Anesthetic management for patient with severe cyanosis following bioprosthetic valve stenosis / Manejo anestésico de paciente com cianose grave após estenose de valva bioprotética

Abstract We presented a 39-year-old female patient with life-threatening hypoxemia after tricuspid valve replacement because of Ebstein's anomaly. And the severe cyanosis is due to bioprosthetic valve stenosis and atrial septal defect. Anesthetic management of a patient with severe obstructive prosthetic valve dysfunction can be challenging. Similar considerations should be given to patients with Ebstein's anomaly to maintain the pressure equalized between the right and left atrial. Transesophageal echocardiography and cerebral oxygen saturation provided real time information in perioperative care.

Resumo Apresentamos o caso de uma paciente de 39 anos, com hipoxemia em risco de vida após a substituição da valva tricúspide devido à anomalia de Ebstein e cianose grave devido à estenose de valva bioprotética e comunicação interatrial. O manejo anestésico de um paciente com disfunção obstrutiva grave de prótese valvar pode ser um desafio. Os pacientes com anomalia de Ebstein também precisam de atenção especial para manter a pressão equalizada entre o átrio direito e o esquerdo. A ecocardiografia transesofágica e a saturação cerebral de oxigênio forneceram informações em tempo real nos cuidados perioperatórios.

Implante de marcapasso endocárdico em paciente com válvulas tricúspide e mitral metálicas / Implantation of endocardial pacemaker in a patient with metal tricuspid and mitral valves

O implante de marcapasso endocárdico transvenoso é contraindicado em pacientes com válvulatricúspide mecânica. Relata-se o caso de uma mulher de 79 anos de idade, com válvulas mitral e tricúspidemetálicas para estimulação permanente devido à fibrilação atrial crônica de baixa resposta ventricular, que passoua apresentar sintomas de pré-síncope. Um cabo-eletrodo endocárdico foi colocado no ventrículo esquerdo porvia transvenosa através do seio coronariano na veia cardíaca posterolateral. O implante foi realizado através doseio coronário. Oferece um ritmo seguro e eficaz em pacientes com válvula tricúspide mecânica, eliminandoa necessidade de toracotomia para o implante epicárdico de cabo-eletrodo. Normalmente, a colocação é feitamediante toracotomia anterolateral ou esternotomia. Nesse caso, tanto a vida do eletrodo é reduzida quanto o seulimiar de comando geralmente aumenta com o tempo. O tecido em torno dos ventrículos é friável, especialmenteapós cirurgia cardíaca, e um eventual dano para os ventrículos durante a incisão pode ser fatal...

Transvenous endocardial pacemaker implantation is contraindicated in patients with a mechanicaltricuspid valve. An endocardial lead was placed in the left ventricle by transvenous approach through thecoronary sinus in the posterolateral cardiac vein in 79 year-old woman with metal mitral and tricuspid valve forpermanent pacing due to chronic atrial fibrillation with low ventricular response and nearsyncope symptoms.It was implanted through the coronary sinus providing a safe and effective rhythm in patients with mechanicaltricuspid valve, thereby eliminating the need for thoracotomy to implant an epicardial electrode. Transvenousendocardial pacemaker implantation is not indicated in patients with a mechanical tricuspid valve. Typically, theyare implanted by anterolateral thoracotomy or sternotomy. However, in this case, the lead mean life is reduced,and its threshold will usually increase over time. The tissue around the ventricles is friable, especially after cardiacsurgery, and an eventual ventricular damage during incision may be fatal...

Cardiac surgery during pregnancy: Continuous fetal monitoring using umbilical artery Doppler flow velocity indices.

The fetal death rate associated with cardiac surgery with cardiopulmonary bypass (CPB) is as high as 9.5‑29%. We report continuous monitoring of fetal heart rate and umbilical artery flow‑velocity waveforms by transvaginal ultrasonography and their analyses in relation to events of the CPB in two cases in second trimester of pregnancy undergoing mitral valve replacement. Our findings suggest that the transition of circulation from corporeal to extracorporeal is the most important event during surgery; the associated decrease in mean arterial pressure (MAP) at this stage potentially has deleterious effects on the fetus, which get aggravated with the use of vasopressors. We suggest careful management of CPB at this stage, which include partial controlled CPB at initiation and gradual transition to full CPB; this strategy maintains high MAP and avoids the use of vasopressors. Maternal and fetal monitoring can timely recognize the potential problems and provide window for the required treatment.

Balloon Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis

No abstract available.

Reflections on the 24 years durability of an isolate tricuspid bovine pericardium IMC/Braile bioprosthesis / Reflexões sobre a durabilidade de 24 anos de uma bioprótese IMC/Braile de pericárdio bovino em posição tricúspide isolada

We were challenged by the experience of one patient reoperation for a bioprosthetic bovine pericardium degenerative stenosis, 24 years after implantation. This bioprosthesis was implanted due to tricuspid valve bacterial staphylococcal endocarditis after septic abortion.

