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DeZorzi C, Marenco A, Valente AM. Tricuspid Regurgitation in Patients with Tetralogy of Fallot. J Clin Med 2023; 12:jcm12072470. [PMID: 37048554 PMCID: PMC10095308 DOI: 10.3390/jcm12072470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Tricuspid regurgitation in patients with repaired tetralogy of Fallot is an important finding with a wide spectrum of primary and secondary etiologies. Moderate or severe tricuspid regurgitation is associated with a greater incidence of atrial tachyarrhythmias in these patients. It remains uncertain which patients with repaired tetralogy of Fallot may benefit from a tricuspid valve intervention at the time of pulmonary valve replacement.
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Affiliation(s)
- Christopher DeZorzi
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Anais Marenco
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Ríos L, Bellot R, Portela F. Reparación tricuspídea asociada a la prótesis pulmonar en la reintervención de Fallot: ¿cuándo y cómo? CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Min J, Kwak JG, Cho S, Kim ER, Lim JH, Lee CH, Kim WH. Tricuspid Valve Repair at Pulmonary Valve Replacement in Repaired Tetralogy of Fallot. Pediatr Cardiol 2022; 43:74-81. [PMID: 34333667 DOI: 10.1007/s00246-021-02694-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulmonary valve replacement (PVR) is often performed in patients with repaired tetralogy of Fallot (TOF). Concomitant tricuspid valvuloplasty (TVP) in those with tricuspid regurgitation (TR) at the time of PVR is still controversial. METHOD We retrospectively reviewed clinical records of patients who underwent PVR between 2001 and 2012. We analyzed the impact of concomitant TVP on the tricuspid valve function and right ventricle function and size in mid-term. RESULTS 119 patients with mild to moderate TR at the time of PVR were enrolled. 33 patients underwent concomitant TVP (TVP group) and 86 patients underwent PVR alone (no-TVP group). There was a significant reduction of TR (p < 0.001) and right ventricular end-diastolic volume index (RVEDVi) (p < 0.001). However, in patients who showed prosthetic pulmonary valve (PV) failure at the last follow-up, there was no significant decrease in TR regardless of concomitant TVP. In the patients with preserved prosthetic PV function, TR was significantly improved (p < 0.001 in both groups). The multivariable analysis showed that significant risk factors for recurrence of significant TR were preoperative moderate TR and prosthetic PV failure. CONCLUSIONS After PVR in repaired TOF patients, there was an improvement in the degree of TR and the RVEDVi. Concomitant TVP at the time of PVR may not be able to prevent the recurrence of TR when prosthetic PV failure occurs; however, it may effectively preserve tricuspid valve function until that time.
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Affiliation(s)
- Jooncheol Min
- Seoul National University Children's Hospital, Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Jae Gun Kwak
- Seoul National University Children's Hospital, Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
| | - Sungkyu Cho
- Seoul National University Children's Hospital, Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Eung Re Kim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Republic of Korea
| | - Jae Hong Lim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Republic of Korea
| | - Chang-Ha Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Republic of Korea
| | - Woong-Han Kim
- Seoul National University Children's Hospital, Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
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Van den Eynde J, Callahan CP, Lo Rito M, Hussein N, Carvajal H, Guariento A, Ruhparwar A, Weymann A, Budts W, Gewillig M, Sá MP, Kutty S. Tricuspid Valve Intervention at the Time of Pulmonary Valve Replacement in Adults With Congenital Heart Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e022909. [PMID: 34873914 PMCID: PMC9075262 DOI: 10.1161/jaha.121.022909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Tricuspid regurgitation (TR) is a common finding in adults with congenital heart disease referred for pulmonary valve replacement (PVR). However, indications for combined valve surgery remain controversial. This study aimed to evaluate early results of concomitant tricuspid valve intervention (TVI) at the time of PVR. Methods and Results Observational studies comparing TVI+PVR and isolated PVR were identified by a systematic search of published research. Random‐effects meta‐analysis was performed, comparing outcomes between the 2 groups. Six studies involving 749 patients (TVI+PVR, 278 patients; PVR, 471 patients) met the eligibility criteria. In the pooled analysis, both TVI+PVR and PVR reduced TR grade, pulmonary regurgitation grade, right ventricular end‐diastolic volume, and right ventricular end‐systolic volumes. TVI+PVR, but not PVR, was associated with a decrease in tricuspid valve annulus size (mean difference, −6.43 mm, 95% CI, −10.59 to −2.27; P=0.010). Furthermore, TVI+PVR was associated with a larger reduction in TR grade compared with PVR (mean difference, −0.40; 95% CI, −0.75 to −0.05; P=0.031). No evidence could be established for an effect of either treatment on right ventricular ejection fraction or echocardiographic assessment of right ventricular dilatation and dysfunction. There was no evidence for a difference in hospital mortality or reoperation for TR. Conclusions While both strategies are effective in reducing TR and right ventricular volumes, routine TVI+PVR can reduce TR grade to a larger extent than isolated PVR. Further studies are needed to identify the subgroups of patients who might benefit most from combined valve surgery.
