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Functional tricuspid regurgitation (TR) can develop either because of right ventricular (RV) remodeling (ventricular functional TR) and/or right atrial dilation (atrial functional TR). This meta-analysis aimed to investigate the association between right heart remodeling and long-term (>1 year) all-cause mortality in patients with significant TR (at least moderate, ≥2+). MEDLINE, ISI Web of Science, and SCOPUS databases were searched. Studies reporting data on at least 1 RV functional parameter and long-term all-cause mortality in patients with significant TR were included. This study was designed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) requirements. Out of 8,902 studies, a total of 14 were included, enrolling 4,394 subjects. The duration of follow-up across the studies varied, ranging from a minimum of 15.5 months to a maximum of 73.2 months. Overall, long-term all-cause mortality was 31% (95% CI: 20%-41%; P ≤ 0.001). By means of meta-regression analyses, an inverse relation was found between tricuspid annular plane systolic excursion (11 studies enrolling 3,551 subjects, −6.3% [95% CI: −11.1% to −1.4%]; P = 0.011), RV fractional area change (9 studies, 2,975 subjects, −4.4% [95% CI: −5.9% to −2.9%]; P < 0.001), tricuspid annular dimension (7 studies, 2,986 subjects, −4.1% [95% CI: −7.6% to −0.5%]; P = 0.026), right atrial area (6 studies, 1,920 subjects, −1.9% [95% CI: −2.5% to −1.3%]; P < 0.001) and mortality. RV dysfunction parameters are associated to worse clinical outcomes in patients with TR, whereas right atrial dilatation is linked to a better prognostic outcome. Further studies are needed to unravel the pathophysiological differences within the functional TR spectrum. (Right heart remodeling and outcomes in patients with tricuspid regurgitation; CRD42023418667) [Display omitted] [ABSTRACT FROM AUTHOR]

In patients undergoing mitral valve surgery, optimal management of less-than-severe concomitant tricuspid valve regurgitation (TR) is unclear, as there are few long-term data. This study examines progression of TR, patient survival, and reoperations in patients undergoing mitral valve surgery. There were 1588 patients who underwent degenerative mitral valve surgery and had pre- and postoperative echocardiograms for assessment of TR severity and tricuspid annulus diameter. Analysis used repeated-measures ordinal regression to model the longitudinal trends in TR grade and proportional hazards regression for long-term survival and reoperation outcomes. Concomitant tricuspid valve (TV) surgery was performed in 235 (14.8%) patients. In response to surgery, TR grades improved more in patients with concomitant TV intervention regardless of the severity of preoperative TR, and these early trends were sustained over long-term follow-up. Risk of progression to severe TR was not influenced by tricuspid annulus diameter (P =.226). After we adjusted for underlying health characteristics, survival following mitral valve surgery was similar in patients with and without TV intervention. Late TV reoperation was observed in 22 patients (5-year cumulative risk 1.5%), but among these, only 6 patients had severe TR as the primary indication for reoperation; preoperative TR grade and initial concomitant TV surgery were not associated with incidence of reoperation. Concomitant TV surgery for moderate TR reduces progression of TR but did not influence survival or incidence of reoperation. Among patients with less-than-severe preoperative TR, tricuspid annular diameter was not associated with progression to severe TR. [ABSTRACT FROM AUTHOR]

