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Lisa K. Hornberger - One of the best experts on this subject based on the ideXlab platform.
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neonatal mitral and Tricuspid valve repair for in utero papillary muscle rupture
The Annals of Thoracic Surgery, 2007Co-Authors: Petros V. Anagnostopoulos, Nelson Alphonso, Anthony Azakie, Gary W. Raff, Lisa K. Hornberger, Lars Nolke, Tom R. KarlAbstract:Background Papillary muscle rupture in the fetus and neonate is a rare event that leads to severe mitral or Tricuspid Insufficiency and is associated with high perinatal mortality. We undertook surgical repair of this lesion in the neonatal period and report on our midterm results. Methods Three neonates with Tricuspid Insufficiency and 1 infant with mitral Insufficiency, all due to papillary muscle or chordal rupture, underwent surgical repair with artificial chordal replacement and a modification of the de Vega annuloplasty technique that allowed external adjustment of the annulus size under transesophageal echocardiographic guidance after separation from cardiopulmonary bypass. Results All patients recovered well from the operation. There have been no late deaths and no valve-related complications. On discharge, all 3 patients had evidence of trace to mild atrioventricular valve regurgitation. At a median follow-up of 33 months (range, 7 to 50; 123 patient-months), all 4 patients are growing normally. Three patients have had no change in the degree of Tricuspid or mitral regurgitation. One patient required reoperation at 54 months postoperatively for acute mitral Insufficiency secondary to separation of an artificial chorda from the ventricular wall. Conclusions Surgical repair of critical neonatal Tricuspid and mitral Insufficiency associated with papillary muscle or chordal rupture is feasible and can result in good early and midterm results. Our modification of the De Vega annuloplasty technique with the ability to externally adjust the size of the annulus under echocardiographic guidance may improve the accuracy of the repair in the neonate.
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left ventricular myocardial performance in the fetus with severe Tricuspid valve disease and Tricuspid Insufficiency
American Journal of Perinatology, 2005Co-Authors: Noboru Inamura, Mio Taketazu, Jeffrey F Smallhorn, Lisa K. HornbergerAbstract:We sought to determine whether left ventricular (LV) function is abnormal in a fetus with severe Tricuspid valve disease (TVD), and whether it may contribute to the outcome. We measured the LV Tei index (including isovolumic relaxation [IRT], contraction, and ejection times) in 31 fetuses with TVD, compared the data with measurements from 32 normal fetuses, and correlated these measurements with pulmonary morphology and outcome. LV Tei index was significantly greater, ejection times shorter, and IRT longer in TVD compared with controls. The Tei index was highest in fetuses with either pulmonary Insufficiency or atresia compared with those with forward flow. Finally, LV Tei index was significantly greater in fetuses with fetal (n = 5) or neonatal (n = 9) demise than in neonatal survivors (n = 7). Global LV performance as assessed by the Tei index is abnormal in TVD and likely contribute to the high mortality associated with TVD.
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Tricuspid valve disease with significant Tricuspid Insufficiency in the fetus diagnosis and outcome
Journal of the American College of Cardiology, 1991Co-Authors: Lisa K. Hornberger, Charles S Kleinman, David J Sahn, Joshua A Copel, Kathryn L ReedAbstract:The echocardiographic studies and clinical course of 27 fetuses (mean gestational age 26.9 weeks) diagnosed in utero with Tricuspid valve disease and significant Tricuspid regurgitation were reviewed. The diagnosis of Ebstein's anomaly was made in 17 of the fetuses, 7 had Tricuspid valve dysplasia with poorly developed but normally attached leaflets and 2 had an unguarded Tricuspid valve orifice with little or no identifiable Tricuspid tissue. One fetus was excluded from data analysis because a more complex heart lesion was documented at autopsy. All fetuses had massive right atrial dilation and most who were serially studied had progressive right-sided cardiomegaly. Hydrops fetalis was found in six cases and atrial flutter in five. Associated cardiac lesions included pulmonary stenosis in five cases and pulmonary atresia in six. Four fetuses with normal forward pulmonary artery flow at the initial examination were found at subsequent study to have retrograde pulmonary artery and ductal flow in association with the development of pulmonary stenosis (n = 1) and pulmonary atresia (n = 3). On review of the clinical course of the 23 fetuses (excluding 3 with elective abortion), 48% of the fetuses died in utero and 35% who were liveborn died despite vigorous medical and, when necessary, surgical management, many of whom had severe congestive heart failure. Of the four infants who survived the neonatal period, three had a benign neonatal course, all of whom were diagnosed with mild to moderate Ebstein's anomaly; only one had pulmonary outflow obstruction. An additional finding at autopsy was significant lung hypoplasia documented in 10 of 19 autopsy reports.(ABSTRACT TRUNCATED AT 250 WORDS)
Keith E Cook - One of the best experts on this subject based on the ideXlab platform.
