Impact of Concomitant Tricuspid Annuloplasty on Tricuspid Regurgitation, Right Ventricular Function, and Pulmonary Artery Hypertension After Repair of Mitral Valve Prolapse

Chikwe, Joanna; Itagaki, Shinobu; Anyanwu, Anelechi C.; Adams, David H.

doi:10.1016/j.jacc.2015.01.059

Cited by 271 publications

(199 citation statements)

References 20 publications

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“…Decidir el mejor momento para la intervención quirúrgica sigue siendo controvertido, debido a los pocos datos disponibles y su naturaleza heterogénea (véanse la tabla de recomendaciones sobre las indicaciones de cirugía de válvula tricúspide y la figura 6) [156][157][158][159][160] . Para evitar una disfunción irreversible del VD, la cirugía debe realizarse pronto.…”

Section: Indicaciones De La Intervenciónunclassified

“…En la insuficiencia tricuspídea secundaria, la combinación de reparación de la válvula, si está indicada, con la cirugía de lado izquierdo no aumenta el riesgo quirúrgico y se ha demostrado que puede favorecer el remodelado inverso del VD y mejorar el estado funcional, incluso en ausencia de insuficiencia tricuspídea significativa si hay dilatación del anillo 156,157,160 . Por lo tanto, debe considerarse sistemáti-camente en estos casos.…”

Section: Indicaciones De La Intervenciónunclassified

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Guía ESC/EACTS 2017 sobre el tratamiento de las valvulopatías

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología

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Section: Indicaciones De La Intervenciónunclassified

Guía ESC/EACTS 2017 sobre el tratamiento de las valvulopatías

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología

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“…When patients who had a normal appearing right ventricle, but a tricuspid annular dimension >40 mm (normal <34 mm), underwent mitral valve surgery and tricuspid valve repair, despite some degree of presumed RV unloading, with a fall in right ventricular systolic pressure from a mean of 38 mmHg to a mean of 29 mmHg, only 30% of the patients had a normal right ventricular ejection fraction postoperatively. Right ventricular function required 3.5-5 years to recover (45). In patients with generally preserved RV ejection fraction and only a load independent sign of right ventricular loss of reserve, a right ventricular end systolic area greater than 20 cm 2 , or another relatively subtle sign of RV impairment, hypersplenism, with a hemoglobin less than 11.3 g/dL, isolated tricuspid valve surgery was associated with a two-year survival in the 44-57% range (2).…”

Section: Prognosismentioning

confidence: 99%

Non-functional tricuspid valve disease

Adler¹

2017

Ann. Cardiothorac. Surg.

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Only 75% of severe tricuspid regurgitation is classified as functional, or related primarily to pulmonary hypertension, right ventricular dysfunction, or a combination of both. Non-functional tricuspid regurgitation occurs when there is damage to the tricuspid leaflets, chordae, papillary muscles, or annulus, independent of right ventricular dysfunction or pulmonary hypertension. The entities that cause non-functional tricuspid regurgitation include rheumatic and myxomatous disease, acquired and genetic connective tissue disorders, endocarditis, sarcoid, pacing, RV biopsy, blunt trauma, radiation, carcinoid, ergot alkaloids, dopamine agonists, fenfluramine, cardiac tumors, atrial fibrillation, and congenital malformations. Over time, severe tricuspid regurgitation that is initially non-functional, can blend into functional tricuspid regurgitation, related to progressive right ventricular dysfunction. Symptoms and signs, including a falling right ventricular ejection fraction, cardiac cirrhosis, ascites, esophageal varices, and anasarca, may occur insidiously and late, but are associated with substantial morbidity and mortality. Attempted valve repair or replacement at late stages carries a high mortality. Crucial to following patients with severe non-functional tricuspid regurgitation is attention to echo quantification of the tricuspid regurgitation and right ventricular function, patient symptoms, and the physical examination. Keynote Lecture Series Review of non-functional tricuspid regurgitationMore than 75% of severe tricuspid regurgitation is classified as functional or related to pulmonary hypertension or right ventricular dysfunction or dilatation, rather than independent abnormalities of the tricuspid valve components: leaflets, annulus, chordal attachments, and papillary muscles. An understanding of non-functional tricuspid regurgitation mandates an appreciation of functional tricuspid regurgitation because the former may ultimately be worsened by some of the same forces that propel the latter (1,2).The anatomy of the tricuspid valve lends itself to functional impairment. Unlike the dense, separate, fibrous structure, with two fibrous trigones, that surrounds the mitral valve, the tricuspid annulus, with only a right fibrous trigone, blends into the right atrial fibro fatty structures and is more susceptible to dilate or not reduce appropriately in size during systole, with either right atrial or right ventricular dilatation. Only two papillary muscles, albeit with an additional posterior commissural chord, supply three leaflets. The chordal attachments to the anterior leaflet arise largely from the anterolateral papillary muscle, not both papillary muscles, and there is a reliance on attachments to the moderator band and free wall. The smallest leaflet, the septal leaflet, is relatively fixed. Right ventricular expansion can readily tether or restrict the anterior leaflet. The posterior leaflet can become restricted via an interesting mechanism: the posteroseptal portion of the valve is more apically ...

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“…Moreover, when patients require reoperation for tricuspid valve dysfunction, a high operative mortality has been observed, mainly due to the irreversible right ventricular systolic or liver dysfunction [5][6][7] . Increasing data now support an early surgical treatment of FTR [8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%