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Xiao W, Ji L, Gao X, Li H, Zou A, He Y, Yu S. A surviving neonate with congenitally unguarded tricuspid valve orifice. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39158835 DOI: 10.1002/jcu.23782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/14/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024]
Abstract
The hospital admitted a 3-day-old female infant presenting with persistent facial cyanosis and hypoxic symptoms, and echocardiography revealed a congenitally unguarded tricuspid valve orifice with an atrial septal defect. After being followed up until the age of one and a half years, the child underwent bidirectional Glenn's surgery and achieved successful survival.
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Affiliation(s)
- Weiwei Xiao
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Liqin Ji
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xue Gao
- School of Imaging, Guizhou Medical University, Guiyang, China
| | - Houyu Li
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Anlingzi Zou
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yao He
- School of Imaging, Guizhou Medical University, Guiyang, China
| | - Shaomei Yu
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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2
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Abdelrehim AA, Dearani JA, Miranda WR, Connolly HM, Stephens EH. Surgical Considerations for the Mitral Valve in Congenitally Corrected Transposition. Ann Thorac Surg 2024; 117:560-566. [PMID: 37488004 DOI: 10.1016/j.athoracsur.2023.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/20/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Systemic atrioventricular valve (morphologic tricuspid valve [TV]) regurgitation has been implicated in the development of systemic ventricular failure in congenitally corrected transposition of the great arteries (ccTGA), leading to timely referral for valve replacement. However, the surgical management of subpulmonary atrioventricular valve (morphologic mitral valve [MV]) regurgitation and outcomes has not been well studied. METHODS Of 108 ccTGA patients undergoing atrioventricular valve surgery from 1979 to 2022, 22 patients (20%) underwent MV surgery. Demographics, etiology of valve regurgitation, operative details, and outcomes of these 22 patients were retrospectively reviewed. Follow-up at 1, 5, and 10 years was available for 18 (82%), 13 (59%), and 11 patients (50%), respectively. RESULTS Median age was 37 years (interquartile range, 29-57 years). Intrinsic MV pathology was present in 18 individuals (82%). Operations included repair in 16 patients (73%), replacement in 6 (27%), and concomitant replacement of TV in 16 (73%). There was 1 perioperative death (5%) in a patient undergoing an emergent operation for severe acute-on-chronic heart failure due to worsening TV regurgitation. During a median follow-up of 12 years (interquartile range, 2-19 years), 7 patients (32%) died. Among the 16 patients who underwent repair, recurrent moderate or greater regurgitation was seen in 15%, 29%, and 43% of repairs in patients with annular, leaflet, and lead-induced regurgitation, respectively. CONCLUSIONS Concomitant TV and MV disease occur much less frequently than isolated TV disease in ccTGA. Intrinsic MV disease is most commonly observed but appears less amenable to successful repair compared with mitral repair in the systemic position and suggests MV replacement may be preferred in ccTGA patients.
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Affiliation(s)
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - William R Miranda
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Quarti AG, Petridis FD, Mangerini VF, Careddu L, Angeli E, Gargiulo GD. The concept of cone creation to treat isolated tricuspid valve dysplasia and the case of a double-orifice tricuspid valve. JTCVS Tech 2023; 20:71-78. [PMID: 37555047 PMCID: PMC10405194 DOI: 10.1016/j.xjtc.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES Isolated tricuspid valve dysplasia is a rare disease characterized by a wide spectrum of possible anomalies. We describe the use of the Cone concept to treat a patient with a double-orifice tricuspid valve with massive regurgitation and severe deficit of coaptation. METHODS Three adult patients with congenital non-Ebstein tricuspid valve anomaly characterized by severe coaptation deficiency underwent tricuspid valve repair applying the Cone technique. In particular, we describe the case of a symptomatic 21-year-old woman with a double-orifice tricuspid valve, with massive regurgitation and severe right ventricular dilatation. The tricuspid valve was transformed from a double-orifice valve into a single-orifice valve. The most superior orifice was opened, and the tissue surrounding the orifice was used to extend the leaflet of the inferior orifice. A Cone was created, and a ring annuloplasty was used to stabilize the result. RESULTS The patient was discharged home after 7 days with trivial residual tricuspid regurgitation and no significant antegrade gradient. The final coaptation height was 2.8 cm. The cardiothoracic ratio decreased from 0.77 to 0.59 after 2 months, and symptoms promptly improved. CONCLUSIONS Over the past 2 years, we have applied the Cone creation concept to patients with a severely dysplastic tricuspid valve with excellent early results. One patient had a double-orifice tricuspid valve, and a Cone repair concept was adopted anyway. One orifice was sacrificed, and surrounding tissue was used to augment the leaflets of the other orifice. A Cone was created to improve central coaptation with a good initial result.
