Tricuspid Valve Papillary Muscles Research Articles

Successful Repair of Neonatal Tricuspid Regurgitation Due to Papillary Muscle Rupture: A Rare Case

Background: Neonatal rupture of the chordae of the tricuspid valve with severe regurgitation is scarce and devastating.Case report: Here, we report the case of a full-term male neonate presented with cyanosis caused by severe tricuspid regurgitation due to anterior leaflet papillary muscle rupture. Following initial stabilization by the infusion of prostaglandins E1, successful early repair was achieved.Conclusion: Early diagnosis of the tricuspid valve papillary muscle rupture is critical, and early surgical repair have a good result during early post-operative period.

Diagnostic accuracy and clarity of steady-state free precession imaging of cardiac valve morphology in congenital heart disease

Purpose: Evaluation of cardiac valve morphology has not been considered an indication for cardiac magnetic resonance imaging (MRI) due to suboptimal imaging quality. Our study aims to evaluate cine of cardiac magnetic resonance-steady-state free precession (CMR-SSFP) imaging quality and diagnostic accuracy in the assessment of cardiac valve morphology for congenital heart disease. Materials and Methods: We retrospectively reviewed consecutive pediatric/congenital cardiac MRI cases. A 5-grade diagnostic clarity score was assigned to the aortic valve annulus and leaflets, tricuspid valve and mitral valve annuli, leaflets, chordae, and papillary muscles by examination of standard cine CMR-SSFP imaging. Among patients with aortic valve imaging, we compared morphologic diagnosis by CMR-SSFP to echocardiography. High-quality diagnostic imaging was defined as a clarity score of 1 or 2. Results: There were a total of 234 cardiac MRI studies evaluated with a total of 1892 valve components. The majority of valve annuli, leaflets, and papillary muscles had high diagnostic clarity score 64%–80% of the time – the tricuspid valve papillary muscles had a high diagnostic clarity score 53% of the time. Among the 39 cases with aortic valve imaging, CMR-SSFP correctly identified the aortic valve morphology including the affected commissure. Conclusions: CMR-SSFP produces high diagnostic quality imaging of cardiac valve morphology in congenital/pediatric cardiac MRI. The valve components with the highest diagnostic clarity score are tricuspid and mitral valve annuli, leaflets and papillary muscles, and aortic valve annuli and leaflets. Aortic valve morphology can be diagnosed with a high degree of reliability.

Ruptured Tricuspid Valve Papillary Muscle in a Neonate with Intractable Persistent Fetal Circulation.

Unguarded tricuspid regurgitation (TR) due to a flail tricuspid leaflet is a rare condition of newborn cyanosis. A high perinatal mortality has been associated with this fatal condition. But, there are feasible surgical repairs to improve survival. We report the case of a male full-term neonate with intractable hypoxia. He had profound tricuspid insufficiency and leaflet prolapse caused by a ruptured papillary muscle supporting the anterior leaflet of the tricuspid valve. He presented with severe cyanosis and respiratory distress immediately after birth. Despite medical management, the pulmonary vascular resistance was not decreased and a low cardiac output persisted. Initial stabilization was accomplished with nitric oxide and extracorporeal membrane oxygenation. The tricuspid valve repair surgery was successfully performed subsequently. TR resulting from papillary muscle rupture is a potentially lethal condition. Timely diagnosis and proper surgical treatment can be lifesaving.

Tricuspid valve papillary muscle avulsion from a pulmonary artery catheter

Tricuspid valve papillary muscle avulsion from a pulmonary artery catheter

Massive calcification of the tricuspid valve papillary muscles in right ventricular endomyocardial fibrosis

Right-sided forms account for one-fourth of endomyocardial fibrosis cases in central Africa. A 50-year-old female patient with endo- myocardial fibrosis presented with unusual calcifications of the right ventricular endocardium that embedded the tricuspid valve papillary muscles. Bioprosthetic tricuspid valve replacement together with right ventricular endocardectomy was performed with a good clinical outcome.

