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Lopes V, Almeida PC, Moreira N, Ferreira LA, Teixeira R, Donato P, Gonçalves L. Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1163-1181. [PMID: 38780710 DOI: 10.1007/s10554-024-03140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.
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Affiliation(s)
- Vanessa Lopes
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
| | - Pedro Carvalho Almeida
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Nádia Moreira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Luís Amaral Ferreira
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Rogério Teixeira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
| | - Paulo Donato
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Univ Coimbra, Coimbra Institute for Biomedical Imaging and Translation Research (CIBIT), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Univ Coimbra, Coimbra, Portugal
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Broncano J, Hanneman K, Ghoshhajra B, Rajiah PS. Cardiac Computed Tomography of Native Cardiac Valves. Radiol Clin North Am 2024; 62:399-417. [PMID: 38553177 DOI: 10.1016/j.rcl.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Valvular heart disease (VHD) is a significant clinical problem associated with high morbidity and mortality. Although not being the primary imaging modality in VHD, cardiac computed tomography (CCT) provides relevant information about its morphology, function, severity grading, and adverse cardiac remodeling assessment. Aortic valve calcification quantification is necessary for grading severity in cases of low-flow/low-gradient aortic stenosis. Moreover, CCT details significant information necessary for adequate percutaneous treatment planning. CCT may help to detail the etiology of VHD as well as to depict other less frequent causes of valvular disease, such as infective endocarditis, valvular neoplasms, or other cardiac pseudomasses.
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Affiliation(s)
- Jordi Broncano
- Cardiothoracic Imaging Unit, Radiology Department, Hospital San Juan de Dios, HT Medica, Avenida El Brillante Nº 36, Córdoba 14012, Spain.
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G2N2, Canada
| | - Brian Ghoshhajra
- Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charles River Plaza East, 165 Cambridge Street, Boston, MA 02114, USA
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Meng H, Zhao X, Wang JD, Wan LY, Shi H, OuYang WB, Pan XB. Comparison between multimodality imaging approaches for measurement of the tricuspid annulus in severe tricuspid regurgitation. Int J Cardiol 2023; 383:151-158. [PMID: 37004945 DOI: 10.1016/j.ijcard.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/25/2023] [Accepted: 03/09/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Tricuspid valve (TV) sizing is crucial for surgical or interventional procedures planning. Imaging TV is frequently challenging and often requires multimodal imaging techniques. Computed tomography (CT) is the gold standard for sizing. The authors compared measurements of the tricuspid annulus (TA) acquired using echocardiography and CT. METHODS Thirty-six patients with severe symptomatic tricuspid regurgitation were included in this retrospective analysis. During mid-diastole, the maximal two-dimensional (2D) TA diameter was directly measured in multiple views using transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). Three-dimensional (3D) TA size was assessed using cross-sectional long-axis and short-axis diameters, areas, and perimeters measured in the projected plane. The TA diameter was quantified by the perimeter measured on the CT images (CT imaging_indirect) and compared with echocardiography measurements. Tenting height and tenting area were also measured using TTE at mid systole. RESULTS The long-axis dimensions measured using 3DTEE (3DTEE_direct) best correlated with the TA diameter (CT imaging_indirect) (R = 0.851, P = 0.0001) and the least discrepancies (difference 1.2 ± 2.4 mm, P = 0.012). The TA diameters quantified by the perimeters measured using 3DTEE (3DTEE_indirect) were smaller than the CT values (difference 2.5 ± 2.5 mm, P = 0.0001). The maximal dimensions directly measured by 2DTEE (2DTEE_direct) were modestly correlated with the CT values. Overall, the maximal dimensions by TTE_direct were less reliable than those by CT. TA eccentricity index correlated with the maximal tenting height and area. CONCLUSION The patients with severe tricuspid regurgitation had a dilated and circular annulus. The long-axis TA dimensions (3DTEE_direct) were similar to the diameters (CT imaging_indirect).
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Affiliation(s)
- Hong Meng
- Echocardiographic Imaging Center, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Xing Zhao
- Echocardiographic Imaging Center, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Jian-De Wang
- Echocardiographic Imaging Center, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Lin-Yuan Wan
- Echocardiographic Imaging Center, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Hao Shi
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Bin OuYang
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang-Bin Pan
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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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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Appadurai V, Safdur T, Narang A. Assessment of Right Ventricle Function and Tricuspid Regurgitation in Heart Failure: Current Advances in Diagnosis and Imaging. Heart Fail Clin 2023; 19:317-328. [PMID: 37230647 DOI: 10.1016/j.hfc.2023.02.002] [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: 05/27/2023]
Abstract
Right ventricular (RV) systolic dysfunction increases mortality among heart failure patients, and therefore, accurate diagnosis and monitoring is paramount. RV anatomy and function are complex, usually requiring a combination of imaging modalities to completely quantitate volumes and function. Tricuspid regurgitation usually occurs with RV dysfunction, and quantifying this valvular lesion also may require multiple imaging modalities. Echocardiography is the first-line imaging tool for identifying RV dysfunction, with cardiac MRI and cardiac computed tomography adding valuable additional information.
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Affiliation(s)
- Vinesh Appadurai
- Bluhm Cardiovascular Institute, Northwestern University, 676 North St Clair Street Suite 19-100 Galter Pavilion, Chicago, IL 60611, USA; School of Medicine, The University of Queensland, St Lucia, QLD, 4067 Australia
| | - Taimur Safdur
- Bluhm Cardiovascular Institute, Northwestern University, 676 North St Clair Street Suite 19-100 Galter Pavilion, Chicago, IL 60611, USA
| | - Akhil Narang
- Bluhm Cardiovascular Institute, Northwestern University, 676 North St Clair Street Suite 19-100 Galter Pavilion, Chicago, IL 60611, USA.
