1/11. Repair of a dysplastic tricuspid valve using artificial chordae: case report. Atrioventricular valve repair with artificial chordal replacement has been widely used for congenital and acquired mitral valve abnormalities, but not for tricuspid valve abnormalities. A case is presented of dysplastic tricuspid valve that was successfully repaired using artificial chordae. A 2-year-old female presented with poor weight gain. echocardiography revealed severe tricuspid regurgitation due to dysplastic tricuspid valve, poor coaptation by prolapse of the anterior leaflet, and tethering of the septal leaflet by short chordae. The prolapsed anterior leaflet was repaired with three pairs of 6-0 expanded polytetrafluoroethylene sutures. The short chordae of the septal leaflet were detached, and the septal and posterior leaflets were sutured together. Trivial tricuspid regurgitation was noted postoperatively. There was no tricuspid regurgitation during the follow up period of three years. The present case provides further evidence that artificial chordal replacement is a useful technique even for small children with congenitally abnormal tricuspid valves. ( info) |
2/11. Gross tricuspid incompetence due to isolated tricuspid valve prolapse. We report a case of isolated prolapse of the tricuspid valve producing gross incompetence as documented by Doppler examination. This case shows that hemodynamically significant tricuspid regurgitation can occur from isolated prolapse of valvar leaflets. ( info) |
3/11. Prolapse of atrioventricular valve leaflets in the setting of double orifice. Prolapse of the valve leaflets is reported in 2 cases in the setting of double orifice atrioventricular valve. diagnosis in the first case, an asymptomatic 8-year-old female, was achieved by echocardiography and consisted in prolapsing leaflets of a double orifice ("bridge type") mitral valve. The second patient, a 24-year-old male, died suddenly. Postmortem examination revealed prolapsing atrioventricular valves, with double orifice ("holy type") of the septal leaflet of the tricuspid valve. There was disruption of the penetrating atrioventricular bundle into multiple fragments with fasciculo-ventricular by-pass fibers. ( info) |
4/11. Isolated prolapse of the tricuspid valve. tricuspid valve prolapse has remained a poorly defined entity. Some authors have stated that prolapse isolated to the tricuspid valve has not been documented. This report contains three cases of isolated tricuspid valve prolapse including the first pathologically confirmed case. A review of worldwide literature including all reported cases of isolated tricuspid valve prolapse is also presented. Although signs and symptoms are similar to those found with mitral valve prolapse, tricuspid valve prolapse may occasionally be differentiated by auscultation. The diagnostic criteria of tricuspid valve prolapse are thoroughly discussed for each of the presently available invasive and noninvasive techniques. Right heart catheterization can define such prolapse but is invasive and requires meticulous technique. Two-dimensional echocardiography supersedes M-mode because of the superior spatial evaluation of the tricuspid leaflets in relation to the right atrium and ventricle. Multiple views including a long-axis view of the right ventricular inflow are often required. This parasternal echocardiographic window is often the only one which permits adequate visualization of the posterior leaflet. The pathologic findings of tricuspid valve prolapse are similar to those of mitral valve prolapse. This report concludes with a description of associated conditions. Severe tricuspid regurgitation has not been noted with tricuspid valve prolapse in the absence of superimposed disease, yet much remains undefined concerning the clinical significance of this condition. ( info) |
5/11. An infant with Marfanoid phenotype and congenital contractures associated with ocular and cardiovascular anomalies, cerebral white matter hypoplasia and spinal axonopathy. An infant is presented with a Marfanoid phenotype and congenital contractures. In addition to this she showed severe neurological and ocular abnormalities. Cardiac insufficiency due to mitral and tricuspidal valve prolapse caused her death at the age of 6 months. Postmortem examination showed axonal pathology of the anterior horns and roots of the spinal cord, and white matter hypoplasia of the brain. ( info) |
| Isolated tricuspid valve prolapse in the absence of mitral valve prolapse or other cardiac defects has not been previously noted. This report describes a patient who on both M-mode and two-dimensional echocardiography demonstrated tricuspid prolapse without other associated abnormalities. The implications of this finding are discussed. ( info) |
7/11. Late systolic click from isolated tricuspid valve prolapse simulating paradoxical splitting of the second heart sound. A 72 year old woman was thought to have a paradoxically split second heart sound. echocardiography with simultaneous phonocardiography revealed a late systolic click resulting from isolated tricuspid valve prolapse. Respiratory variation of the click in relation to the second heart sound resulted in an auscultatory phenomenon simulating paradoxical splitting of the second heart sound. ( info) |
8/11. Left ventricular outflow tract obstruction due to tricuspid valve prolapse through a high ventricular septal defect. A rare case is described of fixed subaortic obstruction due to a prolapsed redundant fibrous septal leaflet of the tricuspid valve, herniated through a membranous ventricular septal defect in a boy aged 11 years. The type of obstruction was not suspected before surgery and there was no shunt through the septal defect. Left ventriculography, was attempted and abandoned due to dangerous arrhythmia. Echocardiogram showed definite fixed subvalvular left ventricular outflow obstruction. Corrective surgery was carried out through aortotomy and right ventriculotomy. Ruptured chordae were resected and the tricuspid valve was replaced into the right ventricle. Redundant fibrous tissue was used to close the septal defect. The postoperative recovery was uneventful after complete AV block in the first 5 days. ( info) |
9/11. Mitral systolic honk in a case of congenitally corrected transposition of the great vessels. A woman suffering from TCGV associated with steno-insufficiency with a prolapse of left atrioventricular valve (tricuspid) and an insufficiency with a prolapse of right atrioventricular valve (mitral) presented a systolic honk which was to be registered in all the precordial area. The increase of this noise at the end of inspiration and after amyl nitrite, in the absence of any relevant change as to the prolapse of both atrioventricular valves, demonstrated that the honk originated from the right atrioventricular valve more than from the left one. ( info) |
10/11. Cardiac involvement in mucolipidosis. Importance of non-invasive studies for detection of cardiac abnormalities. Although mucolipidosis, a fatal metabolic storage disorder, is associated with cardiovascular abnormalities, detailed, non-invasive cardiac examinations have not been well documented. We studied 4 children with type II and type III mucolipidosis, 3 of whom had unequivocal evidence of aortic regurgitation characterized by phonocardiography and M-mode echocardiography. Two-dimensional echocardiography showed an aortic valve prolapse in 3, a mitral valve prolapse in 2 and a tricuspid valve prolapse in 1. The QT interval was prolonged in 2 cases. In 1 autopsy case, we found considerably thickened and retracted aortic, mitral, and tricuspid valves, and accumulation of the foam cells in the myocardium. echocardiography revealed similar findings in another 3 cases. We conclude that cardiac manifestations in this disorder should be examined carefully particularly by the use of echocardiography which is an excellent technique for detecting cardiovascular abnormalities in mucolipidosis. ( info) |