1/10. Surgical correction of unusual double-outlet right ventricle.This paper presents the case history of an 8-year-old girl who had total situs inversus and double-outlet right ventricle with pulmonary stenosis and severe tricuspid insufficiency in the presence of dextrocardia with ventricular discordance. A successful repair was performed using the Rastelli technique in conjunction with replacement of the tricuspid valve with a Bjork-Shiley prosthesis. The postoperative course was uneventful, and follow-up catheterization revealed a good operative result. However, the patient died suddenly during an emotionally upsetting period about two months after the operation. Postmortem examination revealed only signs of moderately severe cardiac decompensation. Some anatomical and embryological comments are made.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/10. De Vega's tricuspid annuloplasty for Ebstein's anomaly.A case of Ebstein's anomaly as demonstrated by echocardiography and electrophysiological studies is discussed. In view of deterioration in tricuspid regurgitation and right ventricular dysfunction, successful surgical repair employing De Vega's tricuspid annuloplasty along with plication of the atrialised portion of the right ventricle is described. Intraoperative transesophageal echocardiography following the procedure revealed satisfactory repair and a significant decrease in tricuspid regurgitation. This simple technique appears to be effective in patients having anterior leaflet sufficiently large area and motion. Adequate long-term follow-up in a large series of patients is essential to confirm that it is also beneficial and durable.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/10. Traumatic tricuspid regurgitation.Tricuspid valvular insufficiency caused by blunt thoracic trauma may be clinically silent and imprecise. diagnosis is often done by cardiac catheterization and two-dimensional echocardiography (2-DE); the latter may show abnormalities of the tricuspid leaflet motion. The surgical technique for its correction is still controversial. We report here the case of an eighteen year old man who was involved in a high-speed motorcycle accident. Seven months later, due to dyspnoea and fatigue, 2D-E examination revealed cardiac enlargement and severe tricuspid regurgitation. Surgery was indicated in order to repair valve incompetence. Reinsertion of the chordae tendineae at the anterolateral papillary muscle and annuloplasty was performed and ten months postoperatively, he is in good clinical condition and 2D-E control shows a trivial residual tricuspid insufficiency.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/10. Echocardiographic findings after tricuspid valvectomy.Resection of the tricuspid valve without prosthetic replacement has successfully been performed in patients with tricuspid valvular endocarditis. Using M-mode, two-dimensional, and Doppler echocardiograms, we studied four patients who underwent tricuspid valvectomy. All patients had previous history of intravenous drug abuse and staphylococcal endocarditis with tricuspid valvular involvement. In all patients, M-mode and two-dimensional echocardiograms showed that the tricuspid valve was absent. The right ventricle was dilated, and the interventricular septum had paradoxical motion in each patient. In each patient the right atrium was dilated, and with each ventricular systole, it expanded and its short axis increased by 20 to 33 percent. This caused shift of the interatrial septum toward the left atrium, with compression of its cavity. Doppler echocardiographic studies showed retrograde flow during systole in the right atrium, inferior vena cava, and hepatic vein. Echocardiographic findings in patients with tricuspid valvectomy correlate with the pathophysiologic findings of this condition.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/10. Systolic click from a Swan-Ganz catheter: phonoechocardiographic depiction of the underlying mechanism.Although echocardiographic manifestations of Swan-Ganz catheters have received increasing attention, auscultatory sequelae have not previously been described. In the patient described in this report, insertion of a Swan-Ganz catheter resulted in a loud mid systolic click; removal of the catheter eliminated the click. Simultaneous phonoechocardiograms suggest that the click resulted from crisp contact of the catheter against the ventricular septum. Catheter momentum was enhanced by wide excursion and systemic pressures in the right ventricle; paradoxical motion of the septum during systole may have accentuated the force of its contact with the catheter.