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Rajiah PS, Reddy P, Baliyan V, Hedgire SS, Foley TA, Williamson EE, Eleid MF. Utility of CT and MRI in Tricuspid Valve Interventions. Radiographics 2023; 43:e220153. [PMID: 37384544 DOI: 10.1148/rg.220153] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Transcatheter tricuspid valve interventions (TTVIs) comprise a variety of catheter-based interventional techniques for treatment of tricuspid regurgitation (TR) in patients at high surgical risk and those with failed previous surgeries. Several TTVI devices with different mechanisms of action are either currently used or in preclinical evaluation. Echocardiography is the first-line modality for evaluation of tricuspid valve disease that provides information on tricuspid valve morphology, mechanism of TR, and hemodynamics. Cardiac CT and MRI have several advantages for a comprehensive preprocedure evaluation. CT and MRI provide complementary information to that of echocardiography on the mechanism and cause of TR. MRI can quantify the severity of TR using indirect or direct techniques that involve two-dimensional or four-dimensional flow sequences. MRI and CT can also accurately quantify right ventricular volumes and function, which is crucial for timing of intervention. CT provides comprehensive three-dimensional information on the morphology of the valve, annulus, subvalvular apparatus, and adjacent structures. CT is the procedure of choice for evaluation of several device-specific measurements, including tricuspid annulus dimensions, annulus-to-right coronary artery distance, leaflet morphology, coaptation gaps, caval dimensions, and cavoatrial-to-hepatic vein distance. CT allows evaluation of the vascular access as well as optimal procedure fluoroscopic angles and catheter trajectory. Postprocedure CT and MRI are useful in detection of complications such as paravalvular leak, pseudoaneurysm, thrombus, pannus, infective endocarditis, and device migration. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Prabhakar Shantha Rajiah
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Prajwal Reddy
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Vinit Baliyan
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Sandeep S Hedgire
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Thomas A Foley
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Eric E Williamson
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Mackram F Eleid
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
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Ahn Y, Koo HJ, Kang JW, Yang DH. Tricuspid Valve Imaging and Right Ventricular Function Analysis Using Cardiac CT and MRI. Korean J Radiol 2021; 22:1946-1963. [PMID: 34668349 PMCID: PMC8628151 DOI: 10.3348/kjr.2020.1507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022] Open
Abstract
Cardiac computed tomography (CT) and cardiac magnetic resonance imaging (CMR) can reveal the detailed anatomy and function of the tricuspid valve and right ventricle (RV). Quantification of tricuspid regurgitation (TR) and analysis of RV function have prognostic implications. With the recently available transcatheter treatment options for diseases of the tricuspid valve, evaluation of the tricuspid valve using CT and CMR has become important in terms of patient selection and procedural guidance. Moreover, CT enables post-procedural investigation of the causes of valve dysfunction, such as pannus or thrombus. This review describes the anatomy of the tricuspid valve and CT and CMR imaging protocols for right heart evaluation, including RV function and TR analyses. We also demonstrate the pre-procedural planning for transcatheter treatment of TR and imaging of postoperative complications using CT.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Lopes BBC, Hashimoto G, Bapat VN, Sorajja P, Scherer MD, Cavalcante JL. Cardiac Computed Tomography and Magnetic Resonance Imaging of the Tricuspid Valve: Preprocedural Planning and Postprocedural Follow-up. Interv Cardiol Clin 2021; 11:27-40. [PMID: 34838295 DOI: 10.1016/j.iccl.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Transcatheter tricuspid valve interventions (TTVIs) are rapidly growing as a less invasive treatment of high surgical risk patients with advanced TR. A comprehensive anatomic and functional assessment of the tricuspid valve and right-sided chambers is essential for candidate selection and procedural planning. Advanced imaging with cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) can provide accurate anatomic and functional assessment of the tricuspid valve, its apparatus, and the right-sided chambers. In this review, we provide an updated overview of the emerging role of CCT and CMR for TR patient evaluation, TTVI planning, and follow-up.
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Affiliation(s)
- Bernardo B C Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA
| | - Go Hashimoto
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55047, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55047, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA
| | - Markus D Scherer
- Sanger Heart & Vascular Institute Adult Cardiology Kenilworth, 1237 Harding Place Suite 3100, Charlotte, NC 28203, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA; Valve Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55047, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA.
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Singh N, Kim H, Haydock DA. Isolated Tricuspid Valve Surgery: the Auckland Experience 2011-2019. Heart Lung Circ 2021; 31:582-589. [PMID: 34711497 DOI: 10.1016/j.hlc.2021.09.020] [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: 07/02/2021] [Revised: 08/28/2021] [Accepted: 09/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Isolated tricuspid valve surgery is an uncommon operation. Historical reports, including a previous review from our unit, demonstrated high morbidity and mortality associated with this operation. Many of these patients had severely impaired right ventricular function at the time of the surgery. Since our previous review, we have actively encouraged our local cardiologists to refer patients with severe isolated tricuspid disease for surgery before right ventricular remodelling occurs. This present study was performed to assess our current results. MATERIAL AND METHODS A prospectively-maintained hospital database was used to identify all adult non-congenital patients receiving standalone tricuspid valve repair or replacement at New Zealand's largest cardiothoracic surgical unit from July 2011 to July 2019. Additional demographic and clinical data were collected by review of patient electronic records. RESULTS During the 8-year study period, a total of 50 patients underwent isolated tricuspid valve surgery. Most patients were operated on for functional (40%) or rheumatic (30%) tricuspid disease. The majority of patients underwent surgery when the right ventricular function preoperatively was normal (30%) or mildly/moderately impaired (60%). Over half the patient sample (56%) underwent valve replacement. The 30-day mortality rate and stroke rate were 6% and 2% respectively. The medium-term survival was 80% at 4 years mean follow-up. CONCLUSION Isolated tricuspid surgery is no longer a high mortality operation when it is performed on patients who have preserved right ventricular function.