Background Tricuspid annular disjunction (TAD) is an annular disjunction of the right-sided heart. Although TAD is often concomitant with mitral annular disjunction (MAD), it often presents as mitral regurgitation (MR), rather than tricuspid regurgitation (TR). While the clinical significance of MAD has been well-established, there is still little data on TAD. This is a rare case of severe TR due to TAD that appears to be isolated from MAD. Case summary A 63-year-old female complaining of pre-syncope and dyspnoea on exertion was referred to our department. Initial transthoracic echocardiography showed MR and TR due to tricuspid valve prolapse (TVP). On transoesophageal echocardiography, the TVP consisted of an excessively redundant anterior leaflet, where the annular disjunction and severe regurgitation were formed. She recently underwent mitral and tricuspid valve plasties for symptomatic primary severe TR. Discussion This case report emphasizes the clinical significance of TAD as a potential cause of severe TR, even without significant MR. Tricuspid annular disjunction progresses more gradually compared with MAD. This case suggests that remodelling of the right atrium, particularly in chronic atrial fibrillation, may contribute to the development of TR. Despite diagnostic challenges due to the flexible and dynamic nature of the tricuspid annulus, this is the first report of TAD-induced severe TR necessitating surgical intervention. Accurately diagnosing TAD remains challenging with current imaging modalities, emphasizing the need for improved diagnostic tools to optimize treatment strategies. [ABSTRACT FROM AUTHOR]

Aims Depending on volume status, secondary tricuspid regurgitation (sTR) has a strong dynamic component. In contrast, associated structural dilatation of the tricuspid annulus and the right heart chambers may be less volume dependent. This study aimed to assess the prognostic value of right heart remodelling in isolated severe sTR (isoTR). Methods and results A total of 36 000 patients from the longitudinal echocardiographic database of our tertiary centre were screened for severe isoTR [vena contracta (VC) ≥ 7 mm] in the absence of atrial fibrillation (AF), other valve disease, and/or reduced systolic left ventricular function. Echocardiographic examinations were re-read, focusing on right ventricular (RV) parameters and on quantitative and qualitative parameters of isoTR. All-cause mortality was defined as the primary endpoint. Two hundred and sixteen patients fulfilled the inclusion criteria. Severe TR was predominant; only few were classified in the new grades massive [ n = 23 (10%)] and torrential TR [ n = 4 (2%)]. During a median follow-up of 35 months (20–53), all-cause mortality was 31% (n = 67). Multivariate Cox regression analysis revealed no association of VC, effective regurgitant orifice area, or regurgitant volume with all-cause mortality. However, indexed RV end-diastolic diameter (P < 0.001), indexed right atrial dimensions (P = 0.019), and particularly tricuspid valve (TV) annulus diameter diastole index (P = 0.002) and TV annulus diameter systole index (P = 0.001) were significantly associated with outcome. Conclusion Severe isolated TR in the absence of AF is a rare finding with a grim prognosis. Tricuspid annular diameter dimensions rather than quantitative measures of TR proved to be of significant prognostic value indicating a continuous remodelling leading to a 'point of no return' with a dismal outcome. [ABSTRACT FROM AUTHOR]

Aims Higher left ventricular (LV) ejection fraction (EF) is related to unfavourable prognosis in patients with heart failure (HF) with preserved ejection fraction (HFpEF). The cause of this finding needs to be haemodynamically explained. Thus, we investigated this crucial issue from the perspective of LV–arterial (A) and right ventricular (RV)–pulmonary arterial (PA) coupling. Methods and results Study patients were derived from our prospective cohort study of patients hospitalized due to acute decompensated HF and LVEF > 40%. We divided the 255 patients into three groups: HF with mildly reduced EF (HFmrEF), HFpEF with 50% ≤ LVEF < 60%, and HFpEF with LVEF ≥ 60%. We compared LV end-systolic elastance (Ees), effective arterial elastance (Ea), and Ees/Ea as a representative of LV–A coupling among groups and compared the ratio of tricuspid annular plane excursion to peak pulmonary arterial systolic pressure (TAPSE/PASP) as a representative of RV–PA coupling. All-cause death and readmission due to HF-free survival was worse in the group with a higher LVEF range. Ees/Ea was greater in HFpEF patients with LVEF ≥ 60% (2.12 ± 0.57) than in those with 50% ≤ LVEF < 60% (1.20 ± 0.14) and those with HFmrEF (0.82 ± 0.09) (P < 0.001). PASP was increased in the groups with higher LVEF; however, TAPSE/PASP did not differ among groups (n = 168, P = 0.17). In a multivariate Cox proportional hazard model, TAPSE/PASP but not PASP was significantly related to event-free survival independent of LVEF. Conclusion HFpEF patients with higher LVEF have unfavourable prognosis and distinctive LV–A coupling: Ees/Ea is elevated up to 2.0 or more. Impaired RV–PA coupling also worsens prognosis in such patients. Clinical trial registration URL: https://www.umin.ac.jp/ctr/index.htm Unique identifier: UMIN000017725. [ABSTRACT FROM AUTHOR]

