Prevalence and clinical significance of fetal tricuspid regurgitation during the third trimester of pregnancy / Prevalência e significado clínico da regurgitação tricúspide em fetos no terceiro trimestre da gestação

Abstract Objectives: the aim of this study was to determine the prevalence of fetal tricuspid valve regurgitation (TR) during the third trimester of low-risk pregnancies and to assess its clinical significance on neonates. Methods: this is a cross-sectional study including 330 singleton fetuses referred for routine fetal echocardiography during 3rd trimester in a fetal medicine center in Recife, Brazil. The presence and degree of tricuspid regurgitation were analyzed. Whenever TR was identified on fetal echocardiography, postnatal data, including the results of postnatal echocardiography were reviewed. Results: the prevalence of tricuspid regurgitation was 10.0% (n=33) in the study population. Regarding regurgitation degree, 90.9% (n=30) presented mild regurgitation and none presented important TR. Postnatal data was obtained from 21 neonates. Twenty of them were discharged without any complications, and one presented respiratory distress due to prematurity. Transthoracic echocardiography was performed in 66.7% (n=14) of the neonates and it was normal in 92.9% (n=13) of them. One neonate, 7.1%, persisted with tricuspid regurgitation, but had no other findings. Conclusions: tricuspid regurgitation in fetuses with normal cardiac anatomy during the 3rd trimester is a common condition in low-risk pregnancies, and is not associated with cardiac abnormalities or need for neonatal intervention.

Resumo Objetivos: determinar a prevalência da regurgitação tricúspide (RT) em fetos no terceiro trimestre de gestações de baixo risco e investigar sua repercussão clínica nos recémnascidos. Métodos: trata-se de um estudo transversal incluindo 330 fetos encaminhados para realização de ecocardiograma fetal de rotina no terceiro trimestre da gestação num centro de medicina fetal em Recife, Brasil. A presença e o grau de insuficiência tricúspide foram estudados. Quando RT estava presente ao ecocardiograma fetal dados pós-natais, incluindo ecocardiograma, também foram analisados. Resultados: a prevalência de RT foi de 10,0% na população estudada, sendo que 90,9% (n=30) dos casos foram classificados como RT leve, e nenhum caso de RT importante foi identificado. Foram obtidos dados pós-natais de 21 recém-nascidos. Destes, 20 receberam alta hospitalar sem nenhuma complicação, enquanto 1 apresentou desconforto respiratório associado à prematuridade. Ecocardiograma transtorácico foi realizado em 66.7% (n=14) dos recém-nascidos avaliados, e foi normal em 92.9% (n=13) deles. Apenas 1 recém-nascido, 7.1%, persistiu com RT mas sem outros achados significativos. Conclusões: a RT em fetos com anatomia cardíaca normal é comum no terceiro trimestre de gestações de baixo risco e não parece associar-se a anomalias cardíacas ou necessidade de intervenção no período neonatal.

Prevalence and predictors of pulmonary artery hypertension in systemic sclerosis.

INTRODUCTION: Development of pulmonary artery hypertension (PAH) worsens the prognosis of systemic sclerosis (SSc). There is paucity of data on PAH in patients with SSc in India. We have attempted to determine the prevalence and predictors of pulmonary artery hypertension in systemic sclerosis using noninvasive cardiopulmonary evaluation. OBJECTIVES: (1) To study the prevalence of PAH in SSc (2) To study the predictors of PAH in SSc (gender, age of onset of disease, duration of disease, extent of skin involvement, digital infarcts/ulcer, interstitial lung disease. MATERIAL AND METHODS: Clinical and functional characteristics of 100 patients of systemic sclerosis who had undergone screening echocardiography to detect pulmonary artery hypertension were studied. RESULTS: PAH was found in 32% patients on 2D-echocardiography. Prevalence of PAH did not differ between patients with limited cutaneous SSc (lcSSc) and patients with diffuse cutaneous SSc (dcSSc). On multiple logistic regression analysis, none of the studied variables was found to be independent predictor of PAH in SSc. CONCLUSION: PAH in SSc occurs in significant proportion of patients without any "red flag signs" in early stages. Non-invasive screening of patients with SSc for PAH will help in early diagnosis and appropriate timely therapeutic intervention before significant end-organ damage occurs.

Late tricuspid regurgitation following mitral valve surgery: prevalence and possible risk factors

Tricuspid regurgitation [TR] may progress or newly develop late after mitral valve surgery without significant mitral stenosis, regurgitation or other causes of left heart failure. The aim of this work was to study the prevalence and the possible risk factors for significant TR late after mitral valve replacement, as assessed both clinically and echocardiographically. A total of 145 patients [87 women, 58 men; mean age 27.9 +/- 8.53 years] who underwent mitral valve replacement were studied. Analysis was based on preoperative and last postoperative Doppler echocardiographic evaluation. Significant TR was defined echocardiographically by grade 3+ or 4+ TR, Preoperative and intraoperative variables were used to evaluate predictors of TR development by multivariate logistic regression model. Echocardiography revealed significant late TR [3 +/- or more] in 19 patients [13.1%] during the follow-up period. In univariate analysis, female gender, atrial fibrillation, huge left atrium, preoperative severe pulmonary hypertension and preoperative 2+ TR were significant risk factors for TR development multivariate logistic regression model identified female gender, atrial fibrillation, preoperative severe pulmonary hypertension and, preoperative 2+ TR as statistically significant predictors for late TR after mitral valve surgery. Significant TR late after mitral valve surgery occurs in 13.1% of patients Therefore, a lower threshold for tricuspid valve repair should be considered at the time of initial surgery particularly in female patients with severe pulmonary hypertension or atrial fibrillation, evently preoperative TR is 2+. Echo Doppler study can be considered the elective approach for preoperative evaluation of tricuspid involvement in patients with mitral valve disease