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/10. Calcific stenosis of the porcine heterograft.We have encountered two cases of late calcification of the porcine heterograft. A patient in chronic renal failure died of sepsis and endocarditis fifteen months after replacement of the mitral and tricuspid valves. At postmortem examination, both heterograft valves exhibited severe calcification and thrombosis. A second patient with rheumatic heart disease and sickle cell disease underwent mitral valve replacement for severe regurgitation. Thirty months later, cardiac catheterization revealed prosthetic valve stenosis. The valve was replaced successfully, and the excised heterograft exhibited severe calcification with restriction of leaflet motion. Although calcification of the porcine heterograft is known to occur in patients with infection or disorders of calcium metabolism, dysfunction of the heterograft is rare in our experience.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/10. Two-dimensional echocardiography in the diagnosis of carcinoid heart disease.tricuspid valve disease accounts for significant morbidity and mortality in the carcinoid syndrome, but M-mode echocardiography is often insensitive in completely defining the tricuspid valve. We performed two-dimensional echocardiography (2DE) in seven patients with proven carcinoid syndrome. There were five males and two females whose ages ranged from 53 to 79 years. The carcinoid syndrome had been present by symptoms for 12 to 84 months and by 5-HIAA levels for 6 to 84 months prior to 2DE. Short, thickened, immobile tricuspid valve leaflets, fixed in a partially open position, were visualized in two patients and confirmed in one patient at surgery. Tricuspid regurgitation was demonstrated angiographically in one and by contrast 2DE in the other. A third patient had clinical evidence of tricuspid stenosis with a doming tricuspid valve on 2DE. The motion of the tricuspid value viewed in real time was clearly distinct in these two situations. Four patients had both normal M-mode and 2DE studies despite the fact that clinical and biochemical evidence of carcinoid disease had been present for equally long periods of time. The tricuspid valve was best visualized in the parasternal right ventricular long-axis and short-axis views. The apical four-chamber view was less helpful. Thus, 2DE demonstrated specific tricuspid valve abnormalities in the carcinoid syndrome with thickening, shortening, and immobility of the leaflets when valvular regurgitation was present and thickening and doming when the valve was stenotic. 2DE should be a useful method in the diagnosis and sequential evaluation of patients with carcinoid heart disease.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/10. rupture of a papillary muscle of the tricuspid valve. Echocardiographic diagnosis.Abnormal tricuspid valve structure and motion resulting from the rupture of a right ventricular papillary muscle were visualised by two dimensional echocardiography. These findings were confirmed at operation. Two dimensional echocardiography appears to be a satisfactory method for evaluating patients with tricuspid regurgitation of sudden onset with a view to surgery.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/10. thrombosis of a St. Jude Medical tricuspid prosthesis. Case report.thrombosis of both valve leaflets of a St. Jude Medical tricuspid cardiac prosthesis, resulting in valvular dysfunction, was detected by systolic and diastolic tricuspid murmurs and confirmed by M-mode and two-dimensional echocardiograms. Thrombus formation at both hinge points of the bileaflet valve caused one leaflet to stick in the nearly closed position and the other to have severely impeded motion. Thrombotic involvement of both valve leaflets, not previously reported, occurred in a 17-year-old boy who has undergone six prosthetic cardiac valvular replacements in the past 2 years. Failure to achieve adequate anticoagulation in the early postoperative period appears to be related to the thrombosis in this case.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/10. The 'sail sound' and tricuspid regurgitation in Ebstein's anomaly: the value of echocardiography in evaluating their mechanisms.We describe a patient with Ebstein's anomaly in whom Doppler echocardiography was used to clarify the mechanism responsible for 'sail sound' and tricuspid regurgitation associated with this condition. phonocardiography revealed an additional early systolic heart sound, consisting of a first low-amplitude component (T1) and a second high-amplitude component (T2, 'sail sound'). In simultaneous recordings of the tricuspid valve motion using M mode echocardiography and phonocardiography, the closing of the tricuspid valve occurred with T1 which originated at the tip of the tricuspid leaflets, while T2 originated from the body of the tricuspid leaflets. Using color Doppler imaging, the tricuspid regurgitant signal was detected during pansystole, indicating a blue signal during the phase corresponding to T1 and a mosaic signal during the phase corresponding to T2 at end-systole. Thus, 'sail sound' in patients with Ebstein's anomaly is not simply a closing sound of the tricuspid valve, but a complex closing sound which includes a sudden stopping sound after the anterior and/or other tricuspid leaflets balloon out at systole.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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