Critical Tricuspid Insufficiency due to Papillary Muscle Rupture

Alkalay, Arie L.; Ferry, David A.; Pepkowitz, Samuel H.; Chou, Paula J.; Oakes, Gary K.; Pomerance, Jeffrey J.

doi:10.1001/archpedi.1988.02150070067027

Cited by 18 publications

(14 citation statements)

References 16 publications

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“…In addition, chronic hypoxemia could contribute to this complication, similarly to hypoxemic insult in neonates with acute spontaneous tricuspid rupture. 4 Treatment for tricuspid valve/apparatus rupture is mainly surgical, either with valve repair or replacement, usually with acceptable results; 1 severity of comorbidities, however, contributed to the patient 0 s death in this case.…”

Section: Discussionmentioning

confidence: 84%

“…The mechanisms that underlie spontaneous tricuspid valve rupture are not clear; a possible explanation for rupture in our patient is the increased wall tension in a dilated ventricle leading to marked mechanical stress on both the valvular and subvalvular apparatus, predisposing to rupture. In addition, chronic hypoxemia could contribute to this complication, similarly to hypoxemic insult in neonates with acute spontaneous tricuspid rupture . Treatment for tricuspid valve/apparatus rupture is mainly surgical, either with valve repair or replacement, usually with acceptable results; severity of comorbidities, however, contributed to the patient′s death in this case.…”

Section: Discussionmentioning

confidence: 89%

“…Tricuspid valve rupture is rare and mainly associated with trauma . Spontaneous rupture of tricuspid valve apparatus is even less common; it has been described in the fetus and the neonate, predominantly associated with hypoxic insult to the papillary muscles, but very rarely in adults. Few cases of spontaneous tricuspid valve apparatus have been reported in the literature: one patient with chronic renal failure under hemodialysis had a heavily calcified valve with shortened and calcified chordae, which may have predisposed it to rupture .…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous Tricuspid Valve Chordal Rupture in Idiopathic Pulmonary Hypertension

et al. 2015

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Rupture of tricuspid valve is unusual, occurring mainly in the setting of blunt trauma or endomyocardial biopsy. Spontaneous tricuspid valve chordal rupture is particularly rare. We report herein a case of a patient with severe pulmonary hypertension, on the lung transplantation waiting list, who presented with spontaneous chordal rupture, exacerbation of tricuspid insufficiency and worsening of clinical status. Diagnosis and treatment, along with possible mechanisms for this complication, are discussed.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Spontaneous Tricuspid Valve Chordal Rupture in Idiopathic Pulmonary Hypertension

et al. 2015

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“…In most cases, the infant will not respond, or will only respond minimally, to maximal respiratory and inotropic support and the only life saving intervention is surgical repair of the valve. In order to improve chances of survival, it is imperative to quickly come to a diagnosis and transfer the infant to a tertiary care facility with pediatric cardiothoracic surgical intervention and/or ECMO for stabilization until surgical intervention can be arranged (Alkalay et al, 1988;Arrington et al, 2005).…”

Section: What Is Your Plan Including Diagnostic Tests and Consultatimentioning

confidence: 99%

The Blue Baby Blues: A Rare Case of Cyanosis in the Newborn

Pados

Philip²

2008

Journal of Pediatric Health Care

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“…In contrast, severe TR caused by a flail leaflet is a rare cause of neonatal cyanosis. The outcome may be fatal if not recognized early (1,2). We report on a full-term female neonate presented with cyanosis caused by severe TR due to anterior leaflet chordal rupture.…”

Section: Introductionmentioning

confidence: 99%

Successful repair of neonatal tricuspid regurgitation due to chordae rupture

2018

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IntroductionFunctional tricuspid regurgitation (TR) is transient and benign in stressed infants. In contrast, severe TR caused by a flail leaflet is a rare cause of neonatal cyanosis. The outcome may be fatal if not recognized early (1,2). We report on a full-term female neonate presented with cyanosis caused by severe TR due to anterior leaflet chordal rupture. After initial stabilization by prostaglandin E1 infusion for keeping ductal patency, successful early repair was achieved with polytetrafluoroethylene artificial chordae implantation. Early diagnosis and timely surgery can be lifesaving. Case presentationA 3,044-gm full term female was born by Cesarean section because of fetal distress and meconium stain. The first and fifth minutes Apgar score was 5 and 9. On physical examination, a grade III/VI pansystolic murmur was noted diffusely. She was cyanotic and the oxygen saturation was 85%. A two-dimensional echocardiography showed severe TR due to a flail and thickened anterior leaflet (Figure 1A,B) with the calculated tricuspid Z score of 1.28, and large patent ductus arteriosus. The antegrade pulmonary flow was compromised and a right-to-left shunt through the patent foramen ovale was noted. The hemodynamic characteristics were quite similar to that of the pulmonary atresia with intact ventricular septum.At 6-day-old, cyanosis got worse due to impending ductal closure. She was intubated and prostaglandin E1 was infused (0.2 µg/kg/min), then the condition was stabilized and surgery was carried. Under mild hypothermia with cold crystalloid cardioplegic cardiac arrest, the patent ductus was ligated and the right atrium was opened. A flail tricuspid anterior leaflet due to extensive marginal chordae rupture was confirmed. The papillary muscle showed no ischemic change. The length of the septal leaflet chordae was measured as the reference and two loops of 6-0 expanded polytetrafluoroethylene artificial chordae were implanted over the unsupported margin of the anterior leaflet. A tricuspid annuloplasty was not necessary because the annulus was not dilated. The patent foramen ovale was not closed for pop-off purpose. Nitric oxide was not needed and under minimal inotrope support, the patient was recovered uneventfully. She was extubated 7 days after the operation Abstract: Neonatal rupture of the chordae of tricuspid valve with severe regurgitation is rare and disastrous. We report on a full-term female neonate presented with cyanosis caused by severe tricuspid regurgitation (TR) due to anterior leaflet chordal rupture. After initial stabilization by prostaglandin E1 infusion, successful early repair was achieved with artificial chordae implantation. The unique pathophysiology and the therapeutic strategy of this situation will be described.

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Critical Tricuspid Insufficiency due to Papillary Muscle Rupture

Cited by 18 publications

References 16 publications

Spontaneous Tricuspid Valve Chordal Rupture in Idiopathic Pulmonary Hypertension

Spontaneous Tricuspid Valve Chordal Rupture in Idiopathic Pulmonary Hypertension

The Blue Baby Blues: A Rare Case of Cyanosis in the Newborn

Successful repair of neonatal tricuspid regurgitation due to chordae rupture

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