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Affiliation(s)
- Jef Van den Eynde
- Helen B. Taussig Heart CenterThe Johns Hopkins Hospital and School of Medicine Baltimore MD.,Department of Cardiovascular Sciences Department of Cardiovascular Diseases KU Leuven, University Hospitals Leuven Leuven Belgium
| | - Connor P Callahan
- Division of Cardiovascular Surgery The Hospital for Sick Children Toronto Canada
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Nabil Hussein
- Department of Congenital Cardiac Surgery Yorkshire Heart CentreLeeds General Infirmary England United Kingdom
| | - Horacio Carvajal
- Section of Pediatric Cardiothoracic Surgery Department of Surgery Washington University School of Medicine in St. Louis/St. Louis Children's Hospital Saint Louis MO
| | - Alvise Guariento
- Division of Cardiovascular Surgery The Hospital for Sick Children Toronto Canada
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery West German Heart and Vascular Center Essen University Hospital of EssenUniversity Duisburg-Essen Essen Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery West German Heart and Vascular Center Essen University Hospital of EssenUniversity Duisburg-Essen Essen Germany
| | - Werner Budts
- Department of Cardiovascular Sciences Congenital and Structural Cardiology Catholic University Leuven, University Hospitals Leuven Leuven Belgium
| | - Marc Gewillig
- Pediatric Cardiology University Hospitals Leuven Leuven Belgium
| | - Michel Pompeu Sá
- Department of Cardiac Surgery Lankenau Heart InstituteMain Line Health Wynnewood PA.,Department of Cardiac Surgery Research Lankenau Institute for Medical ResearchMain Line Health Wynnewood PA
| | - Shelby Kutty
- Helen B. Taussig Heart CenterThe Johns Hopkins Hospital and School of Medicine Baltimore MD
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Tricuspid valve surgery in adults with congenital heart disease: Indications, techniques and outcomes. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Li VWY, Wong JYL, Wang C, Chow PC, Cheung YF. Tricuspid Regurgitation in Adults after Repair of Right Ventricular Outflow Obstructive Lesions. Pediatr Cardiol 2020; 41:1153-1159. [PMID: 32394061 DOI: 10.1007/s00246-020-02366-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
We determined the prevalence and factors associated with tricuspid regurgitation (TR) in adults with repair of right ventricular (RV) outflow obstruction. A total of 256 patients (128 males) were studied at 25.7 ± 7.2 years after surgery, of whom 179 had repaired tetralogy of Fallot (TOF), 31 had pulmonary atresia with intact ventricular septum (PAIVS), and 46 had pulmonary stenosis (PS). The mitral and tricuspid annulus diameters, maximum right atrial (RA) area, RV end-systolic and end-diastolic areas, and tricuspid and pulmonary regurgitation were assessed using echocardiography. The prevalence of moderate-to-severe TR was 20.7%. Subgroup analysis revealed that prevalence was greater in patients with repaired TOF (20.7%) and PAIVS (35.5%) than PS patients (10.9%). As a group, severity of TR was found to be correlated with RA area (r = 0.35, p < 0.001), RV end-diastolic (r = 0.28, p < 0.001) and end-systolic (r = 0.22, p = 0.001) areas, and tricuspid valve annulus diameter (r = 0.15, p = 0.022). Moderate-to-severe TR was associated with development of cardiac arrhythmias with an odds ratio of 2.9 (95% CI 1.1 to 8.1, p = 0.031). Multivariate analysis revealed maximum RA area (β = 0.36, p = 0.016) as an independent determinant of severity of TR. Moderate-to-severe TR occurs in about one-fifth of adults with repaired TOF, PAVIS, and PS and is associated with RA dilation and risk of development of cardiac arrhythmias.
