWe report the case of a patient with underlying substance abuse disorder and systolic heart failure presenting with fever, altered mental status, and shower emboli subsequently found to have native tricuspid valve vegetations and blood cultures positive for cryptococcus neoformans in the absence of immunosuppression.ConclusionsHistorically, Cryptococcus neoformans fungemia manifests clinically as pneumonia or meningitis among the immunosuppressed. There have been rare reports of endocarditis in this population and even fewer reports of native valve endocarditis exist. The present case along with mortality reported in prior literature, suggest suspicion must be maintained in the absence of immunosuppression, even in patients with native valves.

Infective endocarditis and COVID-19: the impact of SARS-CoV-2 infection on diagnostics, course, and prognosis

Aim. To study the impact of coronavirus disease 2019 (COVID-19) pandemic on hospitalization rates, diagnosis, and outcomes of infective endocarditis (IE) with a subanalysis of IE course in combination with COVID-19.Material and methods. This prospective cohort study included 168 patients with definite or probable IE (DUKE 2015) hospitalized in the V.V. Vinogradov City Clinical Hospital from July 2017 to July 2022. All patients underwent a conventional examination in accordance with current clinical guidelines. We studied clinical, paraclinical and etiological parameters, as well as outcomes.Two clinical observations of the combination of IE and COVID-19 are presented.Results. When assessing the local registry of patients with IE, a trend towards an increase in hospitalizations rate of IE in 2021-2022 was shown, with a decrease during the period of long-term lockdowns in Moscow and a subsequent surge after their cancellation. Patients with IE during the COVID-19 pandemic had a more favorable clinical profile, a 2-fold increase in IE diagnosis (due to late hospitalization), frequent detection of Staphylococcus aureus MSSA (32,6%), and frequent surgical treatment (up to 87,6% with a combination of IE and COVID-19), as well as high in-hospital mortality, but without a tendency to increase (30,4%). Clinical observations of IE and COVID-19 combination are presented, which demonstrates the contribution of COVID-19 as the only risk factor for native tricuspid valve IE in a patient without predisposing causes, as well as a factor in the unfavorable prognosis for native aortic valve IE after the addition of COVID-19, which led to lethal outcome.Conclusion. The present study demonstrates the profile of patients with IE and COVID-19 depending on the epidemiological situation of COVID-19 and the association with SARS-CoV-2 infection. The data obtained make it possible to discuss the potential relationship between COVID-19 and IE. The "endocarditis team" determines the timely implementation of surgery and the absence of an increase in inhospital mortality, regardless of the epidemiological situation.

A rare case of native tricuspid valve endocarditis caused by Aerococcus sanguinicola

• Aerococcus sanguinicola bacteremia is mostly seen in older males with urinary tract abnormalities or indwelling catheters. • Complicated bloodstream infections and infective endocarditis are rare. • More complicated infections are being reported due to improved methods for identification. • We describe the first presentation of right sided endocarditis caused by A. sanguinicola. An elderly man with no known valvular disease or history of intravenous drug use, intracardiac devices or central venous catheters was diagnosed with a tricuspid valve endocarditis and corresponding septic pulmonary emboli. Blood cultures showed Aerococcus sanguinicola being the likely causative pathogen. The patient did have a suprapubic catheter and bladder stones. Urinary tract abnormalities in older males and an indwelling urinary tract catheter are known risk factors for A. sanguinicola bacteremia but complicated bloodstream infections and infective endocarditis are rare. More complicated infections are being reported recently though possibly due to improved methods for identification. We describe a unique presentation of right sided endocarditis caused by A. sanguinicola to increase awareness of its potential to cause invasive disease.

Texas TriValve 1.0 : a reverse‑engineered, open model of the human tricuspid valve.

Nearly 1.6 million Americans suffer from a leaking tricuspid heart valve. To make matters worse, current valve repair options are far from optimal leading to recurrence of leakage in up to 30% of patients. We submit that a critical step toward improving outcomes is to better understand the "forgotten" valve. High-fidelity computer models may help in this endeavour. However, the existing models are limited by averaged or idealized geometries, material properties, and boundary conditions. In our current work, we overcome the limitations of existing models by (reverse) engineering the tricuspid valve from a beating human heart in an organ preservation system. The resulting finite-element model faithfully captures the kinematics and kinetics of the native tricuspid valve as validated against echocardiographic data and others' previous work. To showcase the value of our model, we also use it to simulate disease-induced and repair-induced changes to valve geometry and mechanics. Specifically, we simulate and compare the effectiveness of tricuspid valve repair via surgical annuloplasty and via transcatheter edge-to-edge repair. Importantly, our model is openly available for others to use. Thus, our model will allow us and others to perform virtual experiments on the healthy, diseased, and repaired tricuspid valve to better understand the valve itself and to optimize tricuspid valve repair for better patient outcomes.

