Quadrangular resection is the gold standard technique for correction of the posterior leaflet prolapse in mitral valve disease. Prompted by the idea that the anterior leaflet of the tricuspid valve corresponds to the posterior leaflet of the mitral valve in its structure and function, we conducted a quadrangular resection of the anterior leaflet of the tricuspid valve in a case of tricuspid endocarditis. Tricuspid regurgitation was well corrected, and the durability of the repair was proven by the patient's freedom from cardiac events for the following 8 years.
Endocarditis ; Freedom ; Mitral Valve ; Prolapse ; Tricuspid Valve ; Tricuspid Valve Insufficiency

Child, Preschool ; Humans ; Male ; Tricuspid Valve Insufficiency ; etiology ; Tricuspid Valve Prolapse ; congenital

OBJECTIVETo explore the approach and the result in tricuspid valve insufficiency treatment by a cusp remodeling technique.

METHODSNine patients with severe tricuspid regurgitation, congenital lack of chordae in 6 cases and traumatic rupture of chordae in 3 cases, underwent surgical repair between April 1997 and March 2006. There were six male and three female. Their ages ranged from 8 years to 57 years. One or two segments of flail leaflets were presented in these patients. Valve repair was performed by suture of the free edge of the affected cusp segment, plication of the segment of annulus devoid of leaflet, and fixation of the neo-annulus with a flexible annuloplasty ring.

RESULTSAll patients survived and recovered after the operation. Echocardiography showed good coaptation with no regurgitation of the tricuspid valve in six patients and a mild residual tricuspid regurgitation in three. A remarkable decrease in the diameter of the right ventricle (anterior to posterior) was observed: from mean (43.6 +/- 4.2) mm (range 29 mm to 64 mm) preoperatively reducing to mean (24.0 +/- 1.8) mm (range 16 mm to 32 mm) postoperatively. All patients are doing well in 1 month to 109 months follow up.

CONCLUSIONThe procedure provided a simple and valuable option for repair of flail leaflet of tricuspid valve caused by congenital lack of chordae or traumatic rupture of chordae.

Adolescent ; Adult ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Tricuspid Valve ; surgery ; Tricuspid Valve Insufficiency ; etiology ; surgery ; Tricuspid Valve Prolapse ; complications ; surgery

Although very rare, the incidence of tricuspid valve regurgitation after blunt chest trauma has risen in line with the increasing rate of car accidents and steering wheel trauma. It is easy to miss the diagnosis of tricuspid valve regurgitation following blunt chest trauma because most patients feel no symptoms at trauma, and the condition is sometimes overlooked for a long period of time due to its mild symptoms. A 49-year-old man suffered dyspnea on exertion for 1 month due to right heart failure 8 years after accidentally falling from a third floor. Preoperative echocardiography revealed severe tricuspid valve regurgitation resulting from prolapse of the anterior leaflet with annular dilatation. The patient underwent tricuspid valvuloplasty with a 36-mm Carpentier tricuspid ring. Intraoperative transesophageal echocardiography showed mild tricuspid valve regurgitation. We report a case of successful native valve salvage of ruptured tricuspid valve after blunt chest trauma, and present a review of the relevant literature.
Diagnosis ; Dilatation ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal ; Heart Failure ; Humans ; Incidence ; Middle Aged ; Prolapse ; Thorax* ; Tricuspid Valve Insufficiency ; Tricuspid Valve* ; Wounds, Nonpenetrating

