With the prevalence of atrial fibrillation and the increasing use of intracardiac pacemakers, the incidence of isolated tricuspid regurgitation is gradually increasing. Severe isolated tricuspid regurgitation has a seriously negative effect on the survival rate and life quality of patients. As the major invasive therapy, surgery is not routinely carried out due to high perioperative mortality. This article attempts to summarize the etiology, natural course and adverse consequences of isolated tricuspid regurgitation, current treatment strategies, surgical indications and techniques, efficacy evaluation, prognostic factors and transcatheter treatment progress of isolated tricuspid regurgitation, aiming to provide references for cardiologists and further researches.
This article described the clinical diagnosis and treatment of a patient with bicuspid aortic stenosis occurring severe mitral regurgitation during transcatheter aortic valve replacement. Before transcatheter aortic valve replacement, the patient’s information about medical history, signs, evaluation of CT and echocardiography were collected. After discussion by the heart team, the trans-femoral aortic valve replacement was performed. After the valve was placed during the procedure, a severe mitral regurgitation occurred. No clear causes were found, and the patient’s hemodynamics was stable. The patient recovered well during follow-up, so surgery and other treatments were not considered. This article discussed the possible mechanism and solutions of mitral regurgitation during transcatheter aortic valve replacement, and owned certain value for similar cases to refer to.
Long-term chronic internal jugular vein (IJV) insufficiency, originally viewed as a non-pathological finding, may result in cerebral venous outflow disturbance, leading to cerebral venous ischemia and cerebral nervous functional disorders. In this article we discuss probable etiologies, symptoms, diagnosis and treatment of IJV disturbance, so as to provide some insights for clinicians.
Objective To summarize the clinical characteristics and management experiences of patients with severe tricuspid regurgitation (TR) after mitral valve surgery. Methods Thirty patients were followed up and reviewed for this report. There were 1 male and 29 female patients whose ages ranged from 32 to 65 years (47.1±92 years). A total of 28 patients had atrial fibrillation and 2 patients were in sinus rhythm. There were 13 patients of mild TR, 10 patients of moderate TR and 7 patients of severe TR at the first mitral valve surgery. Five patients received the tricuspid annuloplasty of De Vega procedure at the same time, 2 patients received Kay procedure. The predominant presentation of patients included: abdominal discomfort (93.3%, 28/30), edema (66.7%,20/30), palpitation (56.7%, 17/30), and ascites (20%, 6/30). Results Nine patients underwent the secondary surgery for severe TR. The secondary surgery included tricuspid valve replacement (6 cases), mitral and tricuspid valve replacement (2 cases) and Kay procedure (1 case). Eight patients were recovered and discharged and 1 patient died from the bleeding of right atrial incision and low output syndrome. Twentyone patients received medical management and were followed up. One case was lost during followup. Conclusion Surgery or medical management should be based on the clinical characteristics of patients with severe TR after mitral valve surgery. It should be based on the features of tricuspid valve and the clinical experience of surgeon to perform tricuspid annuloplasty or replacement.
ObjectiveTo evaluate the early- and mid-term outcomes of surgical repair of persistent truncus arteriosus in children in a single institution of China.MethodsThe clinical data of 27 consecutive patients with persistent truncus arteriosus undergoing surgical repair in Guangzhou Women and Children’s Medical Center from November 2009 to May 2018 were retrospectively reviewed. There were 14 males and 13 females. Median age was 3.0 months (range: 13 days -11 years), of whom 10 (37.0%) were older than 6 months. ResultsThere were three early deaths with a mortality of 11.1%. The main complications included VSD partial repair in 2 patients, complete atrioventricular block in one patient. The mean follow-up time was 24.5±19.3 months (range: 1–76 months). There were three late deaths, and two patients lost follow. Echocardiology showed seven patients of right heart outflow tract obstruction, including three in pulmonary artery trunk, and four of pulmonary artery branches. One patient showed moderate aortic valve regurgitation. None required re-intervention during the follow-up. Survival estimates for the entire cohort following surgery were both 76.1% (95%CI 59.2% to 92.9%) at 1 year and 5 years.ConclusionThe surgical repair of persistent truncus arteriosus (PTA) remains challenges. The early- and mid-term outcomes of surgical repair of persistent truncus arteriosus are acceptable. For older children with severe pulmonary artery hypertension and/or trunk valve regurgitation, the risk of death is still higher. Some children have the higher risk of late right heart obstructive lesions.
Severe symptomatic native aortic regurgitation (AR) is associated with poor prognosis. Surgical aortic valve replacement is presently the main choice of treatment according to current guidelines. The data of safety and efficacy of transcatheter aortic valve replacement (TAVR) for patients with pure native AR were limited. In this paper, a case of AR patient with heart failure was reported. After preoperative CT evaluation and operation plan, the postoperative symptoms improved significantly. Bundle branch block and retroperitoneal hematoma appeared during hospitalization. After the treatment, the patient’s condition improved. Before the discharge, cardiac ultrasound indicated that the reflux was significantly improved, no perivalvular leakage was observed, and cardiac function was improved. AR remains a challenging pathology for TAVR. TAVR is a feasible and reasonable option for carefully selected patients with pure AR.