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Affiliation(s)
- Navneet Singh
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand.
| | - Hannah Kim
- The University of Auckland Medical School, Auckland, New Zealand
| | - David A Haydock
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
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Hell MM, Emrich T, Kreidel F, Kreitner KF, Schoepf UJ, Münzel T, von Bardeleben RS. Computed tomography imaging needs for novel transcatheter tricuspid valve repair and replacement therapies. Eur Heart J Cardiovasc Imaging 2021; 22:601-610. [PMID: 33247897 DOI: 10.1093/ehjci/jeaa308] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/30/2020] [Indexed: 01/03/2023] Open
Abstract
Transcatheter tricuspid valve therapies are an emerging field in structural heart interventions due to the rising number of patients with severe tricuspid regurgitation and the high risk for surgical treatment. Computed tomography (CT) allows exact measurements of the annular plane, evaluation of adjacent structures, assessment of the access route, and can also be used to identify optimal fluoroscopic projection planes to enhance periprocedural imaging. This review provides an overview of current transcatheter tricuspid valve repair and replacement therapies and to what extent CT can support these interventions.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany.,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
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Francone M, Aquaro GD, Barison A, Castelletti S, de Cobelli F, de Lazzari M, Esposito A, Focardi M, di Renzi P, Indolfi C, Lanzillo C, Lovato L, Maestrini V, Mercuro G, Natale L, Mantini C, Polizzi G, Rabbat M, Secchi F, Secinaro A, di Cesare E, Pontone G. Appropriate use criteria for cardiovascular MRI: SIC - SIRM position paper Part 2 (myocarditis, pericardial disease, cardiomyopathies and valvular heart disease). J Cardiovasc Med (Hagerstown) 2021; 22:515-529. [PMID: 34076599 DOI: 10.2459/jcm.0000000000001170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cardiovascular magnetic resonance (CMR) has emerged as an accurate diagnostic technique for the evaluation of patients with cardiac disease in the majority of clinical settings, thanks to an established additional diagnostic and prognostic value. This document has been developed by a joined group of experts of the Italian Society of Cardiology (SIC) and Italian Society of Radiology (SIRM) to provide a summary about the current state of technology and clinical applications of CMR, to improve the clinical diagnostic pathways and to promote its inclusion in clinical practice. The writing committee consisted of members and experts of both societies in order to develop a more integrated approach in the field of cardiac imaging. This section 2 will cover myocarditis, pericardial disease, cardiomyopathies and valvular heart disease.
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Affiliation(s)
- Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan
| | | | | | - Silvia Castelletti
- Istituto Auxologico Italiano IRCCS, Center for the Cardiac Arrhythmias of Genetic Origin
| | - Francesco de Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan
| | - Manuel de Lazzari
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Italy
| | - Antonio Esposito
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan
| | - Marta Focardi
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena
| | - Paolo di Renzi
- U.O.C. Radiologia, Ospedale 'San Giovanni Calibita' Fatebenefratelli - Isola Tiberina - Rome
| | - Ciro Indolfi
- Division of Cardiology, University Magna Graecia, Italy and Mediterranea Cardiocentro, Naples
| | | | - Luigi Lovato
- Cardiovascular Radiology Unit, Department of Imaging S.Orsola-Malpighi University Hospital, Bologna
| | - Viviana Maestrini
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | - Luigi Natale
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology - Diagnostic Imaging Area
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Universita ' Cattolica del Sacro Cuore, Rome
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University, Chieti
| | - Gesualdo Polizzi
- Unit of Radiodiagnostics II, University Hospital 'Policlinico-Vittorio Emanuele', Catania, Italy
| | - Mark Rabbat
- Loyola University of Chicago, Chicago
- Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, Bambino Gesù Children's Hospital, Rome
| | - Ernesto di Cesare
- Department of Life, Healt and Enviromental Sciences, University of L'Aquila, L'Aquila
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Hołda J, Słodowska K, Malinowska K, Strona M, Mazur M, Jasińska KA, Matuszyk A, Koziej M, Walocha JA, Hołda MK. Morphology and Position of the Right Atrioventricular Valve in Relation to Right Atrial Structures. Diagnostics (Basel) 2021; 11:960. [PMID: 34073631 PMCID: PMC8227200 DOI: 10.3390/diagnostics11060960] [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: 04/25/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
The right atrioventricular valve (RAV) is an important anatomical structure that prevents blood backflow from the right ventricle to the right atrium. The complex anatomy of the RAV has lowered the success rate of surgical and transcatheter procedures performed within the area. The aim of this study was to describe the morphology of the RAV and determine its spatial position in relation to selected structures of the right atrium. We examined 200 randomly selected human adult hearts. All leaflets and commissures were identified and measured. The position of the RAV was defined. Notably, 3-leaflet configurations were present in 67.0% of cases, whereas 4-leaflet configurations were present in 33.0%. Septal and mural leaflets were both significantly shorter and higher in 4-leaflet than in 3-leaflet RAVs. Significant domination of the muro-septal commissure in 3-leflet valves was noted. The supero-septal commissure was the most stable point within RAV circumference. In 3-leaflet valves, the muro-septal commissure was placed within the cavo-tricuspid isthmus area in 52.2% of cases, followed by the right atrial appendage vestibule region (20.9%). In 4-leaflet RAVs, the infero-septal commissure was located predominantly in the cavo-tricuspid isthmus area and infero-mural commissure was always located within the right atrial appendage vestibule region. The RAV is a highly variable structure. The supero-septal part of the RAV is the least variable component, whereas the infero-mural is the most variable. The number of detected RAV leaflets significantly influences the relative position of individual valve components in relation to right atrial structures.