Although very rare, the incidence of tricuspid valve regurgitation after blunt chest trauma has risen in line with the increasing rate of car accidents and steering wheel trauma. It is easy to miss the diagnosis of tricuspid valve regurgitation following blunt chest trauma because most patients feel no symptoms at trauma, and the condition is sometimes overlooked for a long period of time due to its mild symptoms. A 49-year-old man suffered dyspnea on exertion for 1 month due to right heart failure 8 years after accidentally falling from a third floor. Preoperative echocardiography revealed severe tricuspid valve regurgitation resulting from prolapse of the anterior leaflet with annular dilatation. The patient underwent tricuspid valvuloplasty with a 36-mm Carpentier tricuspid ring. Intraoperative transesophageal echocardiography showed mild tricuspid valve regurgitation. We report a case of successful native valve salvage of ruptured tricuspid valve after blunt chest trauma, and present a review of the relevant literature.
Diagnosis ; Dilatation ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal ; Heart Failure ; Humans ; Incidence ; Middle Aged ; Prolapse ; Thorax* ; Tricuspid Valve Insufficiency ; Tricuspid Valve* ; Wounds, Nonpenetrating

BACKGROUND: With an increasing awareness of the limitations of both mechanical prostheses and bioprostheses, aortic valvuloplasty has gained attention as an alternative procedure for aortic valve disease. MATERIAL AND METHOD: Eight consecutive patients underwent aortic valvuloplasty caused by leaflet prolapse between June 1999 to June 2000. Mean age of the patients was 18.4+/- 12.6 year. Four paitents(50%) were male. Six patients had tricuspid valves and ventricular septal defect and two patients had bicuspid valves. The extent of aortic insufficiency was 3.5+/- 0.5 by preoperative Doppler echocardiography. The technique involved triangular resection of the free edge of the prolapsed leaflet, annular plication at the commissure, and resection of a raphe when present in bicuspid valves. RESULT: There was no in-hospital mortality or morbidity. Mean follow-up was complete at 11.9+/- 3.6months. There was no late mortality or morbidity. The amount of the severity of aortic insufficiency, as assessed by echocardiography preoperatively, postoperatively and at late follow-up was 3.5+/- 0.5, 0.6+/- 0.5 and 0.8+/- 0.6, respectively(p value = 0.01). There was one patient with grade 2/4 aortic insufficiency and in the other patients, grade 1/2 or trivial aortic insufficiency were detected with late echocardiograms. CONCLUSION: Triangular resection in the patients with aortic leaflet prolapse offers a good early clinical result, but long-term follow-up is necessary.
Aortic Valve ; Bioprosthesis ; Echocardiography ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Septal Defects, Ventricular ; Hospital Mortality ; Humans ; Male ; Mitral Valve ; Mortality ; Prolapse ; Prostheses and Implants ; Tricuspid Valve

PURPOSE: Infantile Marfan syndrome (MFS) is a rare congenital inheritable connective tissue disorder with poor prognosis. This study aimed to evaluate the cardiovascular manifestations and overall prognosis of infantile MFS diagnosed in a tertiary referral center in Korea. METHODS: Eight patients diagnosed with infantile MFS between 2004 and 2014 were retrospectively evaluated. RESULTS: Their median age at the time of diagnosis was 2.5 months (range, 0-20 months). The median follow-up period was 25.5 months (range, 0-94 months). The median length at birth was 50.0 cm (range, 48-53 cm); however, height became more prominent over time, and the patients were taller than the 97th percentile at the time of the study. None of the patients had any relevant family history. Four of the 5 patients who underwent DNA sequencing had a fibrillin 1 gene mutation. All the patients with echocardiographic data of the aortic root had a z score of >2. All had mitral and tricuspid valve prolapse, and various degrees of mitral and tricuspid regurgitation. Five patients underwent open-heart surgery, including mitral valve replacement, of whom two required multiple operations. The median age at mitral valve replacement was 28.5 months (range, 5-69 months). Seven patients showed congestive heart failure before surgery or during follow-up, and required multiple anti-heart failure medications. Four patients died of heart failure at a median age of 12 months. CONCLUSION: The prognosis of infantile MFS is poor; thus, early diagnosis and timely cautious treatment are essential to prevent further morbidity and mortality.
Connective Tissue ; Diagnosis ; Early Diagnosis ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Infant, Newborn ; Korea ; Marfan Syndrome* ; Mitral Valve ; Mitral Valve Insufficiency ; Mortality ; Parturition ; Prognosis ; Retrospective Studies ; Sequence Analysis, DNA ; Tertiary Care Centers* ; Tricuspid Valve Insufficiency ; Tricuspid Valve Prolapse

