1/22. Difference in structural change in the Carpentier-Edwards pericardial valves implanted in the mitral and tricuspid positions.We report a 29-year-old patient with prosthetic valve dysfunction with severe calcific stenosis in the mitral position but no structural change in the tricuspid position after mitral valve replacement and tricuspid valve supra-annular implantation with same bioprostheses at the seven years before. The difference in structural change between the mitral position and the tricuspid position might be due mainly to the effect of mechanical stress on the cusps, rather than to any difference in serum calcium levels. However, some hormonal effect other than that of the parathyroid hormone on the systemic and pulmonary circulation might be related to the early progression in cusp calcification in the systemic circulation.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
2/22. Fetal diagnosis of lethal dysfunction of the right heart in three siblings.A woman, having already delivered one child, underwent fetal echocardiography during three subsequent pregnancies. All three showed enlargement and poor function of the right-sided chambers. The first was still-born, the second died as a neonate, while the third pregnancy was terminated. Pathological examination revealed the same findings in each fetus, possibly representing a variation of Uhl's anomaly, or alternatively a hitherto unrecognised cardiomyopathic process.- - - - - - - - - - ranking = 4keywords = dysfunction (Clic here for more details about this article) |
3/22. Tricuspid dura mater bioprostheses: more than 20-year follow-up of 3 patients.Replacement of the tricuspid valve is sometimes necessary. We report 3 consecutive patients with tricuspid insufficiency who underwent valve replacement with glycerol-preserved, homologous dura mater cardiac bioprostheses between 1971 and 1973. The first 2 patients are well 28 and 27 years later; the last patient was lost to follow-up after 20 years. We conclude that preservation of homologous dura mater bioprostheses in glycerol may reduce rates of thromboembolism, thrombosis, and structural dysfunction during the late postoperative period.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
4/22. Acquired right heart outflow tract anomaly without systemic hypertension in recipient twins in twin-twin transfusion syndrome.Significant hemodynamic changes are commonly observed in both fetuses in twin-twin transfusion syndrome. In the recipient twin there is cardiac dysfunction with hypertrophy of both ventricles and overall enlargement of the heart. We describe five cases of recipient twins in twin-twin transfusion syndrome with right ventricle hypertrophy, pulmonary stenosis and tricuspid regurgitation acquired in utero. These symptoms developed with no signs of systemic hypertension. Three of the five recipient twins survived and were developing normally at 3-30 months of age. Postnatal outcome is likely to have improved as a result of prenatal diagnosis of right ventricle outflow tract obstruction and timed delivery. These acquired anomalies of the right heart might be related to the particular hemodynamic conditions of the recipient twin. A global heart dilatation is logically expected, but this hypertrophy without dilatation is probably related to the shared plasma of fetuses with opposite hemodynamic conditions. This is what we consider as the hemodynamic-hormonal paradox. These acquired anomalies, though severe, are accessible to neonatal treatment if treated early.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
5/22. Staged fontan procedure for mitral atresia associated with severe tricuspid regurgitation, pulmonary hypertension, and pulmonary artery distortion.Optimal initial palliation and a subsequent staged approach is mandatory for high-risk Fontan candidates. We describe the case of mitral atresia with severe tricuspid regurgitation and pulmonary hypertension successfully managed by repeated palliation from the neonatal period and 2-stage Fontan surgery. A 1-month-old boy diagnosed with mitral atresia and double-outlet right ventricle underwent pulmonary artery banding at 1 month of age, followed by repeated pulmonary artery banding accompanied by tricuspid annuloplasty and atrial septal defect enlargement at 6 months. Because of the presence of pulmonary artery distortion, right ventricular dysfunction, and borderline pulmonary vascular resistance, a hemi-fontan procedure was conducted with extended pulmonary artery plasty when the boy was 3 years and 8 months old. cardiac catheterization done 3 months after showed improvement in risk factors, and the final Fontan operation (total cavopulmonary connection) was successfully done in conjunction with repeated tricuspid annuloplasty when the boy was 4 years and 5 months old. The patient remains in excellent clinical condition at the last follow-up 5 years after the final fontan procedure with sinus rhythm and good ventricular function.- - - - - - - - - - ranking = 364.54224566887keywords = ventricular dysfunction, dysfunction (Clic here for more details about this article) |