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Affiliation(s)
- Jakub Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Katarzyna Słodowska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Karolina Malinowska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, 31-007 Cracow, Poland;
| | - Małgorzata Mazur
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Katarzyna A. Jasińska
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Aleksandra Matuszyk
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Mateusz Koziej
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Jerzy A. Walocha
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
| | - Mateusz K. Hołda
- HEART—Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.H.); (K.S.); (K.M.); (M.M.); (K.A.J.); (A.M.); (M.K.); (J.A.W.)
- Department of Cardiovascular Sciences, University of Manchester, Manchester M13 9PL, UK
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Sabatino J, Bassareo PP, Ciliberti P, Cazzoli I, Oreto L, Secinaro A, Guccione P, Indolfi C, DI Salvo G. Tricuspid valve in congenital heart disease: multimodality imaging and electrophysiological considerations. Minerva Cardiol Angiol 2021; 70:491-501. [PMID: 33944535 DOI: 10.23736/s2724-5683.21.05656-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The tricuspid valve (TV) has been neglected for many years. Only recently, new studies demonstrated the prognostic role of the tricuspid valve lesions. In addition to that, new interventional approaches offer the possibility to non-invasively treat tricuspid valve disease. In this review, our aim is to summarize the role of different imaging techniques in the assessment of tricuspid valve with particular regards to congenital heart diseases. Finally, we analyze the importance of the TV and its adjacent regions from an electrophysiological point of view, both in structurally normal hearts and in congenital heart diseases. The most relevant transthoracic echocardiography (TTE) views to visualize the TV are the "modified" parasternal long axis, the apical views and subcostal projections, such as right oblique or left oblique views. However, simultaneous visualization of the three leaflets is possible only with three-dimensional TTE, or, sometimes, in parasternal short axis and subcostal short axis views in children. 3D echocardiography (3DE) is promising in this field. Indeed, its unique projections, such as en face views from the right ventricular and atrial perspectives, are able to define the spatial relationship of the tricuspid leaflets with the surrounding structures. Moreover, multimodality imaging assessment has been recently proposed for the diagnostic assessment of the TV, especially before percutaneous intervention. Cardiac Computed Tomography (CCT) provides valuable anatomic spatial information of the TV apparatus. Cardiac Magnetic Resonance (CMR) is able to provide, non-invasively, detailed morphological and functional information of the valve.
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Affiliation(s)
- Jolanda Sabatino
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Pier P Bassareo
- Adult Congenital Heart Disease Unit, University College of Dublin, Dublin, Ireland
| | - Paolo Ciliberti
- Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ilaria Cazzoli
- Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lilia Oreto
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Pediatric Hospital, Taormina, Messina, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Guccione
- Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giovanni DI Salvo
- Department of Women's and Children's Health, University of Padua, Padua, Italy - giodisal@.yahoo.it
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Fortuni F, Hirasawa K, Bax JJ, Delgado V, Ajmone Marsan N. Multi-Modality Imaging for Interventions in Tricuspid Valve Disease. Front Cardiovasc Med 2021; 8:638487. [PMID: 33634175 PMCID: PMC7900427 DOI: 10.3389/fcvm.2021.638487] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 12/13/2022] Open
Abstract
Several studies have demonstrated that severe tricuspid regurgitation (TR) has a significant negative impact on morbidity and mortality. Nowadays, several therapeutic options to treat TR are available and patients at high surgical risk can also be treated with transcatheter procedures. For the management of patients with TR, an accurate assessment of the tricuspid valve and its surrounding structures is therefore of crucial importance and has gained significant interest in the medical community. Different imaging modalities can provide detailed information on the tricuspid valve apparatus, right ventricle, right atrium, and coronary circulation which are fundamental to define the timing and anatomic suitability of surgical and percutaneous procedures. The present review illustrates the role of 2D and 3D echocardiography, cardiac magnetic resonance, and multidetector row computed tomography for the assessment of the tricuspid valve and right heart with a particular focus on the data needed for planning and guiding interventional procedures.
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Affiliation(s)
- Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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Wunderlich NC, Landendinger M, Arnold M, Achenbach S, Swaans MJ, Siegel RJ, Ho SY. State-of-the-Art Review: Anatomical and Imaging Considerations During Transcatheter Tricuspid Valve Repair Using an Annuloplasty Approach. Front Cardiovasc Med 2021; 8:619605. [PMID: 33614749 PMCID: PMC7892591 DOI: 10.3389/fcvm.2021.619605] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Transcatheter techniques for the treatment of tricuspid regurgitation (TR) are being more frequently used and several new devices are in development. Since 90% of patients with TR have secondary TR, catheter based systems which reduce the dilated tricuspid annulus area are of particular interest. In order to perform an annuloplasty procedure effectively and safely, knowledge about the anatomy of the tricuspid valve apparatus and especially of the annulus in relation to the important neighboring structures such as the aortic root, the RCA, the electrical pathways and the CS is fundamental. In addition, comprehensive understanding of the device itself, the delivery system, its maneuverability and the individual procedural steps is required. Furthermore, the use of multi-modality imaging is important. For each step of the procedure the appropriate imaging modality as well as the optimal; imaging planes are crucial to provide the necessary information to best guide the individual procedural step.