Severe systemic right ventricular failure with tricuspid regurgitation is associated with poor prognosis. Here, we report a case of 49-year-old patient who experienced severe systemic right ventricular failure following atrial switch. We chose the surgical strategy for this challenging case using comprehensive four-dimensional imaging. The patient underwent tricuspid valve repair and cardiac resynchronization therapy and recovered with improved cardiac function and regulated tricuspid valve regurgitation. [ABSTRACT FROM AUTHOR]

Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Uncertainties persist about whether to aggressively and effectively treat tricuspid regurgitation (TR) during mitral valve (MV) surgery. REVIEW METHODS: Systematic literature searches were performed in five databases to collect all relevant studies published before May 2022 on whether the tricuspid valve was treated during MV surgery. Separate meta-analyses were performed on data from unmatched studies and randomized controlled trials (RCT)/adjusted studies. MAIN RESULTS: A total of 44 publications were included, of which eight were RCT studies and the rest were retrospective studies. There was no difference in 30-day mortality [odds ratio (OR): 1.00, 95% CI: 0.71-1.42, OR: 0.66, 95% CI: 0.30-1.41)] or overall survival [hazard ratio (HR): 1.01, 95% CI: 0.85-1.19, HR: 0.77, 95% CI: 0.52-1.14] in unmatched studies and RCT/adjusted studies. Late mortality (OR: 0.37, 95% CI: 0.21-0.64) and cardiac-related mortality (OR: 0.36, 95% CI: 0.21-0.62) were lower in the tricuspid valve repair (TVR) group in the RCT/adjusted studies. In the unmatched studies, overall cardiac mortality (OR: 0.48, 95% CI: 0.26-0.88) was lower in the TVR group. In the late TR progression analysis, the late TR progression was lower among patients in the concomitantly intervened tricuspid group, and patients in the untreated tricuspid group were prone to TR progression in both studies (HR: 0.30, 95% CI: 0.22-0.41, HR: 0.37, 95% CI: 0.23-0.58). CONCLUSIONS: TVR concomitant with MV surgery is most effective in patients with significant TR and dilated tricuspid annulus, especially those with a significantly reduced risk of distant TR progression.

BackgroundSevere tricuspid regurgitation is a progressive disease with an unfavourable prognosis. In recent years there have been extraordinary gains in knowledge through both clinical and basic scientific work. We performed a bibliometric analysis on tricuspid regurgitation with a focus on imaging techniques and treatment approaches and to identify scientific milestones and emerging research trends.MethodsPublications, published between 2015 and 2023 were identified. Study characteristics, impact factors and countries of origin studies were recorded. Heat maps were created to visualise data and to identify leading centers. Most frequently cited publications were recognised as milestones.ResultsWe screened 3,519 studies. 368 studies were included, of which 326 were clinical studies. Clinical studies were further subdivided into interventional (n = 138), surgical (n = 115) or studies on imaging modalities (n = 74). We detected an enormous increase in scientific output worldwide, especially in imaging and interventional studies. The United States, Germany and Poland were identified as leading countries in imaging, interventions and preclinical studies respectively.ConclusionsOur study reflects the global gain in knowledge over the last 9 years. We were able to identify an annually rising number of interventional studies. Imaging studies have also seen a rapid increase, especially since 2020. In recent years, we monitored a decline in surgical studies.