6/22. Triple valve replacement in a patient with severe carcinoid heart disease.We report on the case of a 34-year-old male patient suffering from end-stage carcinoid heart disease with severe tricuspid, pulmonary and mitral valve regurgitation. In addition, a persisting foramen ovale was present. The primary carcinoid tumor was never discovered. However, urine 5-hydroxy-indole-acetic-acid (5-HIAA) were consistently elevated after the first diagnosis of carcinoid disease and after eight years of medication with octreotide and Interferon alpha-2b our patient developed significant cardiac insufficiency mainly due to severe valvular dysfunction. Ultimately, mechanical tricuspid, mitral and pulmonary valve replacement was performed. Twelve hours following the operation the patient had to be returned to the operating room for persisting intrathoracic hemorrhage. He recovered uneventfully and was discharged from hospital on day 37. Twelve months following triple valve replacement the cardiac status recovered from preoperative NYHA-IV to NYHA-I.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
7/22. Reversible left ventricular function after tricuspid valve replacement for a patient with congenital isolated severe tricuspid regurgitation.We describe the case of a 30-year-old man presenting with congenital, isolated severe tricuspid regurgitation due to posterior leaflet dysfunction. An impaired left ventricular ejection fraction and restrictive filling pattern were noted, recovering after tricuspid valve replacement. The left ventricular dysfunction, reversible in this case, may have been the result of right ventricular volume overload, resulting in ventricular septal paradox.- - - - - - - - - - ranking = 365.54224566887keywords = ventricular dysfunction, dysfunction (Clic here for more details about this article) |
8/22. Ebstein's anomaly: one and a half ventricular repair.patients with Ebstein's anomaly can present after childhood or adolescence with cyanosis, arrhythmias, severe right ventricular dysfunction and frequently with left ventricular dysfunction secondary to the prolonged cyanosis and to the right ventricular interference. At this point conventional repair is accompanied by elevated mortality and morbidity and poor functional results. We report our experience with three patients (8, 16 and 35 years of age) with Ebstein's anomaly, very dilated right atrium, severe tricuspid valve regurgitation (4/4), bi-directional shunt through an atrial septal defect and reduced left ventricular function (mean ejection fraction = 58%, mean shortening fraction = 25%). All underwent one and a half ventricular repair consisting of closure of the atrial septal defect, tricuspid repair with reduction of the atrialised portion of the right ventricle and end-to-side anastomosis of the superior vena cava to the right pulmonary artery. All patients survived, with a mean follow-up of 33 months. In all there was complete regression of the cyanosis and of the signs of heart failure. Postoperative echocardiography showed reduced degree of tricuspid regurgitation (2/4) and improvement of the left ventricular function (mean ejection fraction = 77%, mean shortening fraction = 40%). In patients with Ebstein's anomaly referred late for surgery with severely compromised right ventricular function or even with reduced biventricular function, the presence of a relatively hypoplastic and/or malfunctioning right ventricular chamber inadequate to sustain the entire systemic venous return but capable of managing part of the systemic venous return, permits a one and a half ventricular repair with good functional results.- - - - - - - - - - ranking = 729.08449133775keywords = ventricular dysfunction, dysfunction (Clic here for more details about this article) |
9/22. Tricuspid regurgitation following inferior myocardial infarction.Tricuspid regurgitation developed in two patients after inferior wall myocardial infarction. Neither patient had preexisting valvular heart disease or evidence of endocarditis, and neither had suffered chest trauma. Because abnormalities in right ventricular function may occur after inferior infarction, and because other known causes of tricuspid incompetence were not present, we postulate that these patients developed valvular regurgitation from dysfunction of the papillary muscle complex controlling tricuspid valve function, a mechanism similar to that proposed to explain mitral regurgitation seen with inferior wall ischemia.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
10/22. Arterial switch operation after multiple-stage left ventricular retraining.Right ventricular dysfunction and tricuspid valve incompetence after atrial repair for transposition of the great arteries is an increasingly frequent problem. Left ventricular retraining to convert an atrial switch to an arterial switch is a well-known surgical option but can require a multiple-stage surgical approach. We report our successful multiple-stage experience with a 5-year-old girl.- - - - - - - - - - ranking = 364.54224566887keywords = ventricular dysfunction, dysfunction (Clic here for more details about this article) |
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