Failure of the GORE HELEX atrial septal defect occluder to treat membranous VSDs in swine

We tested the suitability of the GORE HELEX septal occluder for closure of membranous ventricular septal defect in three Yucatan minipigs that had naturally-occurring membranous ventricular septal defects. The animals were studied in the Gore Science Center Laboratory in Flagstaff, Arizona. In all of the device implantations, seating of the right disk along the right ventricular septum was problematic with resultant entanglement of one device in the chordae tendinae during attempted removal, implantation of one device onto the tricuspid valve papillary muscle and unlocking of one device occurring after implantation. A new occluder design appears to be needed to minimize the risk of disk entanglement with cardiac structures, particularly within the right ventricle. These studies did establish that the Yucatan mini swine are an acceptable and appropriate model for evaluating occluders intended for closure of membranous ventricular septal defects.

Tricuspid Valvular Papillary Muscle Rupture With Intractable Hypoxia: A Rare Complication Post MI

Acute inferior ST-elevation myocardial infarction (STEMI) alone contributes to approximately 10% of in-hospital mortality due to ischemic heart disease. Right ventricular involvement occurs in 50% of patients who present with inferior STEMIs, increasing in-hospital mortality to 31%. In the setting of concomitant severe tricuspid regurgitation, acute rupture of the papillary muscles within the right ventricle should be considered in the differential diagnosis. The authors present the case of a patient with intractable hypoxia in the setting of an acute inferior STEMI complicated by rupture of the posterior tricuspid valve papillary muscle.

Spontaneous Prenatal Ductal Closure: Postnatal Diagnosis?

Prenatal ductal constriction and closure usually are related to maternal intake of prostaglandin receptor inhibitors during late gestation but may occur spontaneously. This report describes three live-born infants sharing echocardiographic features of spontaneous intrauterine ductal constriction, closure, or both, although only one had a prenatal diagnosis. Interestingly, in addition to severely hypertrophied right ventricles, all three had hyperechogenic tricuspid valve papillary muscles. Two also had mild ascending aorta dilation. These cases raise mechanistic questions because of intrauterine ductal occlusion, bright papillary muscles, and potential dilated ascending aortas.

Right Ventricular Reduction as an Adjunct Procedure in Tricuspid Valve Repair

Functional tricuspid regurgitation secondary to mitral valve disease can not be attributed to the dilatation of the tricuspid annulus alone. Furthermore, geometrical changes of the right ventricle lead to tethering of the tricuspid valve leaflets and thereby to an incomplete leaflet coaptation. With this pathologic entity, conventional isolated tricuspid valve annuloplasty will presumably result in significant residual tricuspid regurgitation. The surgical goal should be the reduction of tricuspid annulus dilatation and annihilation of tethering forces on the tricuspid leaflets. In combination with conventional tricuspid valve annuloplasty, right ventricular reduction surgery, as demonstrated, may be effective in reaching these goals and hereby avoiding residual tricuspid regurgitation in this patient population.

Management of Ebstein’s Anomaly and Pure Tricuspid Insufficiency in the Neonate

Because the pulmonary vascular resistance is very elevated at birth, severe tricuspid regurgitation is poorly tolerated and even life-threatening in the newborn. The etiology may be tricuspid valve papillary muscle rupture or the more ominous Ebstein's anomaly, with its associated dysfunctional right ventricle. After the diagnosis is established and the patient is supported with prostaglandin infusion and nitric oxide, definitive surgical management is undertaken with the expectation of excellent outcomes for isolated tricuspid valve regurgitation. For neonates with Ebstein's anomaly, therapy is tailored to the severity of the malformation and the degree of right ventricular outflow tract obstruction, assessed in the context of declining pulmonary vascular resistance. The surgical approach may involve ligation of a patent ductus arteriosus, placement of a systemic to pulmonary shunt, establishment of functional tricuspid atresia, or tricuspid valve repair. With the application of these various approaches, the outlook for neonatal Ebstein's anomaly has improved remarkably.

