Tricuspid Valve Position Research Articles

Effectiveness of Balloon Valvuloplasty for Stenosis of a Bioprosthesis in the Tricuspid Valve Position

A 67-year-old man underwent percutaneous balloon valvuloplasty for bioprosthetic tricuspid stenosis. He had undergone two tricuspid valve replacements over a period of 39 years and became symptomatic. After the valvuloplasty, his symptoms were resolved. Stenosis of a bioprosthetic tricuspid valve can be successfully and safely treated with balloon valvuloplasty.

Transcatheter valve-in-valve implantation in the tricuspid position.

Transcatheter implantation of valved stents (Melody and Edwards valves) for replacement of the pulmonary valve is currently an established procedure. We reviewed our experience on implantation of such valves in the tricuspid valve position. Transcatheter valve implantation in the tricuspid position was attempted in five patients. Four patients had predominantly tricuspid valve regurgitation, two of whom also had tricuspid valve stenosis. All patients had severely symptomatic right heart failure. Patient median age and weight were 12 years and 50 kg (range six-43 years and 13-68 kg, respectively). All patients had a bioprosthetic valve already in place. The mean gradient across the tricuspid valve decreased from 12 to 3 mmHg after the procedure. Median procedure time and fluoroscopy time were 100 and 39 min (range 60-180 and 30-57 min, respectively). The patients' functional class improved from NYHA Class III to II in three and from Class III to I in two patients during a follow-up period of 15-22 months. Transcatheter replacement of malfunctioning bioprosthetic valves in the tricuspid position using valved stents is an attractive alternative to repeat surgery in high-risk or multi-operated patients. Longer follow-up and a larger number of patients are required to establish the long-term benefit of the procedure and freedom from reinterventions.

Long Term Results Comparing Mechanical and Biological Prostheses in the Tricuspid Valve Position: Which valve types are better - mechanical or biological prostheses?

The aim of this study was to evaluate the clinical outcome of patients who underwent TVR focusing on long-term survival- and valve-related complications. Between January 1993 and June 2011, 132 patients underwent tricuspid valve replacement in our centre. Sixty-eight bioprosthetic valves (52%) and 64 mechanical valves (48%) were implanted for tricuspid position. For 51 patients (39%) this was a first-time tricuspid valve operation. Nineteen patients died during hospitalisation, yielding a hospital mortality rate of 14%. The hospital mortality and morbidity were not statistically significantly different between the two groups. Sixteen patients (14,1%) died after discharge from the hospital. Twelve-year actuarial survival after mechanical and bioprosthetic TVR was 72,1±5,9 and 61.6±6,6%, respectively. No statistically significant difference was detected between mechanical and bioprosthetic valves in regard to event-free survival. The choice between mechanical or biological prostheses in the tricuspid position should be individualised according to the clinical judgment, even though absence of any difference in the survival data supports the opinion that there is no "gold standard" for prosthetic tricuspid valve replacement.

Prognosis of patients with carcinoid heart disease after valvular surgery.

A best evidence topic in cardiac surgery was written according to a structured protocol. We addressed the following question: in patients who are diagnosed with carcinoid heart disease (CHD), do valvular surgeries improve their prognosis? Fifty percent of the patients with clinically diagnosed carcinoid syndrome had cardiac involvement which was present either as valvular dysfunction or as cardiac metastases. These patients often require surgery due to their heightened risk of cardiac disease. Altogether 217 relevant papers were identified as a result of the below-mentioned search, of which 10 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Of the patients who were identified to have carcinoid heart disease in different studies, 193 patients had valve procedure, mainly replacements at tricuspid, mitral and aortic valve positions and either valvuloplasty or replacement at pulmonary valve. Tricuspid and pulmonary valves represented the majority of the excised valves among patients undergoing valvular surgery for CHD. The pathology of carcinoid valve was attributed to the presence of plaque, causing thickening and retraction. Pure regurgitation was the most common finding in all the valves except pulmonary valve which had both stenosis and insufficiency. Thirty-day mortality was 17% (range 1-63%) and long-term survivors were reported to be alive at an average of 58 months (28-80 months) after the valve surgery. The evidence demonstrates that surgical intervention can lead to improved prognosis and reduce the symptoms of heart failure. Postoperative mortality was mainly due to the carcinoid disease itself and not as a complication of the surgery. Therefore, surgery could be considered for symptomatic palliation in carefully selected individuals.