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Affiliation(s)
| | - Melanie Landendinger
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Martin Arnold
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Robert J Siegel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom
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Aremu OO, Samuels P, Jermy S, Lumngwena EN, Mutithu D, Cupido BJ, Skatulla S, Ntusi NAB. Cardiovascular imaging modalities in the diagnosis and management of rheumatic heart disease. Int J Cardiol 2020; 325:176-185. [PMID: 32980432 DOI: 10.1016/j.ijcard.2020.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/09/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
Rheumatic heart disease (RHD) is prevalent in sub-Saharan Africa, where the capacity for diagnosis and evaluation of disease severity and complications is not always optimal. While the medical history and physical examination are important in the assessment of patients suspected to have RHD, cardiovascular imaging techniques are useful for confirmation of the diagnosis. Echocardiography is the workhorse modality for initial evaluation and diagnosis of RHD. Cardiovascular magnetic resonance is complementary and may provide additive information, including tissue characteristics, where echocardiography is inadequate or non-diagnostic. There is emerging evidence on the role of computed tomography, particularly following valve replacement surgery, in the monitoring and management of RHD. This article summarises the techniques used in imaging RHD patients, considers the evidence base for their utility, discusses their limitations and recognises the clinical contexts in which indications and imaging with various modalities are expanding.
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Affiliation(s)
- Olukayode O Aremu
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Petronella Samuels
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Stephen Jermy
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Evelyn N Lumngwena
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Centre for the Study of Emerging and Ee-emerging Infections (CREMER), Institute for Medical Research and Medicinal Plant studies (IMPM), Ministry of Scientific Research and Innovation, Cameroon
| | - Daniel Mutithu
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Blanche J Cupido
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sebastian Skatulla
- Division of Structural Engineering and Mechanics, Department of Civil Engineering, University of Cape Town, South Africa; Department of Civil Engineering, Centre for Research in Computational and Applied Mechanics (CERECAM), University of Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa; Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa.
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17
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Calcification of tricuspid valve chordae tendineae on echocardiography and computed tomography. Radiol Case Rep 2020; 15:214-217. [PMID: 31890071 PMCID: PMC6931194 DOI: 10.1016/j.radcr.2019.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 12/03/2022] Open
Abstract
We present the appearance of chordae tendineae calcification on transthoracic echocardiography and ECG-gated cardiac computed tomography in a 75 year-old woman. While the etiology is unclear, the abnormality can be clearly delineated on a properly performed CT study. We also discuss modification of the cardiac CT protocol to optimize visualization of the tricuspid valve apparatus.
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Functional Regurgitation of Atrioventricular Valves and Atrial Fibrillation: An Elusive Pathophysiological Link Deserving Further Attention. J Am Soc Echocardiogr 2020; 33:42-53. [DOI: 10.1016/j.echo.2019.08.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 12/15/2022]
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Hołda MK, Zhingre Sanchez JD, Bateman MG, Iaizzo PA. Right Atrioventricular Valve Leaflet Morphology Redefined: Implications for Transcatheter Repair Procedures. JACC Cardiovasc Interv 2019; 12:169-178. [PMID: 30678795 DOI: 10.1016/j.jcin.2018.09.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/20/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The authors aimed to comprehensively detail the right atrioventricular valve functional leaflet anatomies. BACKGROUND The rapid development of both surgical and percutaneous repair techniques for tricuspid regurgitation has renewed interest in variations in the morphology of the right atrioventricular valve. METHODS The functioning right atrioventricular valves of 40 reanimated human hearts were imaged using Visible Heart methodologies. Hearts were then perfusion-fixed and dissected, uniquely allowing for the comparative assessments of functional versus fixed valve anatomies from the same set of donor hearts. RESULTS The right atrioventricular valves have "3-leaflet" configurations in 57.5% and "4-leaflet" configurations in the remaining hearts. For 4-leaflet valves, extra leaflets were commonly observed in the most inferior regions of the annuli. No difference in valve perimeters between 2 valve types were observed (112.2 vs. 117.1 mm; p = 0.14). In 3-leaflet valves, septal, mural, and superior leaflets occupied 32.2 ± 6.5%, 15.9 ± 5.5%, and 25.5 ± 6.2% of the annulus, respectively, whereas in the 4-leaflet arrangements, these values were 27.0 ± 5.8% (septal), 12.0 ± 4.5% (inferior), 13.7 ± 9.4% (mural), and 19.8 ± 6.1% (superior). The muroseptal/inferoseptal commissures were usually located in the cavotricuspid regions, whereas the inferomural and superomural commissures were in the right atrial appendage vestibule area. CONCLUSIONS The right atrioventricular valve has 4 functional leaflets in more than 40% of cases. The authors found that the inferomural region is the most variable area of the valve and believe that anatomic variation is an important consideration for planned interventions.
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Affiliation(s)
- Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University, Kraków, Poland; Department of Cardiac and Vascular Diseases, Jagiellonian University, Kraków, Poland.
| | - Jorge D Zhingre Sanchez
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Michael G Bateman
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota; Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Iaizzo
- Visible Heart Laboratory, Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, Minnesota; Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota
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Tricuspid Annular Diameter Measurement on Routine Chest CT Can Detect Significant Tricuspid Regurgitation. AJR Am J Roentgenol 2019; 213:W257-W263. [DOI: 10.2214/ajr.19.21602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Computed tomography for transcatheter tricuspid valve development. Eur Radiol 2019; 30:682-690. [DOI: 10.1007/s00330-019-06410-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/17/2019] [Accepted: 08/07/2019] [Indexed: 01/18/2023]
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Abstract
PURPOSE OF REVIEW This review aims to provide an updated overview and a clinical perspective on novel transcatheter tricuspid valve interventions (TTVI), highlighting potential challenges and future directions. RECENT FINDINGS Severe tricuspid regurgitation (TR) is a predictor of mortality. However, a sizeable number of patients remain untreated until the end-stage when cardiac surgery presents a prohibitive risk. The emergent need in finding a treatment for patients with TR, deemed for surgery options, has encouraged the development of TTVI. These procedures mimic classical surgery techniques and are mainly divided in four categories: annuloplasty and coaptation devices, edge-to-edge techniques and transcatheter tricuspid valve replacement. Early studies showed promising results, but long-term follow-up data are not available. For patients with severe TR and high surgical risk, several percutaneous options are available. However, these therapies are in a growing phase and bigger studies and long term follow-up are needed to prove their efficacy.