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veno venous extracorporeal membrane oxygenation with interatrial shunting a novel approach to lung transplantation for patients in right ventricular failure
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Daniele Camboni, Begum Akay, Joshua R Pohlmann, Kelly L Koch, Jonathan W Haft, Robert H Bartlett, Keith E CookAbstract:Objective This study evaluated the effectiveness of an atrial septostomy with veno-venous extracorporeal membrane oxygenation in alleviating high afterload right ventricular dysfunction while providing respiratory support. This technique could be applied as a bridge to lung transplantation. Methods Sheep (56 ± 3 kg) underwent a clamshell thoracotomy and hemodynamic instrumentation, including right ventricular pressure and cardiac output. Sheep with and without Tricuspid Insufficiency (n = 5 each) were examined. While sheep were on extracorporeal membrane oxygenation, right ventricular failure was established by banding the pulmonary artery until cardiac output was 40% to 60% of baseline. An extracardiac atrial shunt was created with modified vascular grafts to examine the effect of shunt flow on hemodynamics. Hemodynamic data were thus collected at baseline, during right ventricular failure, and for 1 hour at 100% (fully open), 70%, 50%, and 30% of baseline shunt flow. Results Cardiac output was returned to baseline values (Tricuspid Insufficiency: 5.2 ± 0.2 L/min, without Tricuspid Insufficiency: 5.3 ± 1.2 L/min) with 100% shunt flow (Tricuspid Insufficiency: 4.8 ± 1.1 L/min, without Tricuspid Insufficiency: 4.8 ± 1.0 L/min; P = .15) but remained significantly lower than baseline at 70% to 30% shunt flow. At 100% shunt flow, Tricuspid Insufficiency shunt flow was 1.4 ± 0.8 L/min and without Tricuspid Insufficiency shunt flow was 1.7 ± 0.2 L/min. Right ventricular pressure was significantly elevated over baseline values at all shunt flows ( P 001). In the group without Tricuspid Insufficiency, all sheep died beginning at the 70% shunt condition, whereas all animals with Tricuspid Insufficiency survived the entire experiment. Normal arterial blood gases were maintained under all conditions. Conclusions An atrial septostomy accompanied by veno-venous extracorporeal membrane oxygenation is capable of eliminating right ventricular failure while maintaining normal arterial blood gases if sufficient shunt flows are achieved. The presence of Tricuspid Insufficiency improves the efficacy of the shunt.
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use of venovenous extracorporeal membrane oxygenation and an atrial septostomy for pulmonary and right ventricular failure
The Annals of Thoracic Surgery, 2011Co-Authors: Daniele Camboni, Begum Akay, Jonathan W Haft, Robert H Bartlett, Peter Sassalos, John M Toomasian, Keith E CookAbstract:Background Right ventricular failure is a major contributor to morbidity and mortality on the lung transplant waiting list. This study was designed to evaluate the effectiveness of an atrial septostomy with venovenous extracorporeal membrane oxygenation (VV-ECMO) as a novel potential bridge to transplantation. Methods Adult sheep (58 ± 3 kg; n=12) underwent a clamshell thoracotomy and instrumentation to measure all relevant pressures and cardiac output (CO). Sheep with Tricuspid Insufficiency (TI [n = 5]) and without Tricuspid Insufficiency (OTI [n = 7]) were examined. After creation of a 1-cm atrial septal defect and initiating VV-ECMO, the pulmonary artery (PA) was banded to allow progressive reduction of pulmonary blood flow, and data were collected. Results The CO in both groups remained unchanged from baseline at all pulmonary blood flow conditions. With TI, the CO was 5.1 ± 1.2 L/min at baseline versus 5.1 ± 1.2 L/min with a fully occluded PA ( p = 0.99). For OTI, the CO was 4.5 ± 1.4 L/min at baseline versus 4.5 ± 1.2 L/min with no pulmonary blood flow ( p = 0.99). Furthermore, CO was not affected by the presence of TI ( p = 0.76). Mean right ventricular pressures were significantly lower in the TI group (TI = 20.2 ± 11 mm Hg versus OTI = 29.9 ± 8.9 mm Hg; p p > 0.5). Lastly, VV-ECMO maintained normal blood gases, with mean O 2 saturations of 99% ± 4.1% in both groups. Conclusions Right to left atrial shunting of oxygenated blood with VV-ECMO is capable of maintaining normal systemic hemodynamics and normal arterial blood gases during high right ventricular afterload dysfunction.
Ettore Vitali - One of the best experts on this subject based on the ideXlab platform.