Rapid-deployment aortic valve replacement for patients with bicuspid aortic valve: a single-centre experience.

The benefit of rapid-deployment aortic valve replacement (RD-AVR) in patients with a bicuspid aortic valve (BAV) is controversial due to aortic root asymmetry and potential increased risk for valve dislocation and paravalvular leak. This study aimed to analyse the outcomes of surgical aortic valve replacement with a rapid-deployment bioprosthesis in patients with a BAV. Between May 2010 and December 2020, all consecutive patients who underwent RD-AVR at the Medical University of Vienna were included in our institutional database. Assessment of preoperative characteristics, operative outcomes, long-term survival and clinical events was performed. The outcomes of patients presenting with a native BAV were compared with a control group of patients with native tricuspid valve (TAV); reoperative aortic valve replacements were excluded. Out of 816 patients, who underwent RD-AVR at our institution, 107 patients with a BAV, mean age 68 (standard deviation: 8) years, were compared with a control group of 690 patients with a TAV, mean age 74 (standard deviation: 7) years; patients presenting with a BAV were significantly younger than patients with a TAV (P < 0.001). Concomitant procedures were performed in 44 (41.1%) patients in the BAV group and in 339 (49.1%) patients in the TAV group (P = 0.123); surgery of the ascending aorta was necessary in 24 (22.4%) in the BAV group, compared with 29 (4.2%) in the control group (P < 0.001). The 5-year cumulative incidence of moderate-to-severe paravalvular regurgitation in the BAV group was 10.7% [95% confidence interval (CI): 4.2-20.7%] and 3.9% (95% CI: 2.4-6.1%) in the TAV group (P = 0.057). Reoperation with valve explantation due to non-structural valve dysfunction at 5 years was 2.8% (95% CI: 0.5-8.8%) in the BAV group, compared to 1.9% (95% CI: 1.0-3.2%) in the TAV cohort (P = 0.89). The overall long-term survival rate in the BAV group was 92% (95% CI: 81-97%) at 5 years and 88% (95% CI: 73-95%), at 10 years, significantly better compared to the TAV group (log-rank test P = 0.002). RD-AVR can be performed in patients with a BAV with convincingly medical outcomes. However, a trend to increased frequency of moderate-severe paravalvular regurgitation was observed at long-term follow-up. Consequently, a different surgical approach, compared to tricuspid valves, with distinctly specific technical- and anatomical considerations and requirements, is recommended.

Imaging for transcatheter native tricuspid valve intervention: patient selection, procedural planning and interventional guidance.

There are an increasing number of transcatheter tricuspid valve interventions being performed worldwide using commercially available and investigational devices. Imaging in the pre-procedural and periprocedural period is essential for procedural and clinical success. Echocardiographic-based techniques are particularly important in these procedures, especially for interventional guidance. This review summarizes the current devices in use and how imaging is used for patient selection, procedural planning, and interventional guidance. The most commonly used method of transcatheter tricuspid intervention is edge-to-edge repair using the MitraClip or TriClip devices (Abbott, Santa Clara, CA, USA). Randomized controlled data is pending but observational studies have demonstrated success, especially in the setting of smaller coaptation gaps and adequate transesophageal imaging windows. Direct annuloplasty with the Cardioband (Edwards Lifesciences, Irvine, CA, USA) has also been used in many centers and has demonstrated success when the anatomy and mechanism of tricuspid regurgitation are appropriate for annuloplasty based on imaging evaluation. Lastly, transcatheter valve replacement is becoming more common using several investigational devices and relies heavily on imaging methods to achieve procedural success.

Incidence of acquired ventricular septal defect after transcatheter aortic valve replacement: A large single center experience.