Reverse Endoventricular Artificial Obturator in Tricuspid Valve Position. Experimental Feasibility Research Study

The concept of vena contracta space reduction in tricuspid valve position was tested in an animal model. Feasibility of specific artificial obturator body (REMOT) fixed to the right ventricular apex and interacting with tricuspid valve leaflets was evaluated in three different animal studies. Catheter-based technique was used in three series of experiment in 7 sheep. First acute study was designed for evaluation if the screwing mode of guide wire anchoring to the right ventricular apex is feasible for the whole REMOT body fixing. Longer study was aimed to evaluate stability of the REMOT body in desired position when fixing the screwing wire on its both ends (to the right ventricular apex and to the skin in the neck area). X-ray methods and various morphological methods were used. The third acute study was intended to the REMOT body deployment without any fixing wire. In all of 7 sheep the REMOT was successfully inserted into the right heart cavities and then fixed to the right ventricular apex area. When the REMOT was left in situ more than 6 months it was stable, induced adhesion to the tricuspid valve leaflet and was associated with a specific cell invasion. Releasing of the REMOT from the guiding tools was also successfully verified. Deployment of the obturator body in the aim to reduce the tricuspid valve orifice is feasible and well tolerated in the short and longer term animal model. Specific cell colonization including neovascularization of the obturator body was observed.

Recurrent thrombotic obstruction of a mechanical prosthetic valve in tricuspid position

Recurrent thrombotic obstruction of a mechanical prosthetic valve in tricuspid position

275: Percutaneous insertion of a Melody valve in tricuspid position: technical aspects

percutaneous transcatheter heart valve replacement of aortic or pulmonary valve is established. Transcatheter atrioventricular valve replacement is been described. We report our experience focusing on the technical aspects. we retrospectively review the files of patients who received a transcatheter valve in tricuspid position between 2008 and 2012. Four patients were found. 3 had a heterograft (conduit of 14-mm, Sorin 33 et Edwards Perimount 33) and one had a connection between the RA and the RV infundibulum without a valve. Two patients had tricuspid regurgitation as a primary lesion, one had stenotic valve and the last one a mixted lesion. All successfully received a Melody valve from a femoral access. In patients with stenotic lesion, a predilatation using a high pressure balloon was performed before valve implant. In patients with regurgitation, the landing zone was calibrated using a low pressure balloon. These patients were presented to create a landing zone of adequate diameter. Melody valves were inserted using a 22-mm balloon catheter in 3 and a 24-mm in one. All but one were post-dilated. There was no significant regurgitation. The mean gradient across the tricuspid valve felt from 12 to 4.6-mmHg. One patient needed an epicardic pacemaker because of AV block following balloon dilatation. One patient required inotropic support and ventilation following the procedure but recovered after few days. Transcatheter tricuspid valve insertion is feasible in patients with surgical hetero or homografts after a careful selection. The mechanism of dysfunction must be known. In case of stenosis or mixted lesions, the only question is to know if the stenosis could be relief. In case of regurgitation, it is very important to know the features of surgical substrats and to calibrate the tricuspid orifice. Finally, patients with inappropriate landing zone should be presented prior to valve insertion.

Cardiac Mass With Calcification Forming Pulmonary Atresia in Utero; A Case of Fetal Endocarditis

Fetal intracardiac mass with calcification is very rare and not well reported. The authors treated a patient with a cardiac mass presumed to be infective endocarditis in the tricuspid valve and pulmonary valve positions with postcalcification echocardiographic shadow forming pulmonary atresia. Although postnatal consecutive blood cultures for bacterial and fungal pathogens tested negative, serial follow-up echocardiograms and surgical findings suggested infective endocarditis. This report describes a very rare case of presumed fetal infective endocarditis presenting as a calcified mass, which was successfully treated by partial resection without significant morbidity.

Cardiovascular magnetic resonance imaging findings in Ebstein anomaly

Methods CMR studies of patients with EA conducted from June 2007 to June 2011 were analized. Cine spin echo images in multiple views, and angiography were evaluated to assess chambers morphology and diameters, wall thickness and left ventricular function, also were measured the atrialized right ventricular portion and the functional tricuspid valve position. And Inversion Recovery sequence for determination of fibrosis.

