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Suwanto D, Dewi IP, Budiarto M. Managing tricuspid valve pathology in multiple valvular heart disease. Ann Med Surg (Lond) 2022; 82:104719. [PMID: 36268395 PMCID: PMC9577839 DOI: 10.1016/j.amsu.2022.104719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/11/2022] [Accepted: 09/11/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Multiple valvular heart disease (MVD) is a general term to describe regurgitant and stenotic combination involving the same valve and/or occurring in ≥2 cardiac valves. Limited data and paucity in guidelines render the diagnosis and management. This article aims to provide a state-of-the-art review concerning the diagnosis and management strategies of MVD. Case presentation We report a 46-year-old female with worsening dyspnea and fatigue. We perform multiple echocardiography parameters. We diagnose patients with the stenotic mitral valve, stenotic-regurgitant aortic valve, and stenotic-regurgitant tricuspid valve (TV). Double mechanical valve replacement and TV commissurotomy with Kay procedure were done with excellent results. Clinical discussion The prevalence of MVD is 15% in those undergoing cardiac surgery; however only 1% of those who underwent triple valve surgery involve TV. The presence of TV lesion may complicate the natural history, clinical presentation, management, and outcomes. Echocardiography with valid method remains an important tool in assessment of patients with MVD. Multidiscipline heart team discussion is essential in determining individual risk, appropriate management methods, and long-term survival. Conclusion The expertise of multidisciplinary heart valve team is of utmost importance in determining diagnosis and optimal management strategy. Multivalvular heart disease (MVD) is a complicated condition. A regurgitant and stenotic combination involves the same valve and/or occurs in ≥2 cardiac valves in MVD cases. The presence of tricuspid valve (TV) lesion may complicate the natural history, clinical presentation, management, and outcomes. Echocardiography is an important modality that can help to diagnose and sometimes can provide a prognosis after surgery.
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Bannehr M, Kahn U, Liebchen J, Okamoto M, Hähnel V, Georgi C, Dworok V, Edlinger C, Lichtenauer M, Kücken T, Kropf S, Haase-Fielitz A, Butter C. Right Ventricular Longitudinal Strain Predicts Survival in Patients With Functional Tricuspid Regurgitation. Can J Cardiol 2021; 37:1086-1093. [PMID: 33453358 DOI: 10.1016/j.cjca.2021.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/29/2020] [Accepted: 01/06/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Functional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Despite general consent that right ventricular (RV) dysfunction impacts outcome of patients with TR, it is still unknown which echocardiographic parameters most accurately reflect prognosis. In this study we aimed to evaluate the prevalence of RV dysfunction and its prognostic value in patients with TR. METHODS Data from 1089 consecutive patients were analysed. Tricuspid annular plane systolic excursion (TAPSE), fractional area change, and right ventricular free wall longitudinal strain (RV strain) were used to define RV dysfunction. Patients were followed for 2-year all-cause mortality. For prediction of survival, reclassification and C statistics of RV functional parameters using TR grade as reference model were performed. RESULTS Among the patients studied, 13.9% showed no TR, 61.2% had mild TR, 19.6% had moderate TR, and 5.3% had severe TR. The TR grade was associated with increased mortality (log rank, P < 0.001). Impaired RV strain and TAPSE were independent predictors for mortality (RV: hazard ratio [HR], 1.130; 95% confidence interval [CI], 1.099-1.160; P < 0.001; TAPSE: HR, 1.131; 95% CI, 1.085-1.175; P < 0.001). Both RV strain and TAPSE improved the reference model for survival prediction (RV: integrated discrimination improvement [IDI], 0.184; 95% CI, 0.146-0.221; P < 0.001; TAPSE: IDI, 0.057; 95% CI, 0.037-0.077; P < 0.001). CONCLUSIONS Echocardiographic evaluation of RV function appears to useful for patients with TR. Assessment of RV strain provides additional value for prediction of 2-year mortality.
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Affiliation(s)
- Marwin Bannehr
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany.
| | - Ulrike Kahn
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Josephin Liebchen
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Maki Okamoto
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Valentin Hähnel
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Christian Georgi
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Victoria Dworok
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Christoph Edlinger
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany; Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Tanja Kücken
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Siegfried Kropf
- Institute for Biometrics and Medical Informatics, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Anja Haase-Fielitz
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany; Institute of Social Medicine and Health Economics, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau and Brandenburg Medical School, Bernau bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
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