Progression of isolated tricuspid regurgitation late after left-sided valve surgery. Clinical features and mechanisms.
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BACKGROUND: Severe tricuspid regurgitation (TR) sometimes develops late after left-sided valve surgery without left heart failure, pulmonary hypertension or rheumatic tricuspid valve. The purpose of the present study was to investigate clinical characteristics and mechanisms of severe isolated TR late after left-sided valve surgery. METHODS AND RESULTS: A total of 372 consecutive patients who underwent left-sided valve surgery between 1990 and 2003 and who were followed up with echocardiography for at least 5 years, were retrospectively investigated. The mean follow-up period was 9.4 years. Clinical background, preoperative and postoperative echocardiographic parameters were evaluated. Among the 372 patients, severe isolated TR was detected in 23 patients, which developed at a mean of 8.6 years after surgery. Twenty-two of 23 patients had undergone mitral valve surgery. Multivariate logistic regression analysis identified the presence of preoperative atrial fibrillation and preoperative ejection fraction as independent determinants for the development of severe isolated TR. In patients with severe isolated TR, the tricuspid annular diameter and the right atrial area were already enlarged early after surgery and both of these increased prior to TR progression. CONCLUSIONS: Severe isolated TR developing late after mitral valve surgery is not uncommon, thus it is important to recognize this disease entity. Annular dilatation was the main cause of isolated TR and serial echocardiographic data are important to detect progression of isolated TR and to assess its mechanisms. (+info)
Mitral valve repair in a patient with mitral regurgitation and osteogenesis imperfecta tarda.
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Improvement of mitral valve coaptation with supraannular plication of the posterior annulus--a newly designed strip for posterior annular plication--.
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PURPOSE: The aim of this study was to evaluate a newly-designed mitral annuloplasty strip (the Mitra-Lift((R)) strip) in patients undergoing mitral valve repair for mitral regurgitation (MR). METHODS: A total of 30 patients who underwent posterior mitral strip annuloplasty for moderately severe to severe MR were evaluated in this study. The strip annuloplasty (SA) consisted of the use of the newly-designed strip and the suture of the supra-annular atrial wall of 5.0 mm width and the posterior annulus. In addition to SA, six patients (20.0%) with tethered posterior leaflets required posterior leaflet augmentation. Improvement in MR and hemodynamic parameters of the valve with the fixed strip were assessed. RESULTS: After SA, all patients exhibited little or no MR, with no individual exhibiting signs of exacerbation during the follow-up period. A stable coaptation occurred below the strip and the posterior annulus due to forward movement and lifting of the posterior annulus without significant reduction of intercommissural dimension. During the cardiac cycle, the intercommissural dimensions showed considerable changes, which meant a dynamic motion of the anterior leaflet and the commissures. CONCLUSIONS: Formation of a stable leaflet coaptation was associated with a dynamic change of the intercommissural dimension during the cardiac cycle and resulted in a reliable, annuloplasty strip, representing a new concept in annuloplasty. (+info)
Percutaneous transvenous Melody valve-in-ring procedure for mitral valve replacement.
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Long-term echocardiographic follow-up after posterior mitral annuloplasty using a vascular strip for ischemic mitral regurgitation: ten-years of experience at a single center.
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