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Affiliation(s)
- Vivian Wing-Yi Li
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Jasmine Yan-Lam Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Pak-Cheong Chow
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Yiu-Fai Cheung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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Deshaies C, Trottier H, Khairy P, Al-Aklabi M, Beauchesne L, Bernier PL, Dhillon S, Gandhi SK, Haller C, Hancock Friesen CL, Hickey EJ, Horne D, Jacques F, Kiess MC, Perron J, Rodriguez M, Poirier NC. Tricuspid Intervention Following Pulmonary Valve Replacement in Adults With Congenital Heart Disease. J Am Coll Cardiol 2020; 75:1033-1043. [PMID: 32138963 DOI: 10.1016/j.jacc.2019.12.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/02/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is common among adults with corrected tetralogy of Fallot (TOF) or pulmonary stenosis (PS) referred for pulmonary valve replacement (PVR). Yet, combined valve surgery remains controversial. OBJECTIVES This study sought to evaluate the impact of concomitant tricuspid valve intervention (TVI) on post-operative TR, length of hospital stay, and on a composite endpoint consisting of 7 early adverse events (death, reintervention, cardiac electronic device implantation, infection, thromboembolic event, hemodialysis, and readmission). METHODS The national Canadian cohort enrolled 542 patients with TOF or PS and mild to severe TR who underwent isolated PVR (66.8%) or PVR+TVI (33.2%). Outcomes were abstracted from charts and compared between groups using multivariable logistic and negative binomial regression. RESULTS Median age at reintervention was 35.3 years. Regardless of surgery type, TR decreased by at least 1 echocardiographic grade in 35.4%, 66.9%, and 92.8% of patients with pre-operative mild, moderate, and severe insufficiency. In multivariable analyses, PVR+TVI was associated with an additional 2.3-fold reduction in TR grade (odds ratio [OR]: 0.44; 95% confidence interval [CI]: 0.25 to 0.77) without an increase in early adverse events (OR: 0.85; 95% CI: 0.46 to 1.57) or hospitalization time (incidence rate ratio: 1.17; 95% CI: 0.93 to 1.46). Pre-operative TR severity and presence of transvalvular leads independently predicted post-operative TR. In contrast, early adverse events were strongly associated with atrial tachyarrhythmia, extracardiac arteriopathy, and a high body mass index. CONCLUSIONS In patients with TOF or PS and significant TR, concomitant TVI is safe and results in better early tricuspid valve competence than isolated PVR.
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Affiliation(s)
- Catherine Deshaies
- Queen Elizabeth II Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada; Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
| | - Helen Trottier
- Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mohammed Al-Aklabi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Luc Beauchesne
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Santokh Dhillon
- Izaak Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sanjiv K Gandhi
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christoph Haller
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Camille L Hancock Friesen
- Queen Elizabeth II Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada; Izaak Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Edward J Hickey
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Horne
- Queen Elizabeth II Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada; Izaak Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Frédéric Jacques
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Marla C Kiess
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Perron
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Maria Rodriguez
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Nancy C Poirier
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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Martin-Garcia AC, Dimopoulos K, Boutsikou M, Martin-Garcia A, Kempny A, Alonso-Gonzalez R, Swan L, Uebing A, Babu-Narayan SV, Sanchez PL, Li W, Shore D, Gatzoulis MA. Tricuspid regurgitation severity after atrial septal defect closure or pulmonic valve replacement. Heart 2019; 106:455-461. [DOI: 10.1136/heartjnl-2019-315287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 11/03/2022] Open
Abstract
ObjectivesCardiac surgery or catheter interventions are nowadays commonly performed to reduce volume loading of the right ventricle in adults with congenital heart disease. However, little is known, on the effect of such procedures on pre-existing tricuspid regurgitation (TR). We assessed the potential reduction in the severity of TR after atrial septal defect (ASD) closure and pulmonic valve replacement (PVR).MethodsDemographics, clinical and echocardiographic characteristics of consecutive patients undergoing ASD closure or PVR between 2005 and 2014 at a single centre who had at least mild preoperative TR were collected and analysed.ResultsOverall, 162 patients (mean age at intervention 41.6±16.1 years, 38.3% male) were included: 101 after ASD closure (61 transcatheter vs 40 surgical) and 61 after PVR (3 transcatheter vs 58 surgical). Only 11.1% received concomitant tricuspid valve surgery (repair). There was significant reduction in the severity of TR in the overall population, from 38 (23.5%) patients having moderate or severe TR preoperatively to only 11 (6.8%) and 20 (12.3%) at 6 months and 12 months of follow-up, respectively (McNemar p<0.0001). There was a significant reduction in tricuspid valve annular diameter (p<0.0001), coaptation distance (p<0.0001) and systolic tenting area (p<0.0001). The reduction in TR was also observed in patients who did not have concomitant tricuspid valve (TV) repair (from 15.3% to 6.9% and 11.8% at 6 and 12 months, respectively, p<0.0001). On multivariable logistic regression including all univariable predictors of residual TR at 12 months, only RA area remained in the model (OR 1.2, 95% CI 1.04 to 1.37, p=0.01).ConclusionsASD closure and PVR are associated with a significant reduction in tricuspid regurgitation, even among patients who do not undergo concomitant tricuspid valve surgery.
