Parachute Tricuspid Valve: A Case Treated by Open Heart Surgery.

Parachute valve is the malformation of an atrioventricular valve in which the tension apparatus springs from a single papillary muscle or group of muscles. Parachute tricuspid valve is a rare anomaly with no surgically repaired case to date. We describe a case of parachute deformity of the tricuspid valve leading to hemodynamically significant severe tricuspid stenosis. The present case was successfully repaired surgically along with atrial septal defect (ASD) and ventricular septal defect (VSD) closure.

Pathology of tricuspid valve stenosis and pure tricuspid regurgitation--Part I.

This three-part article examines the histologic and morphologic basis for stenotic and purely regurgitant tricuspid valves. In Part I, conditions producing tricuspid valve stenosis are reviewed. In over 90% of stenotic tricuspid valves, the etiology is rheumatic disease. In isolated tricuspid stenosis, the etiology is either carcinoid or congenital. Rare causes of tricuspid stenosis include active infective endocarditis, metabolic or enzymatic abnormalities (Fabry's, Whipple's disease), and giant blood cysts.

Atrial septostomy: stationary angioplasty balloon technique--experimental work and preliminary clinical applications.

A new approach to creating an interatrial communication using a stationary fixed-diameter angioplasty balloon is presented. Stationary balloon septostomy was used to create an atrial communication in 19 young swine using a transseptal technique through a closed atrial septum, and in 18 newborn lambs through a patent foramen ovale. In animals with an intact septum, there was persistent patency of the atrial communication using balloons larger than 12 mm in diameter. The average diameter of the atrial communication was 96% of the expanded diameter of the angioplasty balloon. For newborn lambs with a patent foramen, a smooth oval atrial communication was noted by 4 weeks, and there was persistent patency of the opening using balloons larger than 15 mm in diameter. The average diameter of the opening was 81% of the diameter of the angioplasty balloon used. The new procedure was used successfully in five patients. All five showed resolution of the clinical symptomology. In conclusion, stationary angioplasty balloon atrial septostomy has been effective in producing interatrial communications, which remained patent for 4-14 weeks, in animals with intact septum, as well as in those with a patent foramen ovale.

A successful pregnancy in a patient with congenital tricuspid stenosis and a patent oval foramen.

Patients with cyanotic congenital heart disease who have obstruction proximal to the pulmonary arteries and, hence, do not develop pulmonary hypertension, can go through pregnancy successfully, if the pregnancy and delivery are adequately cared for, with possible complications in mind. We report a successful pregnancy in a woman with congenital tricuspid stenosis and a patent oval foramen.

Successful balloon valvotomy in isolated congenital tricuspid stenosis.

Isolated congenital tricuspid valve stenosis is a rare entity. The modalities of definitive treatment have been surgical repair or replacement. We present the first reported patient with congenital tricuspid stenosis successfully treated by percutaneous balloon valvotomy. This appears to be an alternative to surgery when the anatomy, as demonstrated by echocardiography, is suitable.

[A rare case of congenital tricuspid stenosis treated with modified Fontan operation].

A rare case of congenital tricuspid stenosis treated with modified Fontan operation was reported. The patient was 13 years old boy and his chief complaint was cyanosis. Cyanosis appeared in his neonatal period and squatting developed in his childhood. He underwent Blalock's shunt operation at 5 years of age. His exercise tolerance was limited at the admission for the radical operation. Angiocardiography showed the annular stenosis of tricuspid valve and the moderate hypoplasia of right ventricle. The right ventricular volume was 56 ml (equivalent to 35% of the normally expected right ventricular volume) and the diameter of tricuspid annulus was 13 mm (equivalent to 58% of the normally expected diameter). Atrial septal defect was associated with but pulmonary stenosis did not exist. His left ventricular function was good and pulmonary vascular resistance was not raised. A diagnosis of tricuspid stenosis was made and Fontan's repair was considered to be possible for his correction. Operative findings showed normal architecture of tricuspid valve with the three leaflets but tricuspid annulus was narrow. Tricuspid valve stenosis was considered to be caused by the hypoplasia of tricuspid ring and surgical dilatation was found to be difficult. Therefore, modified Fontan operation (RA-RV connection) was performed. His cyanosis disappeared and exercise tolerance was improved after the operation. Cardiac catheterization and angiocardiography were performed 8 months and 28 months after the operation. His righ ventricular volume was increased to 123 ml (equivalent to 57% of the normally expected volume) followed by RA-RV connection.

