Current applications of transcatheter edge-to-edge tricuspid valve repair / 中国介入心脏病学杂志

Tricuspid regurgitation(TR)is a common heart valve disease.According to the pathogenesis,TR can be divided into primary(organic)and secondary(functional)regurgitation,of which functional TR accounts for more than 90%.Patients with severe TR have poor prognosis and poor drug treatment,and surgery(valvuloplasty)is the main treatment.At present,transcatheter edge-to-edge tricuspid valve repair(T-TEER)has become an essential program of transcatheter treatment for TR,providing minimally invasive treatment for TR patients who cannot undergo surgery or are at high risk of surgery.T-TEER reduces the degree of regurgitation by clamping leaflets,and is currently in the early stage of research and development exploration and clinical validation,mainly for functional TR.T-TEER devices have also made significant progress(TriClip,PASCAL),and Chinese-made novel-designed T-TEER devices are also undergoing clinical trials(DragonFly-TTM,SQ-Kyrin-TTM,NeoBlazarTM).This paper reviews the current applications and research progress of T-TEER.

Observation of the prophylactic use of prokinetic agents in patients after tricuspid valve replacement under cardiopulmonary bypass / 药学实践与服务

Objective To analyze the postoperative therapeutic effect of prokinetic agents in patients after tricuspid valve replacement （TVR） under cardiopulmonary bypass. Methods Patients received TVR under cardiopulmonary bypass （during June 2010 to December 2021） in the department of Cardiovascular Surgery of the First Affiliated Hospital of Naval Medical University were selected as the subjects of our study. The data of basic characteristics, first postoperative defecation time and postoperative recovery condition were collected and retrospectively analyzed in the patients taking prokinetic agents within three days after surgery （prevention group） and patients not taking prokinetic agents within three days after surgery （control group）. Results A total of 184 patients were selected, including 101 in the prevention group and 83 in the control group. The first defecation time of patients in the prevention group was significantly earlier than that in the control group （P<0.05）. The incidences of abdominal distension and pulmonary infection in the prevention group were significantly lower than that in the control group. The length of time in ICU, postoperative mechanical ventilation and nasogastric tube decompression in the prevention group were significantly shorter than that in the control group （P<0.05）. Conclusion Taking prokinetic agents within three days after TVR under cardiopulmonary bypass could effectively improve the prognosis of patients.

Research advances in animal models of tricuspid regurgitation / 复旦学报（医学版）

Tricuspid regurgitation(TR)cases are widely distributed in China.Poor clinical drug efficacy,high surgical risk,and poor prognosis for right heart failure are found in patients with moderate or severe TR.In recent years,with the innovation of valve instruments and the development of technology,transcatheter tricuspid valve treatment could be a new choice for high-risk TR patients in surgery.Many TR animal models have emerged these years for the research of the mechanism of TR and for the clinical verification of instruments.Therefore,this review focuses on how to develop an animal model of TR and discusses the advantages and disadvantages of these techniques.

Reconstruction and analysis of K-Clip surgery process based on finite element method / 中国胸心血管外科临床杂志

@#Objective     To investigate the effects of different types of tricuspid regurgitation, implantation positions, and device models on the treatment outcomes of K-Clip for tricuspid regurgitation using numerical simulations. Methods     Three-dimensional reconstruction of the heart model was performed based on CT images. Two different regurgitation orifices were obtained by modifying the standard parameterized tricuspid valve leaflets and chordae tendineae. The effects of different K-Clip models at different implantation positions (posterior leaflet midpoint, anterior-posterior commissure, anterior leaflet midpoint, posterior septal commissure) were simulated using commercial explicit dynamics software Ls-Dyna. Conclusion     For the two types of regurgitation in this study, clipping at the posterior leaflet midpoint resulted in a better reduction of the regurgitation orifice (up to 75% reduction in area). Higher clamping forces were required for implantation at the anterior leaflet midpoint and posterior septal commissure, which was unfavorable for the smooth closure of the clipping components. There was no statistical difference in the treatment outcomes between the 18T and 16T K-Clip components, and the 16T component required less clamping force. Therefore, the use of the 16T K-Clip component is recommended.