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Caughron H, Kim D, Kamioka N, Lerakis S, Yousef A, Maini A, Reginauld S, Sahu A, Shashidharan S, Jokhadar M, Rodriguez FH, Book WM, McConnell M, Block PC, Babaliaros V. Repeat Pulmonary Valve Replacement: Similar Intermediate-Term Outcomes With Surgical and Transcatheter Procedures. JACC Cardiovasc Interv 2018; 11:2495-2503. [PMID: 30503596 DOI: 10.1016/j.jcin.2018.07.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study compares 30-day, 1-year, and 3-year echocardiographic findings and clinical outcomes of transcatheter pulmonary valve-in-valve replacement (TPVR) and repeat surgical pulmonary valve replacement (SPVR). BACKGROUND In patients with adult congenital heart disease and previous pulmonary valve replacement (PVR) who require redo PVR, it is unclear whether TPVR or repeat SPVR is the preferred strategy. METHODS We retrospectively identified 66 patients (TPVR, n = 36; SPVR, n = 30) with bioprosthetic pulmonary valves (PVs) who underwent either TPVR or repeat SPVR at Emory Healthcare from January 2007 to August 2017. RESULTS The TPVR cohort had fewer men and more patients with baseline New York Heart Association (NYHA) functional class III or IV. There was no difference in mortality, cardiovascular readmission, or post-procedural PV reintervention at 30 days, 1 year, or 3 years. Post-procedural echocardiographic findings showed no difference in mean PV gradients between the TPVR and SPVR groups at 30 days, 1 year, or 3 years. In the TPVR cohort, there was less right ventricular dysfunction at 30 days (2.9% vs. 46.7%; p < 0.01), despite higher baseline NYHA functional class in the SPVR cohort. CONCLUSIONS In patients with bioprosthetic PV dysfunction who underwent either TPVR or SPVR, there was no difference in mortality, cardiovascular readmission, or repeat PV intervention at 30 days, 1 year, or 3 years. Additionally, TPVR and SPVR had similar intermediate-term PV longevity, with no difference in PV gradients or PVR. The TPVR cohort also had less right ventricular dysfunction at 30 days despite a higher baseline NYHA functional classification. These intermediate-term results suggest that TPVR may be an attractive alternative to SPVR in patients with previous bioprosthetic surgical PVs.
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Affiliation(s)
- Hope Caughron
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Dennis Kim
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Stamatios Lerakis
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Altayyeb Yousef
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Aneesha Maini
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Shawn Reginauld
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anurag Sahu
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Subhadra Shashidharan
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Maan Jokhadar
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Fred H Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Wendy M Book
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael McConnell
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Peter C Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Vasilis Babaliaros
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
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Englert JAR, Gupta T, Joury AU, Shah SB. Tetralogy of Fallot: Case-Based Update for the Treatment of Adult Congenital Patients. Curr Probl Cardiol 2018; 44:46-81. [PMID: 30172549 DOI: 10.1016/j.cpcardiol.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Driessen MMP, Schings MA, Sieswerda GT, Doevendans PA, Hulzebos EH, Post MC, Snijder RJ, Westenberg JJM, van Dijk APJ, Meijboom FJ, Leiner T. Tricuspid flow and regurgitation in congenital heart disease and pulmonary hypertension: comparison of 4D flow cardiovascular magnetic resonance and echocardiography. J Cardiovasc Magn Reson 2018; 20:5. [PMID: 29332606 PMCID: PMC5767973 DOI: 10.1186/s12968-017-0426-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 12/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tricuspid valve (TV) regurgitation (TR) is a common complication of pulmonary hypertension and right-sided congenital heart disease, associated with increased morbidity and mortality. Estimation of TR severity by echocardiography and conventional cardiovasvular magnetic resonance (CMR) is not well validated and has high variability. 