Ruptured Tricuspid Valve Papillary Muscle: A Treatable Cause of Neonatal Cyanosis

Severe tricuspid regurgitation resulting from a flail leaflet is a rare cause of neonatal cyanosis. We report two neonates with profound cyanosis and severe tricuspid regurgitation caused by rupture of the papillary muscle supporting the anterior leaflet, without other structural heart defects. Ductal patency could not be established. Repair of the tricuspid valve was performed by reimplantation of the ruptured papillary muscle head, after initial stabilization using extracorporeal membrane oxygenation. Early recognition and treatment of this otherwise fatal condition can be lifesaving.

Rupture of tricuspid valve papillary muscle during balloon pulmonary valvuloplasty

Rupture of tricuspid valve papillary muscle during balloon pulmonary valvuloplasty

Hemodynamic, pulmonary vascular, and myocardial abnormalities secondary to pharmacologic constriction of the fetal ductus arteriosus. A possible mechanism for persistent pulmonary hypertension and transient tricuspid insufficiency in the newborn infant.

The prostaglandin synthetase inhibitor indomethacin was given orally or intravenously to pregnant ewes. This resulted in a significant rise in the fetal pulmonary-to-systemic arterial mean blood pressure difference across the ductus arteriosus, presumably secondary to constriction of the ductus arteriosus. In five experiments the pressure difference could be promptly but temporarily reversed by the administration of prostaglandin E1 (PGE1) into the fetal inferior vena cava. Fetal lungs from study and control animals were fixed by perfusion at measured pulmonary arterial mean blood pressure, and fifth-generation resistance vessels were studied. The medial width/external diameter ratio was significantly increased in the study vs the control lungs due to increased smooth muscle and decreased external diameter. In addition, study fetuses had acute degenerative myocardial changes in the tricuspid valve papillary muscles, the right ventricular free wall and the interventricular septum. Similar changes were not seen in control fetuses. Indomethacin administration during pregnancy causes constriction of the fetal ductus arteriosus, fetal pulmonary arterial hypertension, and right ventricular damage. If severe, this may cause rapid fetal death. If less severe, in the newborn infant, this mechanism may be one cause of persistent pulmonary hypertension due to vasoconstriction and increased pulmonary arterial smooth muscle and/or tricuspid insufficiency due to papillary muscle infarction.

99 MYOCARDIAL NECROSIS IN STRESSED NEWBORNS

The recent association of transient tricuspid insufficiency of the newborn with papillary muscle necrosis prompted a detailed retrospective clinical and histologic analysis of all autopsied infants to find sites of myocardial necrosis. In a four year period, 19 of 80 autopsied infants who died within 7 days of birth were found to have one or more sites of significant myocardial damage. None of the 80 had congential heart disease. 10/19 pregnancies were classified as high risk. All were singleton births. Of 9/19 monitored during labor, 7 had abnormal monitor patterns. Seven infants had tricuspid insufficiency (TI) murmurs and one had the murmur of mitral insufficiency (MI). All those with the TI murmurs had distinct necrotic foci in the tricuspid valve papillary muscles. The infant with the MI murmur had moderate to severe damage of the mitral valve papillary muscles. Six of seven with TI murmurs were term infants. Thirteen of 19 had suffered asphyxia, 6 of them had had massive aspiration of meconium stained amniotic fluid. Six of nineteen infants had creatine phosphokinase studies and 5 of 6 had significant elevation of the MB fraction. The occurrence of a severe asphyxial episode or abnormal monitor pattern associated with the development of TI or MI murmurs and elevated CPK-MB fraction suggests that the infant has suffered a papillary muscle or other myocardial necrosis.

Rupture of the papillary muscle of the triscupid valve: A complication of cardiopulmonary resuscitation and a rare cause of tricuspid insufficiency

Rupture of a papillary muscle is a rare occurrence. Two patients are described in whom rupture of a papillary muscle of the tricuspid valve developed after external cardiac massage during cardiopulmonary resuscitation. One of these patients survived briefly with clinical evidence of triscupid regurgitation immediately after resuscitation. Although tricuspid valve papillary muscle rupture has been described as a complication of bacterial endocarditis, chest trauma and myocardial infarction, it is a generally unrecognized complication of external cardiac massage. Findings in the two patients reported here suggest that patients with a dilated right ventricle may be more susceptible to this rare complication of cardiopulmonary resuscitation.