Tricuspid Valve Geometry of Idiopathic Pulmonary Hypertension:a Three-dimensional Transthoracic Echocardiography Study / 中国循环杂志

Objectives:To evaluate the tricuspid valve(TV)geometric remodeling in patients with idiopathic pulmonary arterial hypertension(IPAH)by three-dimensional transthoracic echocardiography. Methods:Two-dimensional and three-dimensional transthoracic echocardiography were performed in 30 IPAH patients and 15 healthy controls,and the geometry parameters of TV were obtained by four-dimensional auto tricuspid valve quantitative(4D Auto-TVQ)in the right ventricular-focused apical view.Pulmonary arterial hypertension was determined by right heart catheterization within 48 hours of echocardiography. Results:The 4-chamber diameter,tricuspid annular(TA)perimeter,TA area,maximal tenting height,coaptation point height and tenting volume were larger in IPAH patients than those in healthy controls(all P＜0.05),2-chamber diameter was similar between two groups.In IPAH group,maximal tenting height and coaptation point height were moderately correlated with right ventricular end-diastolic volume(r=0.710,r=0.515,both P＜0.05),while TA perimeter,4-chamber diameter and TA area were moderately correlated with right atrial end-systolic volume(r=0.712,r=0.558,r=0.545,all P＜0.05). Conclusions:IPAH patients have larger maximal tenting height,coaptation point height and tenting volume,TA enlargement is mainly visible in 4-chamber diameter.TV tenting height is associated with right ventricular volume,but TA size is associated with right atrial volume in IPAH patients.

Analysis of the efficacy of adjustable pericardial soft annulus plasty in the treatment of functional tricuspid regurgitation secondary to rheumatic heart disease / 中华胸心血管外科杂志

Objective:To compare the surgical efficacy of pericardial soft ring tricuspid valvuloplasty with DeVega and artificial valvuloplasty.Methods:227 patients undergoing tricuspid valvuloplasty due to rheumatic heart disease complicated with functional tricuspid valve insufficiency were retrospectively analyzed and divided into 3 groups according to tricuspid valvuloplasty dynamic cohort(pericardial ring group, 89 cases; the artificial flap ring group, 61 cases, and the DeVega group, 77 cases) were matched 1∶1 for propensity score(match A: pericardial ring group and artificial flap ring group; match B: pericardial ring group and DeVega group), the successful matching was included in follow-up and data collection, and cases with incomplete case data during follow-up were removed from the study cohort in pairs according to matching conditions. The results of follow-up 1 month, 6 months and 24 months after surgery were compared.Results:1 month after operation: the tricuspid valve regurgitant in all groups was significantly reduced or even disappeared compared with that before operation, and the right atrium and right ventricle were also smaller than that before operation, with statistical significance( P<0.05). 6 months after surgery: There was no statistical significance in the area of tricuspid regurgitation and right atrial/indoor diameter between all groups compared with the results one month after surgery( P>0.05), and there was no statistical significance in the recurrence rate of tricuspid regurgitation between all groups( P>0.05). 24 months after surgery: There were no significant differences in the recurrence rate of tricuspid regurgitation, area of tricuspid regurgitation and right atrial/indoor diameter between the two groups in matching A( P>0.05). There was no statistical significance in the right atrial/indoor diameter between the matched pericardial ring group and the Devega group, but the tricuspid valve regurgentation area of the Devega group at 24 months after surgery was higher than that of the Devega group at 1 month after surgery, and the difference was statistically significant( P<0.05). The regurgitation area and recurrence rate of tricuspid valve were significantly higher than those of pericardium-TVP group( P<0.05). Conclusion:Pericardial soft ring tricuspid valvuloplasty can effectively correct functional tricuspid valvuloplasty and reverse right heart remodeling, which is an effective tricuspid valvuloplasty.