4D velocity-encoded (4D-flow) CMR was used to measure tricuspid flow in patients with complex right ventricular (RV) geometry and varying degrees of TR. The aims of the present study were: 1) to assess accuracy of 4D-flow CMR across the TV by comparing 4D-flow CMR derived TV effective flow to 2D-flow derived effective flow across the pulmonary valve (PV); 2) to assess TV 4D-flow CMR reproducibility, and 3) to compare TR grade by 4D-flow CMR to TR grade by echocardiography. METHODS TR was assessed by both 4D-flow CMR and echocardiography in 21 healthy subjects (41.2 ± 10.5 yrs., female 7 (33%)) and 67 RV pressure-load patients (42.7 ± 17.0 yrs., female 32 (48%)). The CMR protocol included 4D-flow CMR measurement across the TV, 2D-flow measurement across the PV and conventional planimetric measurements. TR grading on echocardiographic images was performed based on the international recommendations. Bland-Altman analysis and intra-class correlation coefficients (ICC) were used to asses correlations and agreement. RESULTS TV effective flow measured by 4D-flow CMR showed good correlation and agreement with PV effective flow measured by 2D-flow CMR with ICC = 0.899 (p < 0.001) and mean difference of -1.79 ml [limits of agreement -20.39 to 16.81] (p = 0.084). Intra-observer agreement for effective flow (ICC = 0.981; mean difference - 1.51 ml [-12.88 to 9.86]) and regurgitant fraction (ICC = 0.910; mean difference 1.08% [-7.90; 10.06]) was good. Inter-observer agreement for effective flow (ICC = 0.935; mean difference 2.12 ml [-15.24 to 19.48]) and regurgitant fraction (ICC = 0.968; mean difference 1.10% [-7.96 to 5.76]) were comparable. In 25/65 (38.5%) TR grade differed by at least 1 grade using 4D-flow CMR compared to echocardiography. CONCLUSION TV effective flow derived from 4D-flow CMR showed excellent correlation to PV effective flow derived from 2D-flow CMR, and was reproducible to measure TV flow and regurgitation. Twenty-five out of 65 patients (38.5%) were classified differently by at least one TR grade using 4D-flow CMR compared to echocardiography.
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Affiliation(s)
- Mieke M. P. Driessen
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
- ΙCΙN-Netherlands Heart Institute, Utrecht, the Netherlands
| | - Marjolijn A. Schings
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Radiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Gertjan Tj Sieswerda
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Pieter A. Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Erik H. Hulzebos
- Department of Paediatric Physical Therapy and Exercise Physiology, Child Development and Exercise Centre, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marco C. Post
- Department of Cardiology, Antonius Hospital, Nieuwegein, the Netherlands
| | - Repke J. Snijder
- Department of Pulmonology, Antonius Hospital, Nieuwegein, the Netherlands
| | - Jos J. M. Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arie P. J. van Dijk
- Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - Folkert J. Meijboom
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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To repair or not to repair: Who should undergo tricuspid valve repair at the time of pulmonary valve replacement in previously repaired tetralogy of Fallot. J Thorac Cardiovasc Surg 2017; 154:224-225. [PMID: 28242018 DOI: 10.1016/j.jtcvs.2017.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/12/2017] [Indexed: 11/23/2022]
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13
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Tricuspid valve repair and pulmonary valve replacement in adults with repaired tetralogy of Fallot. J Thorac Cardiovasc Surg 2017; 154:214-223. [PMID: 28292589 DOI: 10.1016/j.jtcvs.2016.12.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 11/22/2016] [Accepted: 12/07/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pulmonary valve replacement (PVR) often is performed in adults with repaired tetralogy of Fallot (TOF). For patients who have tricuspid regurgitation (TR), tricuspid valve (TV) repair associated to PVR is still debated. OBJECTIVE We sought to evaluate perioperative factors related to TV repair when performed at the time of PVR in patients with repaired TOF. METHODS We retrospectively reviewed 104 patients with repaired TOF (or its equivalent) who underwent PVR (2002-2014). RESULTS Mean age at initial complete correction and at PVR was 20.1 ± 17.2 months and 26.3 ± 9.5 years, respectively. Forty-one patients had significant preoperative TR: 24 were moderate (group M) and 17 were severe (group S). A total of 16 TV repair were performed (8 for each group). Moderate and severe tricuspid regurgitation observed in the first year following the initial complete repair were significantly associated with severe TR at PVR (P < .001). In group M patients, TR was improved regardless of TV repair, whereas, in group S, residual significant TR was reported in 7 patients who did not have TV repair. No cases were observed for patients who underwent concomitant TV repair (P = .002). Among these patients with residual significant TR, 2 needed a tricuspid valve replacement. The functional status (New York Heart Association classification) of group S patients was significantly improved by concomitant TV repair. CONCLUSIONS In adults with repaired TOF, TV repair is a safe procedure when performed at the time of PVR. If, at mid-term follow-up, there is probably no benefit of TV repair when preoperative TR is moderate, TV repair may improve both tricuspid valve function and functional status of the patients in case of severe preoperative TR.