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Abstract
Valvular heart disease is a common clinical problem. Although echocardiography is the standard technique for the noninvasive evaluation of the valves, cardiac CT has evolved to become a useful tool in the evaluation of the cardiac structures as well. Importantly, CT allows for improved quantification of valvular calcification due to its superior spatial resolution. It may improve the detection of small valvular or perivalvular pathology or the characterization of valvular masses and vegetations. This review describes the assessment of normal and diseased heart valves by cardiac CT and discusses its strengths and weaknesses.
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Yin H, Li Y. Diagnostic value of Omniview technique on the agenesis of corpus callosum. J Matern Fetal Neonatal Med 2018; 32:3806-3811. [PMID: 29726726 DOI: 10.1080/14767058.2018.1472230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: This study aimed to discuss the diagnostic value of Omniview technique on the agenesis of corpus callosum. Methods: A total of 43 pregnant women with no obvious structural abnormality and eight pregnant women who diagnosed with agenesis of corpus callosum (ACC) were included in this study. The 2D ultrasonography and the 3D ultrasonography Omniview technique were used to carry out ultrasonic examination on 43 normal fetuses and eight fetuses with agenesis of corpus callosum (as verified through magnetic resonance), respectively. Results: The Omniview technique visually displayed the median sagittal plane of the fetus. The ROC curve of Omniview (0.999) was much higher than that of 2D ultrasonography (0.817). Rating of ACC and normal fetuses showed that the diagnostic efficiency of 3D ultrasonography Omniview technique was much higher than 2D ultrasonography. Conclusion: 3D ultrasonography Omniview technique has certain advantage in the diagnosis of agenesis of corpus callosum, and is of great significance in the prenatal screening of callosum.
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Affiliation(s)
- Hong Yin
- a Department of Ultrasound , Maternal and Child Health Care of Shandong Province, Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Key Laboratory for Improving Birth Outcome Technique, Shandong Provincial Family Planning Institute of Science and Technology , Jinan , PR China
| | - Yang Li
- a Department of Ultrasound , Maternal and Child Health Care of Shandong Province, Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Key Laboratory for Improving Birth Outcome Technique, Shandong Provincial Family Planning Institute of Science and Technology , Jinan , PR China
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Ciepłucha A, Trojnarska O, Kociemba A, Łanocha M, Barczynski M, Rozmiarek S, Kramer L, Pyda M. Clinical aspects of myocardial fibrosis in adults with Ebstein's anomaly. Heart Vessels 2018; 33:1076-1085. [PMID: 29468473 PMCID: PMC6096744 DOI: 10.1007/s00380-018-1141-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/16/2018] [Indexed: 01/19/2023]
Abstract
Heart failure and arrhythmia are common complications in adults with Ebstein's anomaly. They may result not only from hemodynamic alterations, but also from myocardial fibrosis. Late gadolinium enhancement (LGE) by CMR enables the evaluation of myocardial fibrosis. The aim of the study was to asses the presence of LGE and its relation to clinical outcome. We studied a group of 37 unoperated adults aged 43.0 ± 14.4 years with Ebstein's anomaly from the congenital heart disease outpatient clinic. Study protocol included: cardiopulmonary test, assessment of supraventricular arrhythmia (SVA), and CMR with evaluation of cardiac chambers' morphology and function, and presence of LGE. Variables following normal distribution were shown as mean ± SD if otherwise median (range) was applied. Fibrosis was found in 18 patients (48.6%) and was distributed as follows: 12 patients (32.4%) in the right atrium, 12 (32.4%) in the atrialized right ventricle, and 2 (5.4%) in the functional right ventricle. In patients with fibrosis, the tricuspid regurgitation fraction was bigger (48.3 ± 19.7 vs. 36.1 ± 22.6%, p = 0.048) and SVA was more frequent [12 (66.7%) vs. 6 (31.6%), p = 0.046] when compared to patients without fibrosis. However, exercise capacity did not differ between patients with and without LGE (peak VO2 24.0 ± 4.7 vs. 23.7 ± 4.4, p = 0.87). In adults with Ebstein's anomaly fibrosis estimated by LGE-CMR was localized in the right atrium and the right ventricle only. Volume overload resulting from tricuspid regurgitation might be a factor conducive to fibrosis. Myocardial fibrosis did not influence exercise capacity. Association between myocardial fibrosis and supraventricular arrhythmia was confirmed.
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Affiliation(s)
- Aleksandra Ciepłucha
- Department of Cardiology, University of Medical Sciences, ½ Dluga Street, 61-848, Poznan, Poland.