Additional tricuspid valve annuloplasty versus isolated closure for atrial septal defect with secondary moderate to severe tricuspid regurgitation: A propensity score matching study / 中国胸心血管外科临床杂志

@#Objective To compare the efficacy of additional tricuspid valve annuloplasty (TVP) and isolated closure for atrial septal defect (ASD) with moderate to severe tricuspid regurgitation (TR). Methods Clinical data of the patients diagnosed with ASD combined with secondary moderate to severe TR and treated in our hospital from January 2009 to June 2020 were retrospectively analyzed. Patients were divided into a TVP group and a non-TVP group based on whether TVP was performed simultaneously. The baseline data of two groups were matched with a ratio of 1∶1 propensity score. Results A total of 32 pairs from 257 patients were successfully matched. In the TVP group, there were 24 females and 8 males with an average age of 44.0±13.1 years. In the non-TVP group, there were 28 females and 4 males with an average age of 44.5±11.6 years. The TR area and estimated pulmonary artery pressure in the two groups were significantly decreased compared with preoperation (all P<0.001). The TR area (P=0.001) and the estimated pulmonary artery pressure (P=0.002) were decreased more significantly in the TVP group than those in the non-TVP group. Linear regression analysis showed that age and preoperative TR area had a positive correlation with TR area at follow-up (β=0.045 and 0.259, respectively, both P<0.05), while additional TVP had a negative correlation (β=–1.542, P=0.001). Conclusion Additional TVP can significantly reduce the TR area and pulmonary artery pressure, and elderly patients with severe TR before surgery should actively receive TVP.

A Successful Case of Redo-Tricuspid Valve Replacement for Prosthetic Valve Endocarditis Thirty-Two Years after Single Tricuspid Bioprosthetic Valve Replacement / 日本心臓血管外科学会雑誌

We present a successful case of redo-tricuspid valve replacement for tricuspid prosthetic valve endocarditis. A 78-year-old man who underwent tricuspid bioprosthetic valve replacement for severe tricuspid regurgitation thirty-two years earlier was referred to our institution with persistent high fever and back pain. The blood culture was positive for Streptococcus oralis, and echocardiography revealed a mobile vegetation attached to the tricuspid prosthetic valve with moderate tricuspid regurgitation. A clinical diagnosis of prosthetic valve endocarditis was established. Redo-tricuspid bioprosthetic valve replacement was performed following antibiotics therapy. The patient was discharged on postoperative day 49 after 6 weeks of additional antibiotic treatment, and had no recurrence of infection for 6 months after redo-surgery.

A Case of Infective Endocarditis Treated with Ventricular Septal Defect Closure with the Sandwich Method, Aortic Valve Replacement, and Tricuspid Valve Replacement / 日本心臓血管外科学会雑誌

A 74-year-old man was diagnosed with infective endocarditis (IE) involving the aortic and tricuspid valves, ventricular septal defect (VSD), and complete atrioventricular block. He was admitted to a previous hospital with complaints of fever and neck pain, and he developed complete atrioventricular block during the course of his illness. An echocardiogram revealed severe aortic regurgitation, aortic valve vegetations, and a ventricular septal defect. He was then transferred to our hospital, and he underwent emergent surgery. The aortic valve cusps were calcified and thick, with significant cusp destruction. The vegetations partly extended to the subvalvular area of the right and non-coronary cusp. The vegetations also extended from the atrial septum to the tricuspid valve septal leaflet and perimembranous VSD. Ventricular septal reconstruction using the sandwich technique with two bovine pericardial patches, aortic valve replacement, and tricuspid valve replacement were performed. Postoperatively, he received antibiotic therapy for six weeks and was discharged from our hospital after the implantation of a cardiac resynchronization therapy pacemaker. Echocardiography showed no residual shunts. Our case suggests that the sandwich technique can be a useful method of septal reconstruction for IE with extensive destruction of the ventricular septum.

A Case of Takotsubo Cardiomyopathy after Elective Mitral Valve Repair / 日本心臓血管外科学会雑誌