To determine the rate and clinical outcomes of post-TAVR VSD. Transcatheter aortic valve replacement (TAVR) is a safe and established procedure for patients with severe symptomatic aortic stenosis. Ventricular septal defect (VSD) is a rare complication of TAVR. The rate of post-TAVR VSD and patient outcomes are not well known. A retrospective record review of VSD cases occurring after all TAVRs performed between January 2012 and September 2020 at one urban US tertiary hospital. VSD rate and early- and long-term outcomes were analyzed. Computed tomography images taken before TAVR and transthoracic echocardiograms done before and after each procedure were analyzed. Of the 1908 patients who underwent TAVR in the study period, 7 patients (0.37%) had post-procedure VSD. The average patient age was 77 ± 11 years with average society of thoracic surgeons short-term risk score of 6%. All 7 implanted valves were balloon-expandable. Of the 7 TAVR procedures, 5 were performed on a native tricuspid valve, 1 was performed on a native bicuspid valve, and 1 was done as a "valve-in-valve" procedure on a prior surgical bioprosthetic valve. All VSDs were small and restrictive in nature. Right heart failure in a patient with preexisting right ventricular dysfunction occurred in 1 (13%) patient who died. The remaining 6 patients (86%) were discharged. All 6 patients (86%) were alive and stable at 1year follow-up, reporting improvement in symptoms (NYHA class I-II), with no evidence of right ventricular dysfunction. VSD is a rare complication of TAVR. Hemodynamic and clinical sequelae in majority of the patients in this study did not result in mortality. Proper imaging techniques and appropriate pre-procedure planning are needed to decrease the incidence of VSD formation post-TAVR.

Pacing leads in transcatheter tricuspid valve

Abstract Funding Acknowledgements Type of funding sources: None. Background Transcatheter therapy of bioprothesis in tricuspid position and the native tricuspid valve are a growing field in interventional cardiology. Yet, the presence of pacing leads can demand a different approach. We performed a systemic review of this topic to understand the risks and the potential impact on the pacing leads. Objective Review the evidence regarding the efficacy and safety of pacing leads with the transcatheter tricuspid valve implantation. Methods A systemic research on MEDLINE and PUBMED with two the following terms "transvenous pacing", "transcatheter valve", "transcatheter tricuspid", "transvalvular leads", "tricuspid valve-in-valve" and "transvalvular pacemaker". 120 results were identified. However, just 5 papers were selected since are the only ones that described the implantation of a transcatheter tricuspid valve in patients with pacing leads and had some follow up, yet one of the papers lacks data and was excluded. The majority of papers reported the success of the procedure yet without a follow-up or the potentials complications on the pacing leads. Results Four studies were selected, including a total of 33 patients. The studies were performed with different techniques and procedures, as well as the reports regarding the echocardiogram and pacing data before the procedure and during the follow-up. Mean age 59.51 years old, 78.78% were female, 72.72% had NYHA class ≥ III, 21.21% was hospitalized in the previous 6 months, 21.21% had acute or chronic renal insufficiency, 18.18% had cirrhosis or liver disease, 51.52% had other prosthetic valves and 12.12 had history of endocarditis. Acquired etiology for tricuspid valve disease in 63.64%, atrial fibrillation in 60.60%, 78.79% had a tricuspid bioprosthetic valve, one patient had a catheter valve and the rest had a ring with or without homograft valve. 60.60% had moderate or severe tricuspid regurgitation and 15.15% had mixed tricuspid regurgitation and stenosis, with a mean tricuspid valve gradient of 7.22 mmHg. SAPIEN transcatheter valve was used in 78.79% and Melody valve in the rest. The transcatheter tricuspid implantation was a success in 32 patients, without any interference in the pacing leads. Of them, the follow-up period was diverse and heterogeneous with a mean of 13.51 months, a mean tricuspid valve gradient of 5.00 mmHg, and a register of 3 death without any relationship with the transcatheter valve or pacing complications. Was reported three complications during the follow-up regarding the pacing leads, two patients had a marked increase in the right ventricle leads impedance and stimulation threshold and one patient developed a right ventricle lead fracture. Conclusions 9.28% of the patients submitted to transcatheter tricuspid valve had pacing lead complications. Considering the small sample, further investigation regarding the impact of this procedure in the pacing leads is required for a clear assessment.

Isolated Native Tricuspid Valve Endocarditis in a Nonintravenous Drug User

Infective endocarditis (IE) is a disease characterized by high morbidity and mortality. IE was first described in the mid-16th century. Right-sided infective endocarditis (RSIE) represents 5% to 10% of all IE episodes in adults. RSIE can be divided into three groups according to the underlying risk factors: intravenous drug users (IDUs), cardiac device carriers, and the “three noes” group (no left-sided IE, no IDUs, and no cardiac devices). Tricuspid valve endocarditis in nonintravenous drug users can occur in a variety of conditions including congenital heart disease, intracardiac devices, central venous catheters, and immunologically debilitated patients. Due to the rareness of isolated native nonrheumatic tricuspid valve endocarditis, here, we like to present an 18-year-old male from rural Ethiopia with the diagnosis of isolated native tricuspid valve endocarditis that was treated and cured.