| | - Olga Trojnarska
- Department of Cardiology, University of Medical Sciences, ½ Dluga Street, 61-848, Poznan, Poland
| | - Anna Kociemba
- Cardiac Magnetic Resonance Unit, University of Medical Sciences, Poznan, Poland
| | - Magdalena Łanocha
- Department of Cardiology, University of Medical Sciences, ½ Dluga Street, 61-848, Poznan, Poland
- Cardiac Magnetic Resonance Unit, University of Medical Sciences, Poznan, Poland
| | - Mikolaj Barczynski
- Department of Cardiology, University of Medical Sciences, ½ Dluga Street, 61-848, Poznan, Poland
| | - Szymon Rozmiarek
- Cardiac Magnetic Resonance Unit, University of Medical Sciences, Poznan, Poland
| | - Lucyna Kramer
- Department of Computer Sciences and Biostatistics, University of Medical Sciences, Poznan, Poland
| | - Malgorzata Pyda
- Department of Cardiology, University of Medical Sciences, ½ Dluga Street, 61-848, Poznan, Poland
- Cardiac Magnetic Resonance Unit, University of Medical Sciences, Poznan, Poland
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Burghard P, Plank F, Beyer C, Müller S, Dörler J, Zaruba MM, Pölzl L, Pölzl G, Klauser A, Rauch S, Barbieri F, Langer CE, Schgoer W, Williamson EE, Feuchtner G. Evaluation of right ventricular function by coronary computed tomography angiography using a novel automated 3D right ventricle volume segmentation approach: a validation study. Eur Radiol 2018; 28:5129-5136. [PMID: 29869175 DOI: 10.1007/s00330-018-5523-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate right ventricle (RV) function by coronary computed tomography angiography (CTA) using a novel automated three-dimensional (3D) RV volume segmentation tool in comparison with clinical reference modalities. METHODS Twenty-six patients with severe end-stage heart failure [left ventricle (LV) ejection fraction (EF) <35%] referred to CTA were enrolled. A specific individually tailored biphasic contrast agent injection protocol was designed (80%/20% high/low flow) was designed. Measurement of RV function [EF, end-diastolic volume (EDV), end-systolic volume (ESV)] by CTA was compared with tricuspid annular plane systolic excursion (TAPSE) by transthoracic echocardiography (TTE) and right heart invasive catheterisation (IC). RESULTS Automated 3D RV volume segmentation was successful in 26 (100%) patients. Read-out time was 3 min 33 s (range, 1 min 50s-4 min 33s). RV EF by CTA was stronger correlated with right atrial pressure (RAP) by IC (r = -0.595; p = 0.006) but weaker with TAPSE (r = 0.366, p = 0.94). When comparing TAPSE with RAP by IC (r = -0.317, p = 0.231), a weak-to-moderate non-significant inverse correlation was found. Interobserver correlation was high with r = 0.96 (p < 0.001), r = 0.86 (p < 0.001) and r = 0.72 (p = 0.001) for RV EDV, ESV and EF, respectively. CT attenuation of the right atrium (RA) and right ventricle (RV) was 196.9 ± 75.3 and 217.5 ± 76.1 HU, respectively. CONCLUSIONS Measurement of RV function by CTA using a novel 3D volumetric segmentation tool is fast and reliable by applying a dedicated biphasic injection protocol. The RV EF from CTA is a closer surrogate of RAP than TAPSE by TTE. KEY POINTS • Evaluation of RV function by cardiac CTA by using a novel 3D volume segmentation tool is fast and reliable. • A biphasic contrast agent injection protocol ensures homogenous RV contrast attenuation. • Cardiac CT is a valuable alternative modality to CMR for the evaluation of RV function.
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Affiliation(s)
- Philipp Burghard
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria. .,, Breitenwangerstrasse 19, 6600, Reutte, Austria.
| | - Fabian Plank
- Department of Internal Medicine III, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christoph Beyer
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Silvana Müller
- Department of Internal Medicine III, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Jakob Dörler
- Department of Internal Medicine III, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Marc-Michael Zaruba
- Department of Internal Medicine III, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Leo Pölzl
- Department of Internal Medicine III, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gerhard Pölzl
- Department of Internal Medicine III, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Andrea Klauser
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Stefan Rauch
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Fabian Barbieri
- Department of Internal Medicine III, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Wilfried Schgoer
- Department of Internal Medicine III, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Eric E Williamson
- Department of Radiology, Mayo Clinic Rochester, Minnesota, 200 1st St SW, Rochester, MN, 55902, USA
| | - Gudrun Feuchtner
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
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Vahanian A, Brochet E, Juliard JM. "Guidelines Recommendations on the Treatment of Tricuspid Regurgitation. Where Are We and Where Do We Go With Transcatheter Valve Intervention". Front Cardiovasc Med 2018; 5:37. [PMID: 29707544 PMCID: PMC5906544 DOI: 10.3389/fcvm.2018.00037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
Tricuspid regurgitation (TR) is an important clinical problem because it is frequent and carries a poor prognosis when it is left uncorrected. However, there is still a lack of awareness of tricuspid disease in the medical community. The indications for evaluation and surgical interventions in patients with TR were recently updated in the ESC/EACTS guidelines. Transcatheter tricuspid valve intervention (TTVI), almost exclusively valve repair, is at an early stage of development as only a few hundreds of patients have been treated. The first-in-man valve implantation was very recently performed. The recent ESC/EACTS Guidelines state that “The potential role of transcatheter tricuspid valve treatment in high-risk patients needs to be determined”. We shall review here which lessons of interest for TTVI can be learned from the Guidelines as regards evaluation and indications for surgery and try to imagine what could be the place of TTVI in the Guidelines in the future.
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Affiliation(s)
- Alec Vahanian
- Department of Cardiology, Bichat hospital, University Paris VII, Paris, France
| | - Eric Brochet
- Department of Cardiology, Bichat hospital, University Paris VII, Paris, France
| | - Jean-Michel Juliard
- Department of Cardiology, Bichat hospital, University Paris VII, Paris, France
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Del Forno B, Lapenna E, Dalrymple-Hay M, Taramasso M, Castiglioni A, Alfieri O, De Bonis M. Recent advances in managing tricuspid regurgitation. F1000Res 2018; 7:355. [PMID: 29636903 PMCID: PMC5865201 DOI: 10.12688/f1000research.13328.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 11/20/2022] Open
Abstract
Isolated tricuspid valve surgery is usually carried out with very high morbidity and mortality given the complexity of the affected patients. In light of this, trans-catheter tricuspid valve interventions have been emerging as an attractive alternative to surgery over the last few years. Although feasibility has been shown with a number of devices, clinical experience remains preliminary and associated with significant clinical and technical challenges. Here we describe currently available trans-catheter treatment options for severe tricuspid regurgitation implanted in different locations.