We describe Takotsubo syndrome, which developed after elective mitral valve repair and tricuspid annuloplasty in a 76-year-old woman. A preoperative echocardiogram confirmed severe mitral regurgitation due to posterior leaflet prolapse, moderate tricuspid regurgitation, and normal left ventricular function. Mitral valve repair and tricuspid annuloplasty were performed. After uneventful weaning off cardiopulmonary bypass, intraoperative transesophageal echocardiography revealed adequate mitral leaflet function and normal left ventricular contractions. After being transferred to the intensive care unit, the patient's hemodynamic parameters progressively deteriorated. Transthoracic echocardiography showed akinesis and ballooning of the apex and hyperkinesis of the base, and the ejection fraction was 20% on postoperative day 1. The serum aminotransferase and CPK-MB levels increased on postoperative day 2. The left ventricular function did not improve despite supportive therapy with vasopressors. She developed cardiogenic cerebral infarction due to obstruction of the right middle cerebral artery on postoperative day 8. Endovascular thrombectomy was performed within 2 h of the onset of cerebral infarction. Thereafter, the patient gradually recovered and was discharged without any sequelae on postoperative day 31. The ejection fraction was 65% with normal left ventricular motion at discharge. An electrocardiogram revealed a deep negative T wave in II, III, aVF, and V3-V6. After 2 months, the electrocardiogram findings were normalized. Coronary lesions were not observed on pre- or postoperative coronary angiographies; therefore, we diagnosed Takotsubo cardiomyopathy after mitral valve repair. Takotsubo cardiomyopathy should be considered as a possible complication of cardiac surgery, especially after mitral valve surgery.

Cirugia de la insuficiencia tricuspidea

La valvulopatía tricuspídea es considerada frecuente y sobre todo en pacientes con afectación mitral, habiendo sido sostenidamente objeto de controversias, tanto en la selección de la correcta actuación terapéutica, como del momento apropiado de su ejecución. Aunque la válvula tricúspide es afectada por estenosis, predominantemente es asiento de lesión tipo insuficiencia, que significa paso retrógrado de sangre desde el ventrículo derecho (VD) a la aurícula derecha durante la sístole. Puede ser primaria (orgánica) o secundaria (funcional), relacionada a dilatación/disfunción ventricular derecha, dilatación anular, tracción de sus valvas e hipertensión arterial pulmonar. La ecocardiografía tridimensional (3D) y la resonancia magnética cardiaca al permitir cuantificar con mayor precisión el tamaño del VD y la función sistólica, han permitido actuaciones terapéuticas más tempranas y con mejores resultados, que incluyen la reparación valvular tricuspídea, sustitución valvular y diversas modalidades de técnicas transcatéter. Con estas consideraciones, presentamos a consideración de ustedes el estado actual de la cirugía en la insuficiencia tricuspídea.

Tricuspid valve disease is considered common and especially in patients with mitral involvement, having been the subject of sustained controversy, both in the selection of the correct therapeutic action and the appropriate moment of its execution. Although the tricuspid valve is affected by stenosis, it is predominantly the seat of an insufficiency-type lesion, which means retrograde passage of blood from the right ventricle (RV) to the right atrium during systole. It can be primary (organic) or secondary (functional), related to right ventricular dilation/dysfunction, annular dilation, traction of its leaflets and pulmonary arterial hypertension. Three- dimensional (3D) echocardiography and cardiac magnetic resonance, by allowing more precise quantification of RV size and systolic function, have allowed earlier therapeutic actions with better results, which include tricuspid valve repair, valve replacement and various modalities of transcatheter techniques. With these considerations, we present for your consideration the current state of surgery in tricuspid regurgitation.

Estenosis Tricuspídea Severa secundaria a enfermedad carcinoide cardiaca: presentación de caso clínico y revisión de la literatura / Severe Tricuspid Stenosis Secondary to Cardiac Carcinoid Disease: Case Report and Literature Review

RESUMEN: La estenosis tricuspídea (ET) es una valvulopatía infrecuente cuyas principales etiologías son la enfermedad reumática y la endocarditis infecciosa. En raras ocasiones puede deberse a un fenómeno carcinoide subyacente, en lo que se conoce como la enfermedad carcinoide cardiaca (ECC). Esta condición lleva a la fibrosis del endocardio del ventriculo derecho, principalmente de sus válvulas, lo cual puede provocar falla cardiaca derecha, complicando el pronóstico. En este artículo se presenta un caso de una ET severa por una posible ECC, en conjunto con las imagenes ecocardiográficas obtenidas durante el abordaje diagnóstico (imágenes bidimensionales, imagen multiplanar y ecocardiografía en 3D). Se discuten las implicaciones clínicas, los retos diagnósticos, las opciones terapeuticas y el pronóstico de esta rara entidad.