Vivenciamos a experiência de reoperar uma paciente por estenose degenerativa de uma prótese biológica de pericárdio bovino, após 24 anos de implante. Essa prótese degenerada havia sido implantada devido à destruição da valva tricúspide por endocardite bacteriana estafilocócica após aborto séptico.

Evaluation of echocardiography results in patients with acute cerebrovascular accidents [CVA]

Cerebrovascular accidents are one of the most common causes of disability and mortality in human population all over the world. Several factors such as age, sex, hypertension, hyperlipidemia and heart diseases are risk factors for stroke. Due to high prevalence of cerebrovascular accidents and its related risk factors and particularly heart diseases, we decided to study echocardiography findings in patients with cerebrovascular accidents. This descriptive study was conducted on 372 cerebrovascular patients who had been admitted to Zanjan Vali-e-Asr hospital in 2008. The data such as gender, age, type of cerebrovascular accidents, underlying disease and findings of echocardiography were collected and then they analyzed by appropriate software. Of 372 patients, 181 were men [48.6%] and 191 were women [51.4%]. Systolic function in 321 cases [86.3%] was normal and it was abnormal in 51 cases [13.7%]. Diastolic function in 304 cases [81.9%] was normal and in 68 cases [18.1%] was abnormal. Twenty -two cases had mitral stenosis and 198 patients had mitral regurgitation, whereas 23 cases showed both of them. Nine cases had aortic stenosis; similarly 80 cases were found with aortic regurgitation and only 5 cases had both of them. 165 cases were found with tricuspid regurgitation, while 1 case had both regurgitation and stenosis. Sixty- three cases had ejection fraction below 40%. In one case there was a clot. High frequency of abnormal echocardiography findings in stroke leading to cardiac disorders is one of the most important risk factor of stroke. Thus, with echocardiography which is a non-invasive technique, many of heart problems can be diagnosed and consequently occurrence of cerebrovascular accidents can be prevented or treated

Aseptic Endocarditis in Behcet's Disease Presenting as Tricuspid Valve Stenosis

Aseptic endocarditis is an uncommon complication of Behcet's disease (BD). We describe a rare case of a 39-year-old female who had BD with aseptic endocarditis of the tricuspid valve (TV) presenting as tricuspid stenosis. She was diagnosed with BD four years ago. The mucocutaneous lesions were well-controlled with colchicine and short courses of corticosteroids. She remained free of signs and symptoms of BD for one year without any medication. Three months before admission, she gradually developed dyspnea on exertion and peripheral edema. Echocardiography revealed dilated right atrium and markedly thickened TV with severe stenosis. TV replacement was performed. Pathologic examination of the valve showed fibrinoid necrotic material and inflammatory cell infiltration. Blood cultures and cultures of the excised valve were negative for microorganisms.

Severe tricuspid stenosis related to endocardial pacemaker lead / Estenose tricúspide severa induzida por eletrocatéter de marcapasso

Tricuspid stenosis (TS) is an uncommon complication of transvenous ventricular pacing. We present a case of TS developed 14 years after pacemacker implantation. The etiology of stenosis appeared to be inflammation and fibrosis of tricuspid valve (TV) secondary to leaflet perforation by the pacemacker lead and it was managed successfully with surgical valvuloplasty. Iatrogenic TS may occur more frequently than is clinically suspected and it should be considered in any patient with endocardial leads presenting with right heart failure.

Trans-esophageal echocardiography for tricuspid and pulmonary valves.

Transesophageal echocardiography has been shown to provide unique information about cardiac anatomy, function, hemodynamics and blood flow and is relatively easy to perform with a low risk of complications. Echocardiographic evaluation of the tricuspid and pulmonary valves can be achieved with two-dimensional and Doppler imaging. Transesophageal echocardiography of these valves is more challenging because of their complex structure and their relative distance from the esophagus. Two-dimensional echocardiography allows an accurate visualization of the cardiac chambers and valves and their motion during the cardiac cycle. Doppler echocardiography is the most commonly used diagnostic technique for detecting and evaluating valvular regurgitation. The lack of good quality evidence makes it difficult to recommend a validated quantitative approach but expert consensus recommends a clinically useful qualitative approach. This review ennumerates probe placement, recommended cross-sectional views, flow patterns, quantitative equations including the clinical approach to the noninvasive quantification of both stenotic and regurgitant lesions.