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Affiliation(s)
- Andrea Giulio Quarti
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Dimitri Petridis
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valeria Francesca Mangerini
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lucio Careddu
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Emanuela Angeli
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gaetano Domenico Gargiulo
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Das M, Samaddar A, Narayan P. Congenital agenesis of anterior leaflet of tricuspid valve. Indian J Thorac Cardiovasc Surg 2023; 39:381-383. [PMID: 37346437 PMCID: PMC10279594 DOI: 10.1007/s12055-023-01482-y] [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: 10/27/2022] [Revised: 12/25/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Complete absence of anterior tricuspid valve leaflet is a rare anomaly. We report the case of a 10-year-old girl who presented with severe tricuspid regurgitation with annular dilatation and non-coapting leaflets. Intra-operatively, an incidental finding of complete agenesis of the anterior leaflet was observed. A tricuspid valve replacement was carried out; the patient made an uneventful recovery and remains well at follow-up.
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Affiliation(s)
- Mrinalendu Das
- Department of Cardiac Surgery, NH-Rabindranath Tagore International Institute of Cardiac Sciences, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
| | - Avishek Samaddar
- Department of Cardiac Surgery, NH-Rabindranath Tagore International Institute of Cardiac Sciences, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
| | - Pradeep Narayan
- Department of Cardiac Surgery, NH-Rabindranath Tagore International Institute of Cardiac Sciences, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
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Blitzer D, Bouhout I, Al Haddad E, Lewis M, Farooqi K, Shah A, Zemer-Wassercug N, Singh H, Anderson B, Bacha E, Kalfa D. Outcomes and risk analysis after tricuspid valve surgery for non-Ebstein 2-ventricle congenital tricuspid valve diseases. JTCVS OPEN 2022; 11:351-362. [PMID: 36172453 PMCID: PMC9510886 DOI: 10.1016/j.xjon.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/25/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- David Blitzer
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Ismail Bouhout
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Eliana Al Haddad
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Matthew Lewis
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Kanwal Farooqi
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Amee Shah
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Noa Zemer-Wassercug
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Harsimran Singh
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Brett Anderson
- Department of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - Emile Bacha
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
| | - David Kalfa
- Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian, Columbia University College of Physicians and Surgeons, New York, NY
- Address for reprints: David Kalfa, MD, PhD, Section of Pediatric and Congenital and Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN-274, New York, NY 10032.
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6
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Tricuspid valve repair with papillary muscle approximation for congenital tricuspid valve regurgitation due to tricuspid valve dysplasia. Cardiol Young 2022; 33:660-662. [PMID: 35912591 DOI: 10.1017/s1047951122002499] [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: 11/07/2022]
Abstract
We experienced a case of a 1-year-old female with congenital tricuspid valve regurgitation caused by tricuspid valve dysplasia. The anterior and septal leaflets were particularly dysplastic, and leaflet tethering was observed. The anterior papillary muscle was approximated to the interventricular septum, and a commissural edge-to-edge suture was inserted on the anteroseptal commissure. Tricuspid valve regurgitation improved to be trivial after surgery and has not worsened 1 year later. Papillary muscle approximation could be one of the feasible reparative techniques for congenital tricuspid valve regurgitation.