ABSTRACT Severe Tricuspid Stenosis Secondary to Cardiac Carcinoid Disease: Case Report and Literature Review Tricuspid stenosis is an unfrequent valvulopathy that can be caused by multiple etiologies, including rheumatic disease and infectious endocarditis. In rare occasions, it occurs in the context of a carcinoid syndrome, in what is known as carcinoid heart disease. This condition causes fibrosis of the valves and the endocardium of the right ventricule, which can progress into right ventricular failure, worsening the patient's prognosis. In this article, we present a case of a severe tricuspid stenosis in which this ethiology is suspected. We show the echocardiographic images obtained for the diagnosis (two-dimensional imaging, multimodal imaging and 3D echocardiography), and we discuss the clinical and diagnostic implications, therapeutic options and prognosis of this rare condition.

Valoración de la relación clínico-ultrasonográfica en la estenosis aórtica

Introducción: El incremento exponencial de la incidencia de la estenosis aórtica en relación con la edad, al igual que la presencia de factores de riesgo como el síndrome metabólico, predisponen a la calcificación aórtica como una manifestación de enfermedad cardiovascular generalizada. Objetivo: Identificar las incongruencias existentes entre las manifestaciones clínicas y el estudio ecocardiográfico en pacientes con estenosis valvular aórtica severa. Materiales y métodos: Se realizó un estudio descriptivo-analítico en una muestra conformada por 50 pacientes diagnosticados, clínica y ecográficamente, de estenosis aórtica severa. Resultados: Se halló predomino de féminas blancas de la tercera edad con historia de dolor anginoso y disnea, acompañados de soplo mesosistólico intenso en foco aórtico, y un segundo ruido débil, y cifras tensionales bajas con pocos criterios ultrasonográficos de hipertrofia del ventrículo izquierdo y velocidad pico, unido al gradiente y el área aórtica, sugestivos de estenosis severa en un elevado por ciento, con calcificación de válvulas y una fracción de eyección del ventrículo izquierdo elevada, junto a la presencia de otras valvulopatías. Conclusiones: El estudio demostró pobre correlación entre las manifestaciones clínicas y las ecocardiográficas.

Introduction: The exponential increase of aortic stenosis incidence in relation to age, as well as the presence of risk factors such as metabolic syndrome, predispose to aortic calcification as a manifestation of a generalized cardiovascular disease. Objective: To identify the incongruences existing between clinical manifestations and the echocardiographic study in patients with severe aortic valvular stenosis. Materials and methods: An analytical-descriptive study was carried out in a sample of 50 patients clinically and echo-graphically diagnosed of severe aortic stenosis. Results: A predominance of elder white women with a history of anginous pain and dyspnea was found, accompanied of intense meso-systolic murmur in aortic focus, and a second weak sound, and low blood tension figures with few ultrasonographic criteria of left ventricular hypertrophy and peak velocity, together with gradient and aortic area, which suggest a high-percent of severe stenosis, with valvular calcification and an elevated left ventricular elevation fraction, plus the presence of other valvular diseases. Conclusions: The study showed poor relationship between clinical and echocardiography manifestations.

Estenosis tricuspídea de bioprótesis tratada mediante implante valvular percutáneo: una solución segura para un paciente inusual

Se comunica el caso de una mujer de 31 años quien había sido previamente sometida a reemplazo valvular aórtico, mitral y tricuspídeo en tres episodios quirúrgicos. Fue ingresada a nuestra sección de cardiologÍa con síntomas compatibles con insuficiencia cardiaca derecha. Se efectuó evaluación mediante ecocardiograma, sondeo cardíaco derecho/izquierdo, angioTAC cardíaco y cardio resonancia. Se diagnosticó una estenosis tricuspídea severa secundaria a disfunción de prótesis biológica. Debido a alto riesgo operatorio y riesgo de falla ventricular derecha post-operatorio, la paciente fue rechazada para reemplazo valvular quirúrgico. Se decidió efectuar reemplazo tricuspídeo procedimiento "valve in valve". Se logró efectuar de manera exitosa por abordeje venoso femoral, prótesis balón expansible. Se demostró corrección de la estenosis tricuspídea y la paciente evolucionó con remisión de los síntomas de falla cardíaca.