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Tricuspid regurgitation secondary to mitral valve disease Tricuspid annulus function as guide to Tricuspid valve repair
Cardiovascular Surgery, 2001Co-Authors: Tiziano Colombo, Claudio Russo, Guglielma Rita Ciliberto, Marco Lanfranconi, Giuseppe Bruschi, Salvatore Agati, Ettore VitaliAbstract:Abstract Methods. A prospective analysis was performed on 50 patients (pts) with rheumatic mitral disease and associate secondary Tricuspid Insufficiency who underwent mitral valve replacement from January 1995 to December 1998. Surgical indication to Tricuspid annuloplasty was considered in patients with echocardiographic Tricuspid annulus diameter >21 mm/m2, regardless semiquantitative evaluation of Tricuspid Insufficiency. De Vega annuloplasty was performed in 33 out of 50 patients. Results. Hospital mortality was 2.0% (CL 0.3–3.6). The follow up of the discharged patients ranged from 3 to 48 months (mean 25±15.9). Three late deaths occurred (6.1% CL 2.8–9.2). Forty-two patients out of the 46 followed up (91.3% CL 84.9–93.8) were in I or II NYHA class. In eight patients (16.3% of discharged patients) the obtained result has been considered as ‘negative late results’: persisting moderate (three cases) or moderate-severe (five cases) TrI, together with congestive heart failure requiring a furosemide intake of >25 mg/day. No patients had severe TrI at follow up. The statistics analysis demonstrated the ‘preoperative fraction shortening of the Tricuspid annulus’ (P=0.038) as factor predictive of late negative result. The incidence of late negative result was 57.1% among patients with fractional shortening lower than 25% and 0% among those patients with fractional shortening greater than 25% (P=0.0001). Conclusions. The choice to treat the Tricuspid Insufficiency according to indexed Tricuspid annulus dimension (>21 mm/m2) has been effective in terms of clinical efficacy and of late functional result. Fractional shortening of the Tricuspid annulus, expression of right ventricular cardiomyopathy in patients with poorest prognosis, affects the postoperative evolution of Tricuspid Insufficiency.
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evaluation and treatment of secondary Tricuspid Insufficiency
European Journal of Cardio-Thoracic Surgery, 1992Co-Authors: A Pellegrini, Tiziano Colombo, Francesco Donatelli, M Lanfranchi, E Quaini, Claudio Russo, Ettore VitaliAbstract:To define the role of functional Tricuspid Insufficiency and right ventricular (RV) failure in patients with mitral disease, the data of 121 patients with secondary Tricuspid Insufficiency that underwent mitral valve replacement (MVR) from January 1982 to December 1987 were analyzed. The mitral hemodynamic lesion was: stenosis in 41 patients (33.9%); Insufficiency in 11 (9.1%) and mixed stenosis and Insufficiency in 69 (57.0%). NYHA functional class was: II in 4 patients (3.3%), III in 78 (64.5%) and IV in 39 (32.2%). In 100 cases (group 1) with Tricuspid Insufficiency defined as moderate or severe, a De Vega annuloplasty was performed while in 21 (group 2) with mild Tricuspid Insufficiency, no Tricuspid surgical procedure was performed. Hospital deaths occurred in 17 of 121 patients [14% (CL 10.8-17.0)]. There was no significant difference in hospital mortality between group 1 and group 2 (15% vs 9.5%; P = 0.75). Incremental risk factors for hospital mortality as determined by multivariate analysis, include: cardiothoracic ratio (P = 0.0016), total aortic cross-clamp time (P = 0.006), associated cardiac disease (P = 0.0209) and emergency operations (P = 0.0318). Mean follow-up of surviving patients was 50.1 +/- 28.1 months. Late deaths occurred in 16 patients [15.4% (CL 11.7-18.7)]. The actuarial survival rate was 85.6% and 73.8% at 5 and 9 years, respectively. Nine patients [8.6% (CL 5.9-11.3)] required reoperation. There was no significant difference between group 1 and group 2 in the rate of late cardiac related deaths (5.9% vs 5.3%, P = 0.66) and of Tricuspid reoperations (4.7% vs 5.3%, P = 0.62).(ABSTRACT TRUNCATED AT 250 WORDS)
Daniele Camboni - One of the best experts on this subject based on the ideXlab platform.
