Tricuspid regurgitation (TR) is a common but often neglected valvular heart disease. Growing evidence has highlighted its association with poor prognosis and the complexity of its management. In recent years, transcatheter tricuspid valve intervention (TTVI) has emerged as a promising minimally invasive approach, with accumulating evidence supporting its safety and short-term efficacy. Transcatheter approaches offer a new therapeutic alternative for high-risk TR patients, but the clinical indications for TTVI are still being refined. This review summarizes recent advancements in TTVI technology, compares the indications for surgical and transcatheter therapies, and discusses the critical role of right heart function and pulmonary circulation in therapeutic decision-making.
Objective To investigate the changes of pulmonary circulation and right ventricular function after lung volume reduction surgery. Methods We retrospectively analyzed the clinical data of 34 patients of severe chronic obstructive pulmonary disease with single or double lung volume reduction surgery through thoracoscope in our hospital from 2013 through 2014. Ultrasonic testing was conducted peroperatively, on postoperative day 3–5, at 1 month and 3 months after surgery. Results Right ventricular stroke volume (61.00±10.54 ml vs. 38.34±10.04 ml) and right ventricular ejection fraction decreased (58.00%±9.00% vs. 49.00%±10.00%), mean pulmonary arterial pressure (23.35±5.07 mm Hg vs. 29.57±6.32 mm Hg) and total pulmonary vascular resistance (9.28±2.14 mm Hg vs. 12.05±4.36 mm Hg) increased with statistical differences (P＜0.05) on postoperative day 3–5. Right heart ejection fraction was 51%±11% with a statistical increase (P＜0.05) at 1 month after surgery. There was no statistical difference in indicators above between 3 months after surgery and before surgery. Conclusion Changes of pulmonary circulation and right ventricular function may be temporary. Right ventricular dysfunction decreases, pulmonary arterial pressure, and total pulmonary vascular resistance increases on postoperative day 3–5 d. But the changes gradually recover in 1–3 months after surgery, and could be gradually restored to preoperative level.
Objective To investigate the surgical indications and the mid and long term results of morphologic tricuspid valve replacement for corrected transposition of the great arteries（cTGA）. Methods From September 1997 to September 2007, 18 cases with cTGA were treated in Fu Wai Hospital. There were 15 male and 3 female, aged from 16 to 51 years（33.3±12.8 years）, and weighed from 47 to 90 kg(60.9±14.7 kg). There were 10 cases with isolated morphologic tricuspid valve insufficiency, 3 complicated with ventricular septal defect, 2 complicated with ventricular septal defect and pulmonary valve stenosis, 2 with morphologic tricuspid valve insufficiency after septal defect repair, and 1 with mechanical valve dysfunction after morphologic tricuspid valve replacement. The preoperative mean morphologic right ventricle ejection fraction was 562%±11.6%. Of the 18 cases, 12 were in grade Ⅱ and 6 were in grade Ⅲ according to New York Heart classification（NYHA）.All the cases had undergone morphologic tricuspid valve replacement. Postoperative indices such as cardiac function and morphological right ventricle ejection fraction were followed up. Results One patient died of postoperative low cardiac output syndrome. Two had pervavlvular leak, which were cured by pervavlvular leak repair at 7th and 30th day after operation, respectively. Sixteen were followed up with a followup time of 57.0±407 months. There was no statistical significance between preoperative and postoperative mean morphologic right ventricle ejection fraction（52.8%±9.2% vs.56.2%±11.6%; t=2.062, Pgt;0.05）. The followup showed that 12 were in NYHA grade Ⅰ or Ⅱ, and 4 were in NYHA grade Ⅲ. There was no statistical significance between preoperative and postoperative percentage of cases in NYHA grade Ⅲ（χ2=1.532，Pgt;0.05）. Conclusion Morphologic tricuspid valve replacement can prevent the further damage to morphologic right ventricular function caused by morphologic tricuspid valve insufficiency. The mid and long term results were satisfying. During the followup, the morphologic right ventricle can function appropriately.
ObjectiveTo summarize the early and mid-term surgical outcomes of cone reconstruction for Ebstein’s anomaly. MethodsPatients with Ebstein’s anomaly who underwent cone reconstruction at Guangdong Provincial People’s Hospital from 2015 to 2024 were retrospectively enrolled. Baseline characteristics, echocardiographic parameters before and after surgery, and follow-up results were collected and analyzed. ResultsA total of 115 patients were included, comprising 28 males and 87 females, with a mean age of (33.29±15.72) years. There were 94 patients in the adult group (>14 years old), and 21 patients in the pediatric group (≤14 years old). Severe or greater tricuspid regurgitation was present in 98.3% of patients preoperatively, and 89.6% were in New York Heart Association (NYHA) functional class Ⅱ. All patients successfully underwent cone reconstruction. The in-hospital reoperation rate for tricuspid valve disease was 1.7%, and no in-hospital death occurred. In the pediatric group, tricuspid regurgitation area and right atrial longitudinal dimension were significantly smaller at 5 days, 6 months, and 1 year postoperatively than preoperative values (P<0.05). In the adult group (n=92, excluding 2 patients who underwent in-hospital reoperation for tricuspid valve disease), tricuspid regurgitation area, pulmonary artery systolic pressure, right atrial longitudinal dimension and anteroposterior diameter of the right ventricular outflow tract were significantly decreased at 5 days, 6 months, and 1 year after surgery (P<0.05), while the right ventricular longitudinal dimension was significantly increased (P<0.001) compared to preoperative levels. The left ventricular end-diastolic and end-systolic diameters were significantly increased at 6 months and 1 year postoperatively (P<0.001). Right heart functional parameters (right ventricular fractional area change, tricuspid annular plane systolic excursion, and tricuspid annular myocardial systolic velocity) demonstrated a trend of gradual recovery after an initial decline in the early postoperative period. The median follow-up duration was 1.8 years, with a follow-up rate of 95.7%. During the follow-up, 3 patients underwent repeated tricuspid valve surgery and 1 patient died. ConclusionCone reconstruction is safe and effective for Ebstein’s anomaly, and can significantly alleviate tricuspid regurgitation and reverse right heart structural remodeling. Both pediatric and adult patients achieve marked improvements in tricuspid regurgitation and right heart morphology, additionally, adult patients also gain obvious benefits in left heart function. Postoperative right heart function shows a gradual recovery trend, with favorable mid-term follow-up outcomes.