We report a 31-year-old woman who was previously subjected to aortic, mitral, and tricuspid valve replacement in three different surgical episodes. She was admitted to our cardiology section with acute right heart failure symptoms. She was studied by echocardiography, right/left heart catheterization, cardiac CT scan and cardiac magnetic resonance. A severe tricuspid stenosis due to biological prosthesis dysfunction was diagnosed. Due to high operative risk and risk of postoperative right ventricular failure, the patient was rejected for cardiovascular surgery. We decided on a percutaneous tricuspid "valve in valve replacement". The procedure was done successfully by venous femoral approach, with a balloon expandable prosthesis. Tricuspid stenosis was corrected and the patient evolved with remission of heart failure symptoms.

Como eu faço a avaliação pós-intervenções tricúspides: dicas e truques / My approach to assessment after tricuspid interventions: tips and tricks

A regurgitação tricúspide (RT) importante está associada à alta morbidade e mortalidade. Como o tratamento cirúrgico da RT isolada tem sido associado à alta mortalidade, as intervenções transcateter na valva tricúspide (VT) têm sido utilizadas para o seu tratamento, com risco relativamente mais baixo. Há um atraso na intervenção da RT e provavelmente está relacionado a uma compreensão limitada da anatomia da VT e do ventrículo direito, além da subestimação da gravidade da RT. Nesse cenário, faz-se necessário o conhecimento anatômico abrangente da VT, a fisiopatologia envolvida no mecanismo de regurgitação, assim como a sua graduação mais precisa. A VT tem peculiaridades anatômica, histológica e espacial que fazem a sua avalição ser mais complexa, quando comparado à valva mitral, sendo necessário o conhecimento e treinamento nas diversas técnicas ecocardiográficas que serão utilizadas frequentemente em combinação para uma avaliação precisa. Esta revisão descreverá a anatomia da VT, o papel do ecocardiograma no diagnóstico, graduação e fisiopatologia envolvida na RT, as principais opções atuais de tratamento transcateter da RT e a avaliação do resultado após intervenção transcateter por meio de múltiplas modalidades ecocardiográficas.(AU)

Severe tricuspid regurgitation (TR) is associated with high morbidity and mortality. Given that surgical treatment of TR alone has been associated with high mortality, transcatheter interventions in the tricuspid valve (TV) have been used for its treatment, with relatively lower risk. There is a delay in intervention for TR, and this is probably related to a limited understanding of the anatomy of the TV and the right ventricle, in addition to an underestimation of the severity of TR. In this scenario, it is necessary to have comprehensive anatomical knowledge of the TV, the pathophysiology involved in the mechanism of regurgitation, and more accurate grading. The TV has anatomical, histological, and spatial peculiarities that make its assessment more complex when compared to the mitral valve, requiring knowledge and training in the various echocardiographic techniques that will often be used in combination for accurate assessment. This review will describe the anatomy of the TV, the role of echocardiography in the diagnosis, grading, and pathophysiology involved in TR; the main transcatheter treatment options currently available for TR; and the assessment of outcomes after transcatheter intervention by means of multiple echocardiographic modalities.(AU)

Comparative Morphological and Morphometrical Analysis of Atrio-Ventricular Valves of Human and Porcine

There is increased incidence of valvular heart diseases in recent years due to life style modifications. The mortality rates in valvular diseases are kept in pace using various modalities of treatments. One such lifesaving treatment is valve replacement surgeries. These are done by using mechanical valve prosthesis or tissue grafts. The tissue valves prosthesis, harvested from porcine heart are called as xenograft and are increasingly used in valve repair and replacement surgeries. In the present scenario, there is a smaller number of systematically analysed literatures available on the comparative anatomy of human and porcine heart valves. Hence this study was carried out to acquire knowledge and to put forth some points to future research works on heart valves. In this study, 20 formalin fixed porcine and human hearts were procured from slaughter house and cadavers respectively. The morphology and morphometry of tricuspid valve and mitral valve was observed and analysed using spss software 20 version. All the dependent variables were compared using student t test and independent sample test. The results were tabulated and compared. It was observed that the tricuspid and the mitral valve of the porcine resembles the corresponding human heart valves in morphology and morphometry and their values were coinciding to their maximum. The porcine valve resembles human heart valves in morphology and it can be used in designing valve substitutes in replacement surgeries. Porcine valve can also be used as bio-prosthesis by matching the morphometry and by reducing the geometrical difference to their minimum by using any interventional radiology.