A Case of Intracardiac Metastasis of Hepatocellular Carcinoma Presenting with Functional Tricuspid Valve Stenosis Accompanied with Hepatopulmonary Syndrome

Intracardiac metastasis of hepatocellular carcinoma with functional tricuspid valve stenosis is not common. Furthermore, hepatopulmonary syndrome associated with hepatocellular carcinoma is rarely encountered. We present a case of intracardiac metastasis of hepatocellular carcinoma presenting with functional tricuspid valve stenosis accompanied with hepatopulmonary syndrome.

Estenosis tricuspídea por enfermedad de Hodgkin / Triwspid stenosis caused by Hodgkin disease

Se describe un paciente con una recurrencia cardíaca de enfermedad de Hodgkin que causó una estenosis tricuspídea grave y en el que, cinco años después de la quimioterapia, no hay evidencia de recidiva del tumor.

Diagnostic dilemma in an elderly woman with intractable ascites and elevated CA-125 level.

In patients with intractable ascites, careful consideration should be given to the patient's past history with emphasis on cardiac, liver and renal disorders. Ascitic fluid cytology indicating the presence of malignant cells should be unequivocal; cytology should be repeated before embarking on potentially toxic anti-cancer treatment in ambiguous cases. Elevated serum CA-125 levels should not be relied upon to make the diagnosis of ovarian/peritoneal carcinoma. We report a case of tricuspid stenosis with severe ascites in an elderly woman who was initially mis-diagnosed and treated as peritoneal/ovarian carcinoma.

Hidropsia fetal não imune associada à pré-eclâmpsia: relato de caso / Nonimmunefetal hydrops assocated with pre-eclampsia: case report

Objetivo: descrever um caso de hidropsia fetal não imune associada à pré-eclâmpsia precoce, tendo como causa primária a estenose da válvula cardíaca tricúspide fetal. Método: getsante de 29 anos, internada na Maternidade da Fundação Santa Casa de Misericórdia do Pará (FSCMPA), com 23 semanas de gestação, com o diagnóstico ultra-sonográfico de edema fetal generalizado, ascite fetal e edma de placenta e apresentando pré-eclâmpsia leve. A vitalidade fetal se encontrava preservada com 150 batimentos cardíacos fetais por minuto. O teste de Coombs indireto era negativo, excluindo a hidropsia fetal imune. a gestação evolui com imunência de eclâmpsia, sendo necessária a interrupção da gravidez por indução do parto com 24 semanas de gestação, devido o risco materno. o feto nasceu sem sinais vitais e a necropsia registrou sinais de insuficiência cardiáca congestiva e presença de estenose da válvula tricúspide, Conclusão: a hidropsia fetal não imune, apesar de rara, impõe um conhecimento aprofundado para possibilitar uma avaliação mais cuidadosa dos fetos hidrópicos, para que dependendo da causa da hidropsia, a intervenção precoce possa diminuir a mortalidade perinatal

Valvuloplastia mitral y tricuspídea en una paciente con estenosis bivalvular / Mitral and tricuspid valvuloplasty in a patient with bivalve stenosis

Se presenta el caso de una mujer de 43 años, con antecedentes de fiebre reumática, accidente vasculoencefálico isquémico, estenosis mitral y tricuspídea y disnea en CF III de 2 años de evolución. Se realizó ecocardiografia transesofágica que demostró estenosis mitral severa con área de 0,78 cm² y estenosis tricuspídea severa, con índice de Wilkins de 9/16. Se realizó valvuloplastia bivalvular percutánea con balón, con resultado exitoso. A un año del procedimiento la paciente evoluciona asintomática.

Surgical treatment of tricuspid valve disease combined with cardiac cachexia syndrome / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the surgical treatment of tricuspid valve disease combined with cardiac cachexia.</p><p><b>METHODS</b>Seven patients with heavy tricuspid valve disease combined with cardiac cachexia underwent tricuspid valve replacement. Heart function and nutrition status were improved in the perioperative period.</p><p><b>RESULT</b>All operations were performed successfully, but one patient died of heavy heart failure postoperatively. The mean follow-up length was 32 months, all patients had good heart function except one with minor right heart function failure.</p><p><b>CONCLUSION</b>Prosthetic heart valve replacement is an effective treatment for patients with serious tricuspid valve disease combined with cardiac cachexia. The perioperative nutrition support and heart function improvement are important in the treatment process.</p>

Isolated thrombus producing tricuspid stenosis: an unusual presentation in primary antiphospholipid syndrome.

We report the case of a female patient who presented with signs and symptoms of tricuspid stenosis. Echocardiography revealed a sessile mass on the tricuspid valve. A diagnosis of primary cardiac tumor was made but histopathologic examination revealed the mass to be an organized thrombus. Subsequent serological tests showed elevated titers of anticardiolipin antibodies in the absence of any associated disease. This case highlights an unusual presentation of the primary antiphospholipid syndrome.