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Affiliation(s)
| | | | - Malcom Dalrymple-Hay
- Plymouth Hospitals NHS Trust, Department of Cardiac Surgery, Derriford Hospital, Plymouth, UK
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29
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Muslem R, Ouhlous M, Akin S, Fares AA, Soliman OI. Tricuspid Valve Disease: A Computed Tomographic Assessment. PRACTICAL MANUAL OF TRICUSPID VALVE DISEASES 2018:179-203. [DOI: 10.1007/978-3-319-58229-0_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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30
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Buzzatti N, De Bonis M, Moat N. Anatomy of the Tricuspid Valve, Pathophysiology of Functional Tricuspid Regurgitation, and Implications for Percutaneous Therapies. Interv Cardiol Clin 2017; 7:1-11. [PMID: 29157516 DOI: 10.1016/j.iccl.2017.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The tricuspid valve is a complex dynamic apparatus made up of many different closely linked structures: the annulus, the three leaflets, the chordae, the papillary muscles and the right ventricle. Other nearby structures, such as the coronary sinus ostium, the conduction system, the membranous septum, and the right coronary artery must be taken into account when dealing with the tricuspid. Annulus dilation and leaflet tethering due to right ventricular remodeling are the 2 major mechanisms responsible for most tricuspid regurgitation cases. Precise knowledge of tricuspid anatomy and function, as well as careful preoperative planning, is fundamental for successful transcatheter tricuspid procedures.
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Affiliation(s)
- Nicola Buzzatti
- Cardiac Surgery Department, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20129, Italy.
| | - Michele De Bonis
- Cardiac Surgery Department, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20129, Italy
| | - Neil Moat
- Cardiac Surgery Department, Royal Brompton & Harefield Trust, Sydney Street, London SW3 6NP, UK
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31
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Hinzpeter R, Eberhard M, Burghard P, Tanner F, Taramasso M, Manka R, Feuchtner G, Maisano F, Alkadhi H. Computed tomography in patients with tricuspid regurgitation prior to transcatheter valve repair: dynamic analysis of the annulus with an individually tailored contrast media protocol. EUROINTERVENTION 2017; 12:e1828-e1836. [DOI: 10.4244/eij-d-16-00891] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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32
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Rodés-Cabau J, Taramasso M, O'Gara PT. Diagnosis and treatment of tricuspid valve disease: current and future perspectives. Lancet 2016; 388:2431-2442. [PMID: 27048553 DOI: 10.1016/s0140-6736(16)00740-6] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and is most often secondary in nature and caused by annular dilatation and leaflet tethering from adverse right ventricular remodelling in response to any of several disease processes. Non-invasive assessment of tricuspid regurgitation must define its cause and severity; advanced three-dimensional echocardiography, MRI, and CT are gaining in clinical application. The indications for tricuspid valve surgery to treat tricuspid regurgitation are related to the cause of the disorder, the context in which it is encountered, its severity, and its effects on right ventricular function. Most operations for tricuspid regurgitation are done at the time of left-sided heart valve surgery. The threshold for restrictive ring annuloplasty repair of secondary tricuspid regurgitation at the time of left-sided valve surgery has decreased over time with recognition of the risk of progressive tricuspid regurgitation and right heart failure in patients with moderate or lesser degrees of tricuspid regurgitation and tricuspid annular dilatation, as well as with appreciation of the high risks of reoperative surgery for severe tricuspid regurgitation late after left-sided valve surgery. However, many patients with unoperated severe tricuspid regurgitation are also deemed at very high or prohibitive surgical risk. Novel transcatheter therapies have begun to emerge for the treatment of tricuspid regurgitation in such patients. Experience with such therapies is preliminary and further studies are needed to determine their role in the management of this disorder.
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Affiliation(s)
- Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Patrick T O'Gara
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Shah S, Jenkins T, Markowitz A, Gilkeson R, Rajiah P. Multimodal imaging of the tricuspid valve: normal appearance and pathological entities. Insights Imaging 2016; 7:649-67. [PMID: 27278389 PMCID: PMC5028338 DOI: 10.1007/s13244-016-0504-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 01/30/2023] Open
Abstract
The tricuspid valve, which is the atrioventricular valve attached to the morphological right ventricle, is affected by a wide range of pathological processes. Tricuspid valve diseases are now increasingly recognized as a significant cause of morbidity and mortality. Echocardiography is the most widely available and, hence, the first-line imaging modality used in the evaluation of tricuspid valve disorders; however, CT and MRI are also increasingly used for further evaluation and characterization of these entities. In this article, we first review the normal anatomy and embryology of the tricuspid valve, followed by a discussion of the role of multiple imaging modalities in the evaluation of tricuspid valve abnormalities. We then review and illustrate the imaging appearance of several congenital and acquired tricuspid valve abnormalities. Main Messages • Tricuspid valve diseases have a significant impact on morbidity and mortality. • CT and MRI are increasingly used in the evaluation of tricuspid disorders. • CT and MRI help in diagnosis, functional evaluation, pre-surgical planning and post-surgical follow-up. • The most common cause of tricuspid regurgitation is functional.
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Affiliation(s)
- Soham Shah
- Cardiothoracic Imaging, Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Trevor Jenkins
- The Heart Valve Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Alan Markowitz
- The Heart Valve Center, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Robert Gilkeson
- Cardiothoracic Imaging, Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Prabhakar Rajiah
- Cardiothoracic Imaging, Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA. .,Cardiothoracic Imaging, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
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34
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Rodés-Cabau J, Hahn RT, Latib A, Laule M, Lauten A, Maisano F, Schofer J, Campelo-Parada F, Puri R, Vahanian A. Transcatheter Therapies for Treating Tricuspid Regurgitation. J Am Coll Cardiol 2016; 67:1829-1845. [DOI: 10.1016/j.jacc.2016.01.063] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/28/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
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