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veno venous extracorporeal membrane oxygenation with interatrial shunting a novel approach to lung transplantation for patients in right ventricular failure
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Daniele Camboni, Begum Akay, Joshua R Pohlmann, Kelly L Koch, Jonathan W Haft, Robert H Bartlett, Keith E CookAbstract:Objective This study evaluated the effectiveness of an atrial septostomy with veno-venous extracorporeal membrane oxygenation in alleviating high afterload right ventricular dysfunction while providing respiratory support. This technique could be applied as a bridge to lung transplantation. Methods Sheep (56 ± 3 kg) underwent a clamshell thoracotomy and hemodynamic instrumentation, including right ventricular pressure and cardiac output. Sheep with and without Tricuspid Insufficiency (n = 5 each) were examined. While sheep were on extracorporeal membrane oxygenation, right ventricular failure was established by banding the pulmonary artery until cardiac output was 40% to 60% of baseline. An extracardiac atrial shunt was created with modified vascular grafts to examine the effect of shunt flow on hemodynamics. Hemodynamic data were thus collected at baseline, during right ventricular failure, and for 1 hour at 100% (fully open), 70%, 50%, and 30% of baseline shunt flow. Results Cardiac output was returned to baseline values (Tricuspid Insufficiency: 5.2 ± 0.2 L/min, without Tricuspid Insufficiency: 5.3 ± 1.2 L/min) with 100% shunt flow (Tricuspid Insufficiency: 4.8 ± 1.1 L/min, without Tricuspid Insufficiency: 4.8 ± 1.0 L/min; P = .15) but remained significantly lower than baseline at 70% to 30% shunt flow. At 100% shunt flow, Tricuspid Insufficiency shunt flow was 1.4 ± 0.8 L/min and without Tricuspid Insufficiency shunt flow was 1.7 ± 0.2 L/min. Right ventricular pressure was significantly elevated over baseline values at all shunt flows ( P 001). In the group without Tricuspid Insufficiency, all sheep died beginning at the 70% shunt condition, whereas all animals with Tricuspid Insufficiency survived the entire experiment. Normal arterial blood gases were maintained under all conditions. Conclusions An atrial septostomy accompanied by veno-venous extracorporeal membrane oxygenation is capable of eliminating right ventricular failure while maintaining normal arterial blood gases if sufficient shunt flows are achieved. The presence of Tricuspid Insufficiency improves the efficacy of the shunt.
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use of venovenous extracorporeal membrane oxygenation and an atrial septostomy for pulmonary and right ventricular failure
The Annals of Thoracic Surgery, 2011Co-Authors: Daniele Camboni, Begum Akay, Jonathan W Haft, Robert H Bartlett, Peter Sassalos, John M Toomasian, Keith E CookAbstract:Background Right ventricular failure is a major contributor to morbidity and mortality on the lung transplant waiting list. This study was designed to evaluate the effectiveness of an atrial septostomy with venovenous extracorporeal membrane oxygenation (VV-ECMO) as a novel potential bridge to transplantation. Methods Adult sheep (58 ± 3 kg; n=12) underwent a clamshell thoracotomy and instrumentation to measure all relevant pressures and cardiac output (CO). Sheep with Tricuspid Insufficiency (TI [n = 5]) and without Tricuspid Insufficiency (OTI [n = 7]) were examined. After creation of a 1-cm atrial septal defect and initiating VV-ECMO, the pulmonary artery (PA) was banded to allow progressive reduction of pulmonary blood flow, and data were collected. Results The CO in both groups remained unchanged from baseline at all pulmonary blood flow conditions. With TI, the CO was 5.1 ± 1.2 L/min at baseline versus 5.1 ± 1.2 L/min with a fully occluded PA ( p = 0.99). For OTI, the CO was 4.5 ± 1.4 L/min at baseline versus 4.5 ± 1.2 L/min with no pulmonary blood flow ( p = 0.99). Furthermore, CO was not affected by the presence of TI ( p = 0.76). Mean right ventricular pressures were significantly lower in the TI group (TI = 20.2 ± 11 mm Hg versus OTI = 29.9 ± 8.9 mm Hg; p p > 0.5). Lastly, VV-ECMO maintained normal blood gases, with mean O 2 saturations of 99% ± 4.1% in both groups. Conclusions Right to left atrial shunting of oxygenated blood with VV-ECMO is capable of maintaining normal systemic hemodynamics and normal arterial blood gases during high right ventricular afterload dysfunction.
Sang Seok Jeong - One of the best experts on this subject based on the ideXlab platform.
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repair of ruptured papillary muscle of the Tricuspid valve as a cause of Tricuspid Insufficiency following blunt chest trauma
The Korean Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Jung Hee Bang, Jong Soo Woo, Pill Jo Choi, Kwon Jae Park, Sang Seok JeongAbstract:A 47-year-old man presented with complaints of chest pain and dyspnea caused by deceleration injury due to an automobile accident. Systolic cardiac murmur was audible at the right sternal border. An electrocardiogram showed sinus tachycardia. Transthoracic echocardiography revealed a flailing anterior leaflet of the Tricuspid valve, papillary muscle rupture, and severe valve Insufficiency. Rupture of papillary muscle of the anterior leaflet and chordae tendineae of the posterior leaflet were confirmed by right atrial incision under routine cardiopulmonary bypass. Artificial chordae tendineaes were implanted between the anterior and posterior leaflet and papillary muscles in the right ventricles. De-Vega annuloplasty was also added. This is a very rare case in which a surgery was done for Tricuspid valve regurgitation caused by post-traumatic papillary muscle rupture.
