Tricuspid Regurgitation Related to Cardiac Implantable Electronic Devices: An Integrative Review.

The use of cardiac implantable electronic devices, including permanent pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy, has dramatically increased in recent years. The interaction between the device lead and tricuspid valve leaflets is a potential cause of tricuspid regurgitation that in turn has an impact on morbidity and mortality. Echocardiography is necessary to grade tricuspid regurgitation severity. The use of three-dimensional imaging helps determine whether the device lead is interfering with normal leaflet coaptation. Early identification of lead-related tricuspid regurgitation is critical to select the optimal treatment, which may include lead extraction or even tricuspid valve repair or replacement in severe cases. The aims of this review are to provide a thorough assessment of the evidence about lead-associated tricuspid regurgitation and the benefits of using three-dimensional echocardiography with some technical considerations and to propose a treatment algorithm.

Molecular and Clinical Aspects of Chronic Manifestations in Chagas Disease: A State-of-the-Art Review.

Chronic manifestations of Chagas disease present as disabling and life-threatening conditions affecting mainly the cardiovascular and gastrointestinal systems. Although meaningful research has outlined the different molecular mechanisms underlying Trypanosoma cruzi's infection and the host-parasite interactions that follow, prompt diagnosis and treatment remain a challenge, particularly in developing countries and also in those where the disease is considered non-endemic. This review intends to present an up-to-date review of the parasite's life cycle, genetic diversity, virulence factors, and infective mechanisms, as well as the epidemiology, clinical presentation, diagnosis, and treatment options of the main chronic complications of Chagas disease.