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Jones TK, Rome JJ, Armstrong AK, Berger F, Hellenbrand WE, Cabalka AK, Benson LN, Balzer DT, Cheatham JP, Eicken A, McElhinney DB. Transcatheter Pulmonary Valve Replacement Reduces Tricuspid Regurgitation in Patients With Right Ventricular Volume/Pressure Overload. J Am Coll Cardiol 2016; 68:1525-35. [DOI: 10.1016/j.jacc.2016.07.734] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/29/2016] [Accepted: 07/05/2016] [Indexed: 11/16/2022]
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15
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Polo López ML, Aroca Peinado Á, González Rocafort Á, Bret Zurita M, Rey Lois J, Sánchez Pérez R, Villagrá Blanco F, Oliver Ruiz JM, Sánchez Recalde Á. Reintervenciones quirúrgicas en adultos con situación Fallot: una población emergente. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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The risk associated with concomitant procedures performed during adult congenital heart surgery. Cardiol Young 2016; 26:909-14. [PMID: 26345601 DOI: 10.1017/s1047951115001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adult patients with CHD often require complex operations, and indications for particular aspects of the operation are sometimes unclear. The aims of our study were as follows: to characterise concomitant procedures performed during adult congenital cardiac surgery, and to better define the risk involved with performing concomitant procedures during a single operation. METHODS We retrospectively studied 458 adult congenital cardiac surgical patients. Major procedures were characterised as aortic, mitral, pulmonary, tricuspid, septal defect, single ventricle, transplant, and others. We constructed logistic regression models to assess the risk for mortality, major adverse event, and prolonged length of stay. RESULTS A total of 362 operations involved a single major procedure, whereas 96 involved concomitant procedures. Performing concomitant procedures increased mortality (7.3 versus 2.5%), major adverse events (21.8 versus 14.9%), and prolonged length of stay (29.2 versus 17.1%). The added risks of concomitant procedures on mortality, major adverse event, and prolonged length of stay were 2.9 (95% CI 1.0-8.5, p=0.05), 1.9 (95% CI 1.1-3.3, p=0.02), and 2.4 (95% CI 1.4-4.1, p=0.003), respectively. There were 200 patients with conotruncal anomalies who underwent pulmonary valve surgery. In this subset, the added risks of concomitant procedures in addition to pulmonary valve surgery on mortality, major adverse events, and prolonged length of stay were 6.6 (95% CI 1.2-37.3, p=0.03), 2.8 (95% CI 1.2-6.6, p=0.03), and 3.3 (95% CI 1.5-7.4, p=0.005), respectively. CONCLUSION Concomitant procedures performed during adult congenital heart surgery increase risk. Awareness of this risk may improve surgical decision making and outcomes.
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Postoperative tricuspid regurgitation after adult congenital heart surgery is associated with adverse clinical outcomes. J Thorac Cardiovasc Surg 2016; 151:460-5. [DOI: 10.1016/j.jtcvs.2015.09.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/28/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
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18
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Huddleston CB. Pulmonary Insufficiency Leads to Right Ventricular Enlargement, which Leads to Tricuspid Regurgitation, which Leads to more Right Ventricular Enlargement, which Leads to more Tricuspid Regurgitation: a Vicious Cycle? Semin Thorac Cardiovasc Surg 2015; 27:166-7. [PMID: 26686443 DOI: 10.1053/j.semtcvs.2015.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2015] [Indexed: 11/11/2022]
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19
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Kogon B. Reply: To PMID 25886809. Ann Thorac Surg 2015; 100:2418. [PMID: 26652561 DOI: 10.1016/j.athoracsur.2015.06.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 06/26/2015] [Accepted: 06/26/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Brian Kogon
- Department of Cardiothoracic Surgery, Emory University, 1405 Clifton Rd, Atlanta, GA 30322.