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7
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Huang Y, Dearani JA, Lahr BD, Stephens EH, Madhavan M, Cannon BC, Schaff HV. Surgical management of transvenous lead-induced tricuspid regurgitation in adult and pediatric patients with congenital heart disease. J Thorac Cardiovasc Surg 2021; 163:2185-2193.e4. [PMID: 34753592 DOI: 10.1016/j.jtcvs.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/22/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate outcomes of surgical management of lead-induced tricuspid regurgitation (TR) in patients with congenital heart disease. METHODS We analyzed data of 54 consecutive patients who underwent tricuspid valve (TV) surgery from 1998 to 2015 for lead-induced TR. Primary end points, including mortality, TV reinterventions, and longitudinal TR measurements, were analyzed with the Kaplan-Meier method or with repeated measures proportional odds modeling. RESULTS The median age of patients was 48.2 years (interquartile range, 37.3-59.0 years); 31 (57.4%) were female; 2 (3.7%) were children. Thirty patients (55.6%) underwent TV repair and 24 (44.4%) had replacement, and 52 underwent concomitant cardiac procedures. Thirty-day mortality was 1.9% (repair: 3.3%, replacement: 0.0%). Five-year survival was 80.4% overall and 79.7% and 81.4% for the repair and replacement groups, respectively. In response to surgery, TR improved in both groups (each P < .001) but more with replacement than repair (P < .001); longitudinal analysis showed that TR trends observed early on favoring replacement were sustained across follow-up (P < .001). The model-estimated risk of moderate or severe TR at 5-year follow-up, conditional on having severe preoperative TR, was 74.4% for the repair and 10.7% for the replacement group. Five-year cumulative risk of TV reintervention was comparable for valve repair and replacement. CONCLUSIONS Despite the need for concomitant cardiac procedures in most of the patients, early mortality was low after TV surgery. Survival and rate of TV reintervention were comparable for the repair and replacement groups. However, TV repair was associated with progressive TR during intermediate follow-up, especially in patients with severe preoperative TR.
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Affiliation(s)
- Ying Huang
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Brian D Lahr
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | | | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Bryan C Cannon
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
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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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9
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Strategies for tricuspid valve repair. Indian J Thorac Cardiovasc Surg 2020; 36:123-130. [PMID: 33061193 DOI: 10.1007/s12055-019-00826-x] [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: 01/24/2019] [Revised: 02/20/2019] [Accepted: 03/20/2019] [Indexed: 10/26/2022] Open
Abstract
Tricuspid valve repair is in many ways more challenging than mitral valve repair, especially since tricuspid valve anatomy is more complex with three leaflets, a saddle-shaped dynamic annulus and a complex subvalvular apparatus. The late referral of patients for tricuspid valve surgery adds to this challenge and contributes to poor prognosis. Nevertheless, studies have shown that the presence of moderate or greater tricuspid valve regurgitation leads to poor survival. Consequently, tricuspid valve surgery is now being performed more often, in order to improve the quality of life and survival. Tricuspid valve disease can be broadly classified into congenital and acquired tricuspid valve pathologies. Various repair techniques besides simple annular reduction maneuvers are used which are primarily aimed at restoring the complex interplay of various anatomical components. This review is a summary of the various operative techniques which provide successful reproducible results and achieve a competent and durable tricuspid valve repair with satisfactory late outcomes.
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10
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Patlolla SH, Dearani JA, Connolly HM, Warnes CA, Lahr BD, Schaff HV, Saran N. Repair of Partial Atrioventricular Septal Defects in Adults: A Single Center Experience. Semin Thorac Cardiovasc Surg 2020; 33:469-478. [PMID: 32858219 DOI: 10.1053/j.semtcvs.2020.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/20/2020] [Indexed: 11/11/2022]
Abstract
Limited data are available on long-term outcome after repair of partial atrioventricular septal defects (pAVSD) in adults. We sought to review our experience. Between January 1, 1957 and December 31, 2016, 179 adult patients [median age (IQR) 34 (18, 72) years] underwent primary repair of pAVSD. The most common associated defects were secundum atrial septal defect (n = 38) and ventricular septal defect (VSD) (n = 7). Left atrioventricular valve (LAVV) zone of apposition (ZOA) was complete in 47 patients and LAVV regurgitation (≥moderate) was present in 73 patients. Autologous pericardium (n = 79, 45%) and polytetrafluoroethylene felt (n = 56, 32%) were mainly used for pAVSD closure. Repair techniques for LAVV regurgitation included: ZOA suture closure (n = 142), suture annuloplasty (n = 10) and posterior band annuloplasty (n = 9). Six had LAVV replacement. There were 61 deaths over a median follow-up of 21 years (IQR 10, 38), with only 4 early deaths. In a limited subset of patients with 80 paired measurements (n = 40), median right ventricular systolic pressure declined from 43 mm Hg (IQR 35-51) to 33 mm Hg (IQR 30-44) postoperatively (P < 0.001), and this improvement was sustained over long-term follow-up (P = 0.513). A total of 34 patients underwent a reoperation (recurrent LAVV regurgitation, n = 26; left ventricular outflow-tract obstruction, n = 7; LAVV stenosis, n = 4; patch dehiscence, n = 1) with cumulative incidence of 6% and 16% at 10 and 15 years, respectively. Repair of pAVSD in adults can be done safely with low early mortality and good long-term outcomes. Postrepair reduction of pulmonary artery pressure is significant. Despite the low re-operation rates, long-term surveillance remains essential.
