Effects of Morphologic Left Ventricular Pressure on Right Ventricular Geometry and Tricuspid Valve Regurgitation in Patients With Congenitally Corrected Transposition of the Great Arteries

Kollars, Catharine A. Kral; Gelehrter, Sarah; Bove, Edward L.; Ensing, Gregory J.

doi:10.1016/j.amjcard.2009.10.066

Cited by 77 publications

(55 citation statements)

References 14 publications

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“…Consequently, many patients with CCTGA are referred in adulthood. In these patients, incidence and degree of tricuspid regurgitation (TR) increase over time,5, 8 and TR has been identified as a major contributor to right ventricular (RV) failure and decreased survival 2, 9, 10, 11, 12. Traditionally, TR was considered secondary to dysfunction of morphological RV, which cannot sustain the systemic circulation, and tricuspid valve (TV) surgery was mostly described as unbeneficial in the early days 10, 13, 14, 15.…”

Section: Introductionmentioning

confidence: 99%

Long‐Term Outcomes of Tricuspid Valve Surgery in Patients With Congenitally Corrected Transposition of the Great Arteries

Deng

Tang

et al. 2018

JAHA

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BackgroundValvuloplasty is generally considered unsuccessful in patients with congenitally corrected transposition of the great arteries. Optimal timing of tricuspid valve surgery in these patients is crucial.Methods and ResultsWe retrospectively reviewed 57 patients with congenitally corrected transposition of the great arteries undergoing tricuspid valve surgery at our institution. Eleven patients had tricuspid valve plasty and 46 had tricuspid valve replacement. Mean duration of follow‐up was 7.4±5.5 years in the group of tricuspid valve plasty and 5.6±3.6 years in the group of tricuspid valve replacement, respectively (P=0.33). For the total of 57 patients, estimates of 1‐, 5‐, and 10‐year survival or freedom from transplantation were 96.4%, 91.6%, and 75.6%, respectively. Late right ventricular ejection fraction of most patients (90%) remained preserved (≥40%) during the follow‐up. In a highly selected group of tricuspid valve plasty recipients, although long‐term survival and right ventricular function were similar compared with tricuspid valve replacement, recurrent tricuspid regurgitation was observed in 60% of these patients. Multivariate Cox regression analysis identified preoperative right ventricular end‐diastolic dimension (1‐cm increment; harzard ratio, 3.22; P=0.02) as an independent predictor of postoperative mortality or need for transplantation. Patients undergoing surgery with a right ventricular end‐diastolic dimension ≥60 mm had a significant lower survival rate compared with those with a right ventricular end‐diastolic dimension <60 mm (P=0.003).ConclusionsTricuspid valve surgery in patients with congenitally corrected transposition of the great arteries could yield satisfactory long‐term outcomes. Recurrent tricuspid regurgitation was frequently observed in tricuspid valve plasty recipients. Preoperative right ventricular end‐diastolic dimension was a risk factor for late mortality and surgery should be performed before cardiac enlargement and dysfunction for best outcomes.

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Section: Introductionmentioning

confidence: 99%

Long‐Term Outcomes of Tricuspid Valve Surgery in Patients With Congenitally Corrected Transposition of the Great Arteries

Deng

Tang

et al. 2018

JAHA

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“…It has been demonstrated in the systemic RV of congenitally corrected transposition of the great arteries that increasing LV pressure reduces TR, possibly attributable to a change in the septal position. 28 A pathological study suggested that septal leaflet support apparatus differed in HLHS patients with smaller LV (mitral atresia/aortic atresia). 29 This pathological series did not have clinical correlates to identify which patient group had significant TR 29 ; however, it is possible that structural differences in subvalvular apparatus may also affect TV function.…”

Section: Tethering and Tv Failurementioning

confidence: 99%

Tricuspid Regurgitation in Hypoplastic Left Heart Syndrome

Kutty

Colen

Thompson

et al. 2014

Circ: Cardiovascular Imaging

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T ricuspid regurgitation (TR) is associated with morbidity and mortality in children with hypoplastic left heart syndrome (HLHS). [1][2][3] Cross-sectional studies using 2-dimensional echocardiography (2DE), 3-dimensional echocardiography (3DE), and intraoperative surgical inspection of the tricuspid valve (TV) after stage 1 palliation have suggested multiple causative factors for TR in HLHS. These include annular and ventricular dilation, leaflet prolapse and tethering, leaflet dysplasia, papillary muscle (PM) displacement, and right ventricular (RV) dyssynchrony. 4-6 Clinical Perspective on p 772Real-time 3DE has emerged as a clinically useful tool for anatomic and functional assessment of atrioventricular valves before and after surgical repair. 7,8 Several studies have shown the added value of 3DE over 2DE in the evaluation of mitral valve disease. 6,[9][10][11][12][13][14][15][16] In pediatric subjects, real-time transthoracic 3DE generates optimal images of the TV. [8][9][10] Quantitative 3DE permits evaluation of the spatial relationships between the TV annulus, leaflets, and the supporting apparatus by measurement of tethering and prolapse volumes, leaflet and annular areas, and PM angles. 4,11 We have reported the use of quantitative 3DE to assess mechanisms of TR and demonstrated that this technique is able to detect areas of TV tethering and prolapse in HLHS. 4 Previous studies have evaluated mechanisms for TR in HLHS at or beyond the time of the second-stage palliation; however, there is a paucity of literature on TV function before Background-Our purpose was to test the following hypotheses: (1) patients with hypoplastic left heart syndrome who develop significant tricuspid regurgitation (TR) or require tricuspid valve (TV) surgery in the medium term have detectable TV abnormalities by 3-dimensional echocardiography (3DE) prestage 1 palliation and (2) TR is associated with reduced survival and increased TV intervention. Methods and Results-Infants were prospectively studied with 3DE and 2DE prestage 1 and followed up for the end points of TR, TV surgery, transplantation, or death. From prestage 1 3DE, spatial coordinates of TV annulus and leaflets were extracted; annulus size, leaflet area, prolapse volume, tethering volume, bending angle, and papillary muscle angle were measured. TR was assessed prestage 1 and at latest follow-up.

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“…In Metton's group the TV was not repaired at PAB placement, as it was thought that PAB placement may improve TR that was present prior to banding (Ly et al, 2009). This mechanism is described by Kral Kollars et al (2010) in 14 patients who underwent PAB for LV retraining (median age 1.1 years, range 0 to 12 years). Eleven of the 14 patients had an increase in LV pressure of ≥2/3 systolic RV pressure with PAB and demonstrated significantly decreased TR as the LV geometry became more spherical and the interventricular septum shifted toward the morphologic RV.…”

Section: Wwwintechopencommentioning

confidence: 99%

“…Physiologic repair may also include relief of www.intechopen.com pulmonary stenosis (PS) and/or LV to PA conduit placement. There is, however, the possibility that decreasing LV pressure by VSD closure and/or PS relief may allow the ventricular septum to realign towards the LV, resulting in displacement of the TV septal leaflet and increasing TR (Kral Kollars et al 2010;Said et al 2011). In a cohort of 123 patients with ccTGA presenting for classic biventricular repair over 33 years, the surgical group undergoing repair of VSD + PS demonstrated the greatest survival whereas patients requiring TV replacement at their initial operation exhibited the shortest survival.…”

Section: Surgical Managementmentioning

confidence: 99%