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20
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Leaving Moderate Tricuspid Valve Regurgitation Alone at the Time of Pulmonary Valve Replacement: A Worthwhile Approach. Ann Thorac Surg 2015; 99:2117-22; discussion 2122-3. [DOI: 10.1016/j.athoracsur.2015.01.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 11/24/2014] [Accepted: 01/13/2015] [Indexed: 11/23/2022]
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21
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Bhatt AB, Foster E, Kuehl K, Alpert J, Brabeck S, Crumb S, Davidson WR, Earing MG, Ghoshhajra BB, Karamlou T, Mital S, Ting J, Tseng ZH. Congenital Heart Disease in the Older Adult. Circulation 2015; 131:1884-931. [DOI: 10.1161/cir.0000000000000204] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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22
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Bokma JP, Winter MM, Oosterhof T, Vliegen HW, van Dijk AP, Hazekamp MG, Koolbergen DR, Groenink M, Mulder BJM, Bouma BJ. Severe tricuspid regurgitation is predictive for adverse events in tetralogy of Fallot. Heart 2015; 101:794-9. [DOI: 10.1136/heartjnl-2014-306919] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/11/2015] [Indexed: 11/03/2022] Open
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Cramer JW, Ginde S, Hill GD, Cohen SB, Bartz PJ, Tweddell JS, Earing MG. Tricuspid repair at pulmonary valve replacement does not alter outcomes in tetralogy of Fallot. Ann Thorac Surg 2015; 99:899-904. [PMID: 25596869 DOI: 10.1016/j.athoracsur.2014.09.086] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/15/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Chronic pulmonary regurgitation after tetralogy of Fallot repair often leads to progressive right ventricle dilation, dysfunction, and frequently, pulmonary valve replacement. For those with significant tricuspid regurgitation at the time of pulmonary valve replacement, it is unknown whether concomitant tricuspid valve repair improves postoperative outcomes. METHODS This is a retrospective review of patients after tetralogy of Fallot repair who underwent pulmonary valve replacement between 1999 and 2012. Preoperative and postoperative echocardiograms were assessed for tricuspid regurgitation (vena contracta) and right ventricular size and function (Tomtec software). RESULTS Sixty-two patients underwent pulmonary valve replacement. Thirty-six (58%) had greater than or equal to moderate tricuspid regurgitation on preoperative echocardiogram. Significant predictors were not identified. Of the 36, 18 (50%) underwent concomitant tricuspid valve repair at the time of pulmonary valve replacement. After surgery, there was a significant reduction in the degree of tricuspid regurgitation (p < 0.001) and measures of right ventricular size (p < 0.05) in both cohorts. Between surgical groups, there was no statistical difference in the grade of tricuspid regurgitation (p = 0.47) or measures of right ventricular size (p > 0.4) at 6-month follow-up. CONCLUSIONS Tricuspid regurgitation is a common finding in repaired tetralogy of Fallot, although risk factors for its development remain unclear. After pulmonary valve replacement with or without tricuspid valve repair there is significant improvement in the degree of tricuspid regurgitation and right ventricular size. Finally, 6 months after pulmonary valve replacement there were no statistical differences between those patients undergoing concomitant tricuspid valve repair and those undergoing pulmonary valve replacements alone.
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Affiliation(s)
- Jonathan W Cramer
- Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Salil Ginde
- Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Internal Medicine, Division of Adult Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Garick D Hill
- Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Scott B Cohen
- Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Internal Medicine, Division of Adult Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter J Bartz
- Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Internal Medicine, Division of Adult Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - James S Tweddell
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael G Earing
- Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Internal Medicine, Division of Adult Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Kurkluoglu M, John AS, Cross R, Chung D, Yerebakan C, Zurakowski D, Jonas RA, Sinha P. Should Tricuspid Annuloplasty be Performed With Pulmonary Valve Replacement for Pulmonary Regurgitation in Repaired Tetralogy of Fallot? Semin Thorac Cardiovasc Surg 2015; 27:159-65. [DOI: 10.1053/j.semtcvs.2015.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2015] [Indexed: 11/11/2022]
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25
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Kogon BE, Rosenblum JM, Mori M. Current Readings: Issues Surrounding Pulmonary Valve Replacement in Repaired Tetralogy of Fallot. Semin Thorac Cardiovasc Surg 2015; 27:57-64. [DOI: 10.1053/j.semtcvs.2015.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 11/11/2022]
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Abstract
The tricuspid valve is frequently affected in adults with congenital heart disease but is also frequently overlooked. Disease of this valve can occur primarily or develop secondary to changes in the right ventricle caused by other disease states. The embryology and anatomy of the tricuspid valve are important to understanding pathogenesis of valve dysfunction in congenital heart disease. Clinical findings can be subtle. Multimodality imaging may be necessary to fully assess the cause and impact of tricuspid valve lesions. More research is needed in pathophysiology, imaging, and treatment in this area.
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Affiliation(s)
- Jonathan Ginns
- Columbia University Medical Center, New York, NY 10032, USA.