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Affiliation(s)
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Carole A Warnes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Brian D Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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11
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Saku K, Inoue H, Yamamoto K, Ueno M. Repair of tricuspid valve regurgitation due to a tricuspid valve cleft. Asian Cardiovasc Thorac Ann 2019; 27:688-690. [DOI: 10.1177/0218492319847365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A cleft in the tricuspid valve, classified as congenital dysplasia, is a rare disease. Here, we report the case of a 79-year-old man with tricuspid regurgitation due to a cleft in the anterior leaflet. The patient underwent successful tricuspid valve repair with cleft closure, chordal reconstruction, and tricuspid annuloplasty.
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Affiliation(s)
- Kosuke Saku
- Department of Cardiovascular Surgery, Tenyokai Central Hospital and Central Clinic, Kagoshima, Japan
| | - Hironori Inoue
- Department of Cardiovascular Surgery, Tenyokai Central Hospital and Central Clinic, Kagoshima, Japan
| | - Keisuke Yamamoto
- Department of Cardiovascular Surgery, Tenyokai Central Hospital and Central Clinic, Kagoshima, Japan
| | - Masahiro Ueno
- Department of Cardiovascular Surgery, Tenyokai Central Hospital and Central Clinic, Kagoshima, Japan
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Saran N, Dearani JA. Tricuspid Valve Repair: How I Teach It. Ann Thorac Surg 2019; 105:675-679. [PMID: 29455799 DOI: 10.1016/j.athoracsur.2017.08.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/10/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
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13
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Rajpal S, Daniels C, Landzberg M. Congenital tricuspid valve disease can masquerade as primary idiopathic tricuspid regurgitation. BRITISH HEART JOURNAL 2018; 104:959. [DOI: 10.1136/heartjnl-2017-312911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Saran N, Said SM, Schaff HV, Maltais S, Stulak JM, Greason KL, Daly RC, Pochettino A, King KS, Dearani JA. Outcome of tricuspid valve surgery in the presence of permanent pacemaker. J Thorac Cardiovasc Surg 2018; 155:1498-1508.e3. [DOI: 10.1016/j.jtcvs.2017.11.093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/21/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
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Navarro-Cubas X, Palermo V, French A, Sanchis-Mora S, Culshaw G. Tricuspid valve dysplasia: A retrospective study of clinical features and outcome in dogs in the UK. Open Vet J 2017; 7:349-359. [PMID: 29296595 PMCID: PMC5738889 DOI: 10.4314/ovj.v7i4.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/19/2017] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to determine the demographic, clinical and survival characteristics and to identify risk factors for mortality due to tricuspid valve dysplasia in UK dogs. Records of client-owned dogs diagnosed with tricuspid valve dysplasia at a referral centre were retrospectively reviewed. Only dogs diagnosed with tricuspid valve dysplasia based on the presence of a right-sided heart murmur identified prior to one year of age, and confirmed with Doppler echocardiography, were included. Dogs with concomitant cardiac diseases, pulmonary hypertension and/or trivial tricuspid regurgitation were excluded. Analysed data included signalment, reason for presentation, clinical signs, electrocardiographic and echocardiographic features, survival status and cause of death. Survival times and risk factors for mortality were evaluated using Kaplan-Meier curves and Cox regression. Eighteen dogs met inclusion criteria. Border collies were over-represented (p= 0.014). Dogs were most frequently referred for investigation of heart murmur. The most common arrhythmia was atrial fibrillation (n=3). Median survival time from diagnosis of tricuspid valve dysplasia was 2775 days (range 1-3696 days; 95% CI 1542.41-4007.59) and from onset of right-sided congestive heart failure was 181 days (range 1-2130 days; 95% CI 0-455.59). Syncope was the sole risk factor for cardiac death. In this population of UK dogs, tricuspid valve dysplasia was uncommon but, when severe, frequently led to right-sided congestive heart failure. Prognosis was favourable for mild and moderate tricuspid dysplasia. Survival time was reduced with right-sided congestive heart failure but varied widely. Risk of cardiac death was significantly increased if syncope had occurred.