Percutaneous Transcatheter Valve-in-Valve Implantation in Stenosed Tricuspid Valve Bioprosthesis

Transcatheter valve-in-valve implantation is a promising treatment option for degenerated bioprosthetic heart valves in high-risk patients.1 Successful percutaneous techniques have been described for pulmonary and aortic valves.2,3 We present the first successful percutaneous tricuspid valve-in-valve implantation. The patient was a fragile 74-year-old woman with chronic obstructive pulmonary disease (forced expiratory volume in 1 second, 53%), impaired renal function (modified diet in renal disease 35 mL/min/1.73 m2), and cardiac hepatic cirrhosis with ascites and cachexia (body mass index 19 kg/m2), admitted with chronic right-sided heart failure and severe stenosis of a degenerated tricuspid bioprosthesis. Previously, a partial atrioventricular canal defect had been treated in 3 consecutive surgical interventions. During the last procedure, 23 years ago, a mechanical mitral valve replacement (St. Jude 25 mm, SJM, Inc., St. Paul, MN) had been performed, combined with a bioprosthetic tricuspid valve replacement (pericardial Carpentier Edwards …

Novel Use of a Melody Percutaneous Pulmonary Valve in the Tricuspid Valve Position—First Reported Experience

Background: A 30-year-old female with severe oedema and effort intolerance had undergone tricuspid valve replacement (27 mm bioprosthesis) 9 years previously for endocarditis complicating intravenous drug use. Echocardiography showed severe tricuspid valve stenosis with calcified leaflets. The desire for children and cervical neoplasia meant a second surgical bioprosthesis would require later re-replacement via a 3rd sternotomy when she may have young children; a mechanical valve with warfarinisation also had significant fetal and maternal pregnancy risks.

Transplantation of Mitral Allograft into the Tricuspid Position - a Sheep Experimental Model

Our research was focused on finding the optimal technique of cryopreserved mitral allograft implantation into the tricuspid valve position in a sheep experiment. We prepared 20 cryopreserved mitral valve allografts preoperatively. These were implanted into the tricuspid position in 20 sheep via right thoracotomy, using extracorporeal circulation with cardioplegic heart arrest. We consider the transventricular papillary muscle fixation to be the best technique for obtaining optimal allograft geometry and long-term durability. We evaluated the valve function by epicardial echo before and after implantation, respectively. The findings were confirmed by haemodynamic measurements as well. It was proved that mitral allografts, harvested, processed, and stored according to the Cardiovascular Tissue Bank Protocol remained mechanically strong enough for implantation into the tricuspid position. It was demonstrated that the mitral allograft transplantation into the tricuspid position is feasible. The immediate postoperative haemodynamic performance was excellent in all animals. The mid-term results are currently being evaluated - prior to the possible application of the technique in humans at our institutions.

ICVTS on-line discussion A Anticoagulation in biologic valves in tricuspid position

ICVTS on-line discussion A Anticoagulation in biologic valves in tricuspid position

Percutaneous Transcatheter Balloon Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis

A 59-year-old woman was admitted to our hospital because of exertional dyspnea, abdominal distension, and leg edema over the past 2 weeks. She had a history of rheumatic fever at the age of 12 years. In 1983, at the age of 37, she had undergone tricuspid valve replacement with a Carpentier-Edwards bioprosthesis for tricuspid stenosis and mitral valve replacement with a mechanical valve for mitral stenosis. The physical examination on admission revealed marked edema in both legs. There was also presystolic pulsation of the liver, which was palpable 4 cm below the right costal margin. A Levine grade III/VI, rough, diastolic rumble at the lower left sternal border was accentuated during inspiration. Echocardiography revealed severe tricuspid stenosis and a large amount of ascites. The leaflets were thickened, …

Evaluation of Pulmonary Artery Banding in the Setting of Ventricular Septal Defects and Severely Elevated Pulmonary Vascular Resistance

Children with pulmonary hypertension secondary to large left-to-right, post-tricuspid valve shunts can eventually have severe and/or irreversible pulmonary vascular disease, yielding them inoperable for conventional surgery. It has been shown, however, that unloading of the pulmonary hypertension can result in remodeling of the pulmonary vasculature and, thus, improvement of the pulmonary hypertension. This study explored whether such patients might experience a significant reduction in pulmonary vascular resistance (PVR) after pulmonary artery band (PAB) placement. Pulmonary hypertension hemodynamics were evaluated by cardiac catheterization in 4 patients with pulmonary hypertension secondary to nonrestrictive left-to-right, post-tricuspid valve shunts before and after PAB placement. Two patients with severe pulmonary hypertension who were considered high risk for conventional surgery benefited from PAB placement with a significant reduction in their PVR, permitting subsequent complete intracardiac repair. The medium-term follow-up for these 2 patients demonstrated good outcomes. The PVR failed to improve after PAB placement in the remaining 2 patients, leading to medical therapy for pulmonary hypertension. There was 1 late death, presumably related to pulmonary hypertension. Current practice provides 3 relatively unattractive options for patients with severe pulmonary hypertension secondary to nonrestrictive left-to-right, post-tricuspid valve shunts: transplantation, high-risk intracardiac repair, or palliative medical therapy. Our study suggests that a staged approach with initial PAB placement can be considered for select patients with large left-to-right, post-tricuspid valve shunts and high PVR prior to committing them to other high-risk therapeutic options.

