Chronic traumatic tricuspid insufficiency.

Isolated tricuspid insufficiency (TI) is relatively uncommon and mostly of traumatic origin. We report clinical noninvasive and invasive findings and surgical results in 5 cases. All patients had complete clinical, noninvasive and invasive studies including right and left catheterization, and coronary angiographies in 3 patients. All but 1 patient had nonpenetrating trauma. All had large jugular V waves, right precordial impulse, systolic liver pulse, positive Carvallo sign documented also by noninvasive techniques. Right heart failure was present in 3 patients. Chest x-ray showed prominent right atrium and distended vena cavae. Electrocardiogram showed normal sinus rhythm in 4 patients and atrial fibrillation in 1. Two patients had right bundle-branch block, and 2 presented RSR'-pattern. Echocardiogram showed large right atrium (RA) (6-10 cm), floppy tricuspid valve (TV) in all, dilated right ventricle (RV) in 2 patients. Findings of left heart were normal in all. Three patients had right-to-left shunt. In RA A waves were 4-8, Y waves 1-3, and V waves 12-22 mmHg, respectively (mean RV and PA pressures were 23/3 and 23/10 mmHg, respectively). Four patients had anuloplasty, 2 of them repair of valve and chordae. Surgical results were good in 2 patients with valve repair, satisfactory in 1; there was significant TI resistance in 1 case. We conclude that TI has distinctive clinical findings and must be ruled out in all patients with chest trauma. Surgery must include not only anuloplasty, but, cusps and chordae must also be evaluated and reconstructed if necessary.

Congestive heart failure in valvular heart disease in pregnancies with and without valvular prostheses and anticoagulant therapy.

The course and complications of pregnancies in 46 patients with valvular disease and congestive heart failure with or without valve prostheses are described. In group I consisting of 33 women without valve replacement and without anticoagulant therapy one thromboembolic event was seen, emergency closed or open heart surgery was necessary five times. One still-birth happened after open heart surgery. In group II, of 13 patients with prosthetic valve replacement and anticoagulation therapy there was no thromboembolism, but 2 spontaneous abortions and 2 premature stillbirths; 2 fetuses died after delivery, 3 had congenital abnormalities. Pregnancies in patients with valvular disease and congestive heart failure can be sustained relatively safely for the mother, even if emergency heart surgery becomes necessary. Heart surgery and anticoagulation treatment carry a higher risk for the fetus. Uterine blood loss is not increased, if coumadine treatment is switched to heparin administration shortly before delivery.

Persistent left superior vena cava draining into the left atrium, atrial septal defect, and absence of the coronary sinus. Recognition and surgical correction.

The diagnosis of atrial septal defect (ASD), persistent left superior vena cava (LSVC) and absence of coronary sinus was established by cardiac catheterization in a 20 years old female. At surgery the coronary vein ostia were located in the left atrium. LSVC was ligated and pericardial patch was sutured around the orifices of the coronary veins and extended to the ASD to redirect the coronary blood flow into the right atrium and close the defect. The postoperative cardiac catheterization and hemodynamic studies revealed good result.