[Congenital mitral and tricuspid double stenosis]. / Double sténose tricuspide et mitrale congénitale.

The authors report the case of a child followed up from the age of 4 months to the age of 15 for asymptomatic congenital heart disease. Initial clinical examination showed the presence of a systolic murmur and a diastolic rumble in the xiphoid area with signs of right atrial dilatation-hypertrophy. During follow-up, an apical diastolic rumble was detected with left atrial dilatation from the age of 3. Doppler echocardiography carried out recently showed double mitral and tricuspid valve stenosis with two-dimensional appearances of doming of both valves and moderate transvalvular pressure gradients with slight elevation of pulmonary artery pressures on the Doppler study. The very early detection of the malformation and the continuous follow-up of this patient indicate the congenital and not rheumatic origin of this double valve stenosis.

Congenital tricuspid valve stenosis with atrial septal defect and left anterior fascicular block.

Congenital tricuspid valve stenosis in the absence of other valvular abnormalities is rare. In this report we describe a patient with congenital tricuspid valve stenosis, ostium secundum atrial septal defect, and electrocardiographic left anterior fascicular block, who presented with paradoxical emboli. This case, as well as previous case reports, suggests that congenital tricuspid stenosis with ostium secundum atrial septal defect is associated with left anterior fascicular block.

Concurrent percutaneous balloon valvuloplasty for combined tricuspid and pulmonic stenoses.

Percutaneous balloon valvuloplasty was successfully performed in a 55-year-old Chinese woman with severe recurrent tricuspid and pulmonic stenoses 11 1/2 years following open valvotomies. An Inoue balloon catheter with the balloon made of double-layered rubber and nylon micromesh was used. The orifices of the tricuspid and pulmonic valves increased from 13 to 27 mm in diameter and from 6 to 14 mm in diameter, respectively, following concurrent balloon valvuloplasties. The present report demonstrated for the first time the feasibility of percutaneous balloon valvuloplasty for combined valvular stenoses.

Balloon valvuloplasty in congenital and acquired heart disease: morphologic considerations.

Balloon valvuloplasty has already gained its place as an alternative option in the treatment of valvar stenoses. In congenital valvar stenosis its application will be limited because of the complexity of the underlying valve deformities. Nevertheless, isolated pulmonary and aortic valve stenosis are amenable to this form of treatment. The major limitations are undeveloped arterial valve rings and valve dysplasia. In acquired valvar stenosis the main limitation of balloon valvuloplasty seems to be massive calcification of the affected valves. Basically, in both the arterial and atrioventricular position, balloon valvuloplasty splits fused commissures and fractures calcific deposits. Excessive radial pressures may cause tears of the leaflets. The potential of thromboembolic complications, therefore, warrants caution. The nature of the damage inflicted on pathologic valves almost by necessity dictates that restenosis will occur and - most likely - with a high incidence.

Absceso cerebral curado en un niño con cardiopatía congénita cianótica / Brain abcess cured in a child with cyanstic congenital heart disease

Presentamos el caso de un paciente con estenosis tricuspídea muy severa que ha sido seguido desde el año y medio de edad hasta la fecha, en que tiene 19 años. A los 2 años se realizó una anatomosis cavo-pulmonar, que mejoró al enfermo importantemente. A los 13 años presentó una cefalea intensa en la región temporo-occipital derecha. Los diversos métodos de estudio demostraron que existía un absceso cerebral, mismo que fue operado con éxito. Meses después presentó una trombosis de la arteria poplitea y sus ramas, operada también con buenos resultados. Al año siguiente se practicó otro estudio angiográfico, encontrándose que el catéter pasaba de la aurícula al ventrículo derecho y que existía una estenosis infundibular acentuada. Se practicó entonces una operación de Taussig-Blalock que ha permitido que el paciente lleve una vida prácticamente normal

[Cured brain abscess in a boy with congenital cyanotic cardiopathy]. / Absceso cerebral curado en un niño con cardiopatía congénita cianótica.

We present a patient with severe tricuspid stenosis whom at the age of 13 developed a brain abscess successfully treated by surgical means.

A case of congenital triple valve disease.

We report a case of congenital triple valve stenosis with dominant pulmonary valve disease, sparing the aortic valve, presenting at the age of 51 years with progressive shortness of breath and central cyanosis. At post mortem, no intracardiac right to left communication could be demonstrated.