Tricuspid Valve-in-Valve Procedure with An Edwards S3 Valve in a 15-kg Child in Latin America

ABSTRACT A 5-year-old child, weighing 15 kg, with three previous sternotomies, presented with right heart failure due to severe stenosis and regurgitation of the bioprosthetic tricuspid valve. A percutaneous tricuspid valve-in-valve procedure with an Edwards S3 valve was ofered for compassionate use, performed with no complications and with a significant clinical condition improvement.

Total Thoracoscopic Surgery for Late Mitral Paravalvular Leakage Repair in A Beating Heart

Abstract Paravalvular leakage (PVL) after mitral valve replacement is a troublesome complication that may lead to severe symptoms and reoperation. Previous case reports on total thoracoscopic cardiac surgery without aortic cross-clamping for repairing late PVL are rare. We describe a 64-year-old man who had undergone aortic and mitral valve replacement via median sternotomy eight years earlier, and who recently developed cardiac failure due to severe tricuspid regurgitation (TR) and PVL in the posterior mitral annulus. During total thoracoscopic surgery with using the beating heart technique, direct closure of the PVL was achieved via pledgeted mattress sutures, and tricuspid valvuloplasty was routinely performed to treat TR. This case indicated that total thoracoscopic surgery on a beating heart may be an excellent option for treating PVL concomitant with TR.

Concomitant repair of moderate or less tricuspid regurgitation during mitral valve surgery improves early and mid-term prognosis of tricuspid valve and right heart function / 中国胸心血管外科临床杂志

@#Objective    To investigate the effect of concomitant tricuspid valve repair during mitral valve surgery on the early and mid-term prognosis of the tricuspid valve and right heart function in the patients with moderate or less tricuspid regurgitation. Methods    A retrospective study of 461 patients with mitral valve disease requiring cardiac surgery combined with moderate or less tricuspid regurgitation in our hospital from 2011 to 2014 was done. They were 309 males and 152 females with a median age of 53.00 (44.00, 60.00) years. According to whether they received tricuspid valve repair (Kay’s annuloplasty, DeVega’s annuloplasty or annular ring implantation), the patients were divided into a mitral valve surgery only group (a nTAP group, n=289) and a concomitant tricuspid valve repair group (a TAP group, n=172). At the same time, 43 patients whose tricuspid valve annulus diameter was less than 40 mm in the TAP group were analyzed in subgroups. Results    The median follow-up duration was 3.00 years (range from 0.10 to 9.30 years). There was no perioperative death. Three months after surgery, the anteroposterior diameter of the right ventricle in the TAP group was significantly improved compared with that in the nTAP group [–1.00 (–3.00, 1.00) mm vs. 0.00 (–0.20, 2.00) mm, P=0.048]. Three years after surgery, the improvement of right ventricular anteroposterior diameter in the TAP group was still significant compared with the nTAP group [–1.00 (–2.75, 2.00) mm vs. 2.00 (–0.75, 4.00) mm, P=0.014], and the patients in the TAP group were less likely to develop moderate or more tricuspid regurgitation (3.64% vs. 35.64%, P<0.001). Annuloplasty ring implantation was more effective in preventing regurgitation progression (P=0.044). For patients with a tricuspid annulus diameter less than 40 mm, concomitant tricuspid valve repair was still effective in improving the anteroposterior diameter of the right ventricle in the early follow-up (P=0.036). Conclusion     Concomitant tricuspid valve repair for patients with moderate or less tricuspid regurgitation during mitral valve surgery can effectively improve the tricuspid valve and right heart function in the early and mid-term after surgery. Annuloplasty ring implantation is more effective in preventing regurgitation progression. Patients whose tricuspid annulus diameter is less than 40 mm can also benefit from concomitant tricuspid repair.