Eisenmenger syndrome: medical prevention and management strategies

The original definition of Eisenmenger syndrome refers to an unrestrictive post-tricuspid valve congenital systemic-to-pulmonary shunt. When the pulmonary arterial systolic pressure becomes equal to the systemic arterial systolic pressure, the direction of the shunt becomes pulmonary-to-systemic. The latter leads to progressive cyanosis, and exercise intolerance is initially proportional to the degree of hypoxaemia. Later, congestive heart failure may occur. The management principle is to avoid any factors that destabilise this delicately balanced physiology. Until recently, this could only be achieved by symptomatic therapy; however, when patients are severely incapacitated, transplantation is needed. At present, new drugs, which are more selective pulmonary vasodilators, are available to interfere with the ongoing disease process to improve functional capacity and delay the decision for transplantation.

Bioprosthetic Dysfunction Caused by Preserved Native Valve in Tricuspid Position

We report a 4-year-old girl who underwent replacement of a bioprosthetic valve in the tricuspid position due to rare bioprosthetic dysfunction. The bioprosthetic valve showed marked tricuspid insufficiency as well as stenosis caused by the adhesion of the preserved native valve leaflets to the undersurface of the implanted bioprosthesis.

Doppler echocardiographic evaluation of prosthetic valves in tricuspid position.

Doppler echocardiographic characteristics of 29 normally functioning prosthetic valves (23 mechanical, 6 biological) and 8 obstructed mechanical prostheses in the tricuspid position are reported. In normally functioning prostheses, peak velocity, mean pressure gradient, and pressure-half time were 1.25 +/- 0.18 m x sec(-1), 2.6 +/- 1.1 mm Hg, and 122.6 +/- 30.7 msec, respectively. Although no significant differences were seen in peak velocity and mean pressure gradient between mechanical and biological valves, the pressure half-time was significantly greater in biological valves. All normally functioning prostheses had a mean pressure gradient 5.5 mm Hg and pressure half-time < 200 msec. In obstructed bileaflet valves, peak velocity was 1.66 +/- 0.28 m x sec(-1), mean pressure gradient was 6.1 +/- 2.8 mm Hg, and pressure half-time was 265.8 +/- 171.7 msec. These Doppler data were significantly greater than those in normally functioning valves where the mean pressure gradient was 5.1 mm Hg and the pressure half-time was 156 msec in all except one patient. Pathological obstruction of a tricuspid prosthesis can be strongly suspected in patients with a mean pressure gradient > 5.5 mm Hg and a pressure half-time > 200 msec on Doppler echocardiography.

Percutaneous double balloon valvuloplasty for stenosis of porcine bioprostheses in the tricuspid valve position: A report of 2 cases

The feasibility and results of percutaneous double balloon valvuloplasty were evaluated in 2 patients with stenosis of porcine bioprostheses in the tricuspid valve position. The procedures were performed with a Trefoil 3 x 10 and a 15 mm balloon. Long inflations (4 and 3 minutes) were well tolerated. A significant immediate increase in the valve area, without significant valvular regurgitation, was achieved in both cases, from 0.65 to 1.15 cm2 in case 1 and from 0.9 to 1.65 cm2 in case 2. Both patients required valve replacement during the follow-up, at 14 and 21 months. There was no restenosis, but echocardiography showed right atrial thrombosis in case 1. Progressive restenosis with peripheral edema and increase of the mean doppler gradient occurred in case 2. The procedure is feasible, safe, and well tolerated. It provides significant immediate hemodynamic improvement, but it should be considered as a palliative technique since a normal valve area can not usually be obtained and a restenosis is likely to occur at midterm follow-up.

Thrombosed Prosthetic Valve in Tricuspid Position: Successful Therapy with Intravenous Streptokinase

The successful use of streptokinase therapy in a child with chronic thrombosis of a prosthetic valve (Carbomedics) in the tricuspid position is presented.