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Affiliation(s)
- Xavier Navarro-Cubas
- University of Liverpool, Small Animal Teaching Hospital, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, UK
| | - Valentina Palermo
- Anderson and Moores Veterinary Specialists, The Granary, Bunstead Barns, Poles Lane, Hursley, Winchester, Hampshire, SO21 2LL, UK
| | - Anne French
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Bearsden Road, Bearsden, Glasgow, G61 1QH, UK
| | - Sandra Sanchis-Mora
- The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK
| | - Geoff Culshaw
- R(D)SVS Hospital for Small Animals, The University of Edinburgh, Easter Bush Veterinary Centre, Roslin, Midlothian, EH25 9RG, UK
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Holst KA, Said SM, Nelson TJ, Cannon BC, Dearani JA. Current Interventional and Surgical Management of Congenital Heart Disease: Specific Focus on Valvular Disease and Cardiac Arrhythmias. Circ Res 2017; 120:1027-1044. [PMID: 28302746 DOI: 10.1161/circresaha.117.309186] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 01/15/2023]
Abstract
Successful outcome in the care of patients with congenital heart disease depends on a comprehensive multidisciplinary team. Surgery is offered for almost every heart defect, despite complexity. Early mortality for cardiac surgery in the neonatal period is ≈10% and beyond infancy is <5%, with 90% to 95% of patients surviving with a good quality of life into the adult years. Advances in imaging have facilitated accurate diagnosis and planning of interventions and surgical procedures. Similarly, advances in the perioperative medical management of patients, particularly with intensive care, has also contributed to improving outcomes. Arrhythmias and heart failure are the most common late complications for the majority of defects, and reoperation for valvar problems is common. Lifelong surveillance for monitoring of recurrent or residual structural heart defects, as well as periodic assessment of cardiac function and arrhythmia monitoring, is essential for all patients. The field of congenital heart surgery is poised to incorporate new innovations such as bioengineered cells and scaffolds that will iteratively move toward bioengineered patches, conduits, valves, and even whole organs.
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Affiliation(s)
- Kimberly A Holst
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Sameh M Said
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Timothy J Nelson
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Bryan C Cannon
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Joseph A Dearani
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN.
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Sassa T, Okamoto K, Tazume H, Noguchi R, Koga A, Fukui T. Tricuspid Valve Repair With Artificial Chorda After Previous Ventricular Septal Defect Repair. Ann Thorac Surg 2017; 103:e335-e337. [PMID: 28359491 DOI: 10.1016/j.athoracsur.2016.09.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/16/2016] [Accepted: 09/21/2016] [Indexed: 11/28/2022]
Abstract
We evaluated a 49-year-old man with severe tricuspid valve regurgitation and coronary artery disease who had undergone congenital ventricular septal defect repair four decades previously. We found an enlarged, prolapsed commissure between the anterior and septal leaflets and a ruptured septal leaflet chorda. Two mattress sutures closed the commissure, with the leaflets' height matched by inverting the prolapsed site ventricularly. After implanting the annuloplasty band, we undertook chordal replacement using expanded polytetrafluoroethylene sutures. Artificial chorda length was determined using a small tourniquet and the saline test. Two coronary artery bypass grafts were also implanted. Postoperative echocardiography demonstrated no tricuspid regurgitation.
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Affiliation(s)
- Toshiharu Sassa
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Ken Okamoto
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Hirokazu Tazume
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryo Noguchi
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Ayumi Koga
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan.