ObjectiveTo utilize a rapid health technology assessment to evaluate the efficacy, safety and cost-effectiveness of the MitraClip device for patients with severe mitral regurgitation (MR). MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, CBM and the CRD databases were electronically searched to collect clinical evidence and economic evaluations on the efficacy, safety and cost-effectiveness of the MitraClip device for patients with severe MR from inception to May 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, descriptive analyses and data summaries were performed. ResultsA total of 33 studies, involving 4 HTA reports, 3 RCTs, 16 systematic reviews or meta-analyses, and 10 economic evaluations were included. In the evidence comparing MitraClip and surgery, most of the literature showed that the MitraClip group had higher postoperative residual MR, fewer blood transfusion events, and fewer hospital days. We found no significant treatment effects on 30-day adverse events and mortality, and the 1-year and above survival rate. In the evidence of MitraClip versus medical therapy alone, all included studies showed that MitraClip benefited mid-term and long-term survival and reduced the incidence of subsequent cardiac hospitalizations. Economic evaluations showed that the clinical benefits were cost-effective in the setting of their health service systems. ConclusionThe available high-grade clinical evidence shows that MitraClip is effective and safe to some extent, and has cost-effectiveness compared with traditional treatment in other countries. However, the real-world effectiveness and cost-effectiveness of the MitraClip need to be tested in the Chinese population and health-care setting.
目的 總結單心室瓣膜反流的外科治療經驗，觀察治療效果。 方法 回顧性分析2006年7月至2012年1月上海交通大學醫學院附屬新華醫院61例單心室患者的臨床資料，其中男36例，女25例；手術年齡2個月至 20歲；體重2～58 kg。右心室型41例，左心室型13例，未定型型7例。根據瓣膜反流程度不同分為3組，無/微量反流組：28例，瓣膜未行處理；輕/中度反流組：21例，瓣膜未行處理；重度反流組：12例，手術同期行瓣膜成形。收集所有患者住院及隨訪資料，分析輕/中度反流組、重度反流組瓣膜反流變化趨勢，以及影響瓣膜反流的因素。結果 住院死亡5例，住院死亡率8.2% （5/61）。重度反流組患者行瓣膜成形術后反流程度較術前明顯減輕（由術前4.00級下降至術后2.08級）。隨訪56例，隨訪時間6～38個月，重度反流組隨訪10例，隨訪期間死亡2例，其余8例中重度反流2例，中度反流3例，輕度反流2例，微量反流1例；瓣膜反流程度增加趨勢明顯（由術后平均2.08級增加至平均2.75級）。輕/中度反流組隨訪19例，隨訪中無死亡，其中反流程度增加至重度3例（原1例輕度反流，2例中度反流），反流程度由輕度增加至中度3例，瓣膜反流程度由術后平均2.33級增加為平均2.58級。輕/中度反流組瓣膜反流增加率與無/輕微反流組比較差異無統計學意義（瓣膜反流增加率為31.5% vs. 19.2%，χ2=0.36，P=0.55）。單因素分析結果顯示，瓣膜反流增加者在隨訪過程中心功能較瓣膜反流無變化或減輕者明顯降低（術后左心室射血分數53.11%±5.61% vs. 59.65%±3.32%，t =-5.49，P=0.00），而左心室舒張期末容積較瓣膜反流無變化或減輕者明顯增加（t =2.58，P=0.01）。 結論 單心室合并重度瓣膜反流行瓣膜成形術近期效果較好，但隨著心功能下降、心室擴張，瓣膜反流程度加重趨勢明顯；輕/中度瓣膜反流可暫不進行處理，但部分患者瓣膜反流有增加趨勢，提示應注重術后隨訪。
ObjectiveTo summarize the surgical strategy on treating mitral desease patient associated with hypertrophic obstructive cadiomyopathy (HOCM). MethodsWe retrospectively analyzed the clinical data of 17 patients with HOCM underwent surgical treatment from November 2003 to May 2015 year. There were 10 males and 7 females with a mean age of 42.2±15.5 years ranging from 7-62 years. There were 16 patients underwent modified Morrow procedure and 1 patient underwent modified Konno procedure to relieve the obstruction of left ventricular outflow tract. And different surgical treatment of mitral valve disease was implemented depending on the severity of regurgitation and under monitoring of transesophageal echocardiography. About 2 weeks after the surgery, we performed transthoracic echocardiography to evaluate the effect of operation. ResultsNo hospital death occurred and the surgery obviously improved the symptom and cardiac function in all cases. After surgery, echocardiography revealed that the mean thickness of the ventricular septum statistically decreased (P < 0.0001), the systolic anterior motion disappeared, the outflow track pressure of left ventricle statistically decreased (P < 0.0001), and the peak flow rate of left ventricle statistically decreased. However, there was no statistical difference in the change of the left ventricular ejection fraction(P=0.083). Nine patients with no mitral regurgitation (MR) or mild MR only underwent the unblock of the left ventricular outflow track, the MR decreased to mild or disappeared. Four patients with moderate or severe MR underwent mitral valve repair, and the MR decrease to mild or disappear. There were no complications occurred regarding to prosthesis implantation over the 4 patients underwent mitral valve replacement for infective endocarditis or other causes. ConclusionFor the HOCM patients with mild MR, the unblock of the left ventricular outflow track alone can effectively improve the MR. For those combined with moderate or severe MR, we should choose mitral valve repair or replacement based on individual situation of patient.