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Zdradzinski MJ, Qureshi AM, Stewart R, Pettersson G, Krasuski RA. Comparison of long-term postoperative sequelae in patients with tetralogy of Fallot versus isolated pulmonic stenosis. Am J Cardiol 2014; 114:300-4. [PMID: 24878128 DOI: 10.1016/j.amjcard.2014.04.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 01/18/2023]
Abstract
Patients with tetralogy of Fallot (TOF) after complete repair and pulmonic stenosis (PS) after surgical valvotomy often develop significant pulmonic regurgitation (PR) that eventually requires valve replacement. Although criteria exist for the timing of pulmonary valve replacement in TOF, it remains less clear when to intervene in valvotomy patients and whether TOF recommendations can be applied. Our aim was to compare the structural and functional sequelae of valvotomy for PS with complete repair for TOF. We compared the clinical characteristics, electrocardiograms, echocardiograms, cardiac magnetic resonance imaging (MRI), and invasive hemodynamics of 109 adults (34 PS and 75 TOF) newly referred to a congenital heart disease center for evaluation of PR between 2005 and 2012. Both cohorts were similar in terms of baseline demographics and presenting New York Heart Association function class. Valvotomy patients had a slightly greater degree of PR by echocardiogram, although it was similar by cardiac MRI. Electrocardiography QRS width was greater in patients with TOF (114±27 vs 150±28 ms, p<0.001). MRI right ventricular ejection fraction (49±8 vs 41±11%, p=0.001) and left ventricular ejection fraction (59±7 vs 52±10%, p=0.002) were lower in patients with TOF. Pacemaker or defibrillator implantation was significantly greater in patients with TOF (3% vs 23%, p=0.011). In conclusion, patients postvalvotomy and complete repair present with similar degrees of PR and severity of symptoms. Biventricular systolic function and electrocardiography QRS width appear less affected, suggesting morphologic changes in TOF and its repair that extend beyond the effects of PR. These findings suggest the need for developing disease-specific guidelines for patients with PR postvalvotomy.
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28
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Management of tricuspid regurgitation in congenital heart disease: Is survival better with valve repair? J Thorac Cardiovasc Surg 2014; 147:412-7. [DOI: 10.1016/j.jtcvs.2013.08.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/18/2013] [Accepted: 08/11/2013] [Indexed: 11/18/2022]
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29
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Cheng JW, Russell H, Stewart RD, Thomas J, Backer CL, Mavroudis C. The Role of Tricuspid Valve Surgery in the Late Management of Tetralogy of Fallot. World J Pediatr Congenit Heart Surg 2012; 3:492-8. [DOI: 10.1177/2150135112450037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
While surgical repair of tetralogy of Fallot (TOF) is generally associated with good early outcomes, late complications affect long-term survival and may require reoperation. Pulmonary regurgitation (PR) and tricuspid regurgitation (TR) may increase the risk of arrhythmias, reduced cardiac function, and sudden death. Tricuspid valve function can be compromised secondarily in the setting of PR or directly as a result of injury or alteration of the valve related to the original TOF repair. This article reviews the etiologic mechanisms, pathophysiological implications, and surgical interventions for TR. Effective management following TOF repair requires consideration of TR to optimize late outcomes.
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Affiliation(s)
- Julie W. Cheng
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Hyde Russell
- Department of Surgery, Division of Cardiovascular-Thoracic Surgery, Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert D. Stewart
- Department of Congenital Heart Surgery, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA
| | - Jamie Thomas
- Department of Congenital Heart Surgery, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA
| | - Carl L. Backer
- Department of Surgery, Division of Cardiovascular-Thoracic Surgery, Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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30
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Said SM, Burkhart HM, Dearani JA. Surgical management of congenital (non-Ebstein) tricuspid valve regurgitation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2012; 15:46-60. [PMID: 22424508 DOI: 10.1053/j.pcsu.2012.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Congenital tricuspid valve regurgitation (TR) is a relatively uncommon condition that includes a heterogeneous group of lesions with a unique management strategy. There are wide anatomic variations that lead to congenital TR in patients without Ebstein malformation. Possible etiologies may include primary valve abnormalities (eg, congenital absence of chordae) or other forms of tricuspid valve dysplasia as in congenitally unguarded tricuspid valve, and patients with pulmonary atresia and intact ventricular septum, which can be similar to Ebstein's valves or secondary regurgitation in association with other anomalies as in atrioventricular septal defects, right ventricular outflow tract obstructive lesions (pulmonary stenosis or atresia with ventricular septal defect [VSD]), tricuspid valve annular dilatation in association with right ventricular volume overload lesions as in congenital coronary arterial fistula with secondary right ventricular enlargement, and Uhl's anomaly. Iatrogenic etiologies in the congenital population include TR secondary to previous VSD closure (chordal or leaflet injury), pacemaker or internal cardiac defibrillator lead-induced TR, and traumatic TR (ruptured chordae). Presentation depends on the severity of the disease and may be apparent in infancy, childhood, or adulthood.
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Affiliation(s)
- Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA
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