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18
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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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19
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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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Abstract
The tricuspid valve is being increasingly recognised as an important safeguard to the heart with congenital heart disease. Both structural anomalies of the valve and functional burdens from other malformations of the right heart can lead to major haemodynamic consequences both upstream and downstream. The indications to surgically intervene on the tricuspid valve are evolving and vary depending on the malformation. The extant surgical techniques and their applications to corresponding frequent congenital anomalies of the tricuspid valve are reviewed.
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21
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Echocardiography of the tricuspid and pulmonary valve in children. Cardiol Young 2014; 24:1023-9. [PMID: 25647376 DOI: 10.1017/s1047951114002194] [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: 11/07/2022]
Abstract
Diseases of the tricuspid and pulmonary valve are common in childhood. These include congenital anomalies, acquired lesions, and secondary valve compromise due to left heart disease. A comprehensive and methodical approach to the echocardiographic assessment of these diseases of the tricuspid and pulmonary valve is necessary for best care of children with these conditions.
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22
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Zhou J, Zhang Y, Gui Y, Chu C, Zhang C, Zhou Q, Zhang Y, Li X, Yan Y. Relationship between isolated mild tricuspid valve regurgitation in second-trimester fetuses and postnatal congenital cardiac disorders. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1677-1682. [PMID: 25154952 DOI: 10.7863/ultra.33.9.1677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES In most cases, the clinical importance of fetal isolated mild tricuspid valve regurgitation is not known. This study evaluated the relationship between fetal isolated mild tricuspid regurgitation in the general obstetric population and postnatal congenital cardiac disorders. METHODS Detailed fetal echocardiography was done between 18 and 24 weeks' gestation to detect tricuspid regurgitation and to exclude complicated cardiac defects. Routine second-trimester targeted organ scans were also performed to exclude extracardiac defects. Follow-up was done until birth. After birth, the cardiac anatomy of the neonates was examined by echocardiography. The association between fetal isolated mild tricuspid regurgitation and postnatal congenital cardiac disorders was assessed by logistic regression analysis. RESULTS No major cardiac disorders were found postnatally. Some minor disorders were found, including a patent foramen ovale, atrial septal defects, a patent ductus arteriosus, and small ventricular septal defects. Fetuses with isolated mild tricuspid regurgitation had a significantly higher likelihood of having ventricular septal defects (odds ratio, 5.80; P = .027) or a patent foramen ovale with atrial septal defects and a patent ductus arteriosus (odds ratio, 11.61; P = .007). There was no significant association between tricuspid regurgitation and an isolated patent foramen ovale or a patent foramen ovale with atrial septal defects in neonates. CONCLUSIONS Fetuses with isolated mild tricuspid regurgitation in the second trimester did not have a higher incidence of major cardiac disorders after birth. The presence of isolated mild tricuspid regurgitation may be an indication of minor postnatal congenital cardiac disorders.
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Affiliation(s)
- Jizi Zhou
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Yun Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Yonghao Gui
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Chen Chu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Congcong Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Qiongjie Zhou
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Ying Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.)
| | - Xiaotian Li
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.).
| | - Yingliu Yan
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (J.Z., Yu.Z., Q.Z., Yi.Z., X.L., Y.Y.); Children's Hospital, Fudan University, Shanghai, China (Y.G., C.C., C.Z.); and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China (X.L.).
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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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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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25
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Affiliation(s)
- Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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26
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Shankarappa RK, Papaiah S, Karur S, Math RS, Nanjappa MC. Giant right atrium due to congenital dysplastic tricuspid valve in an elderly female patient. Echocardiography 2013; 30:E128-31. [PMID: 23489067 DOI: 10.1111/echo.12160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Isolated tricuspid valve disease is rare. We report the case of a 65-year-old female patient who presented with right heart failure. Initial echocardiographic evaluation revealed a giant right atrium (RA) with severe tricuspid inflow obstruction with regurgitation. A comprehensive two- and three-dimensional echocardiographic evaluation revealed a dysplastic tricuspid valve resulting in the inflow obstruction and regurgitation. Rheumatic and carcinoid etiologies were ruled out by relevant tests. It is very rare for dysplastic tricuspid valve to present in late adulthood. The classic echocardiographic findings are discussed followed by a brief review of the literature.
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