We sudied, with echocardiography as a main tool, the natural processes of 211 patients with uncomplicated ventricular septal defect (VSD) (incidence, 5.33 per 1,000 live births); 146 (69.2%) had a perimenbranous VSD and 32 (15.2%) had a subarterial, 25 (11.8%) had a muscular type of VSD. Cumulative rate of spontaneous closure was 26.1%. In the closure processes, about three-fourth of perimembranous VSD showed a partial closure or tunnel formation by changes of septal leaflet of the tricuspid valve, remaining one-fourth showed a "functional" complete closure. Four of 58 neonates had a partially closed-perimembranous VSD. Rates of infundibular stenosis and Eisenmenger syndrome were 6.6% and 1.4% respectively. Aortic prolapse with insufficiency was detected in 6 patients who were over 6 years of age. Surgical closure was required in 27.5% of all studied patients and in 12% of infants (14 of 177). No natural deaths were observed during the study-periods of recent 3 years. But, 3 of 58 (5.2%) were dead postoperativel (two were early, one late). Doppler color flow mapping is a valuble aid in the diagnosis of VSD and may be on reason for the observed increase in the incidence of VSDs.
Constriction, Pathologic ; Diagnosis ; Echocardiography* ; Eisenmenger Complex ; Heart Septal Defects, Ventricular* ; Humans ; Incidence ; Infant ; Infant, Newborn ; Prolapse ; Tricuspid Valve

The incidence and importance of tricuspid valve regurgitation after a blunt chest injury has risen with the increase in the number of automobile accidents and steering wheel traumas. This kind of injury has been reported more frequently in the last decade because of the better diagnostic procedures and understanding of the pathology. However, tricuspid valve regurgitation following a blunt chest injury can still be easily missed because most patients do not show symptoms at the time of the trauma. A 55-year-old male patient presented himself at our facility after suffering a chest injury from an automobile accident. His transthoracic echocardiography (TTE) revealed severe tricuspid valve regurgitation due to the prolapse of his anterior valve leaflet. We report a case of asymptomatic tricuspid regurgitation that developed after a blunt chest injury.
Automobiles ; Chordae Tendineae* ; Echocardiography ; Humans ; Incidence ; Male ; Middle Aged ; Pathology ; Prolapse ; Rupture* ; Thoracic Injuries* ; Thorax* ; Tricuspid Valve Insufficiency* ; Wounds, Nonpenetrating

Unguarded tricuspid regurgitation (TR) due to a flail tricuspid leaflet is a rare condition of newborn cyanosis. A high perinatal mortality has been associated with this fatal condition. But, there are feasible surgical repairs to improve survival. We report the case of a male full-term neonate with intractable hypoxia. He had profound tricuspid insufficiency and leaflet prolapse caused by a ruptured papillary muscle supporting the anterior leaflet of the tricuspid valve. He presented with severe cyanosis and respiratory distress immediately after birth. Despite medical management, the pulmonary vascular resistance was not decreased and a low cardiac output persisted. Initial stabilization was accomplished with nitric oxide and extracorporeal membrane oxygenation. The tricuspid valve repair surgery was successfully performed subsequently. TR resulting from papillary muscle rupture is a potentially lethal condition. Timely diagnosis and proper surgical treatment can be lifesaving.
Anoxia ; Cardiac Output, Low ; Cyanosis ; Diagnosis ; Extracorporeal Membrane Oxygenation ; Female ; Humans ; Infant, Newborn* ; Male ; Nitric Oxide ; Papillary Muscles* ; Parturition ; Perinatal Mortality ; Persistent Fetal Circulation Syndrome* ; Prolapse ; Rupture ; Thoracic Surgery ; Tricuspid Valve Insufficiency ; Tricuspid Valve* ; Vascular Resistance