The article discusses the importance of timely surgical intervention for severe tricuspid regurgitation, emphasizing the need for better risk stratification and patient selection. It highlights the benefits of tricuspid valve surgery, especially in patients with low to intermediate risk scores, and the advancements in surgical techniques that have improved outcomes. The authors stress the significance of early treatment to prevent irreversible damage and emphasize that conservative approaches may not be effective in advanced cases of tricuspid valve disease. [Extracted from the article]

The article focuses on a study that examines the prognostic value of right ventricular (RV) function in advanced heart failure patients with dilated cardiomyopathy (DCM). Topics include the assessment of conventional echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE), tissue Doppler-derived systolic motion velocity (S′) and fractional area change (FAC) in relation to patient outcomes. It found that FAC is a better predictor of outcomes compared to TAPSE.

A recent study published in the Journal of Cardiovascular Imaging explores the use of speckle tracking echocardiography (STE) as a reliable tool for evaluating right ventricle (RV) function in patients with severe tricuspid regurgitation (TR). Traditional echocardiographic methods for assessing RV function have limitations, and cardiac magnetic resonance imaging (CMR) is considered the gold standard but is expensive and time-consuming. The study found that RV free-wall longitudinal strain (RVFWLS) demonstrated the best correlation with CMR-derived RV ejection fraction (RVEF) and had superior discrimination of RV dysfunction. The use of RVFWLS could enhance clinical practice by providing a more accessible and frequent evaluation of RV function in patients with severe TR. However, there are challenges that need to be addressed before RV strain can be widely adopted in clinical practice, such as establishing normal reference values, addressing intervendor variability, and conducting prospective studies. Overall, this study advances our understanding of RV function assessment and highlights a practical and cost-effective alternative for routine clinical use. [Extracted from the article]

Background: Infective endocarditis (IE) involving tricuspid valve is rarely reported in children. Common etiological organisms of IE include Staphylococci, viridans group Streptococci, and Enterococci. Other less frequent organisms include Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella (HACEK) group, and Candida, accounting for 1% of cases. We describe the rare case scenario of tricuspid valve endocarditis caused by an unusual pathogen. Clinical Description: An 8-year-old girl presented with complaints of cough, shortness of breath, and intermittent fever for the past 2 months. Since 10 days before presentation, the fever had become high grade, continuous, and associated with chills and rigors. As per parents, the child had incidentally been detected with some congenital heart disease (CHD) at 3 months of age, documents being unavailable, child remaining asymptomatic till this presentation, without any medications. On examination, the child was malnourished with pallor, Grade 3 clubbing, tachypnea, and tachycardia. Auscultation revealed bilateral basal crepitations and a pansystolic murmur of Grade 4 in tricuspid area. Management and Outcome: Along with routine investigations, a two-dimensional echocardiography was done which revealed perimembranous ventricular septal defect with left-to-right shunt, tricuspid valve vegetations with anterior tricuspid leaflet prolapse with ruptured chordea, severe tricuspid regurgitation, and thickened aortic valve with good biventricular function. Blood culture showed growth of Streptococcus sinensis. The child was treated with oxygen, diuretics, and intravenous ciprofloxacin and gentamicin according to antibiotic sensitivity pattern. The child became hemodynamically stable and symptomatically improved after 3 weeks of treatment. Conclusion: This case creates awareness regarding an usual pathogen – S. sinensis as an etiological agent of IE, involving an unusual site – the tricuspid valve, in a child with CHD.

Background: Survival of low birth weight preterm neonates has increased with the availability of better neonatal care, however, the use of central lines for longer duration increases the risk of bacterial and fungal sepsis. Neonatal infective endocarditis (IE) is a rare presentation of neonatal sepsis and is often associated with complications and high mortality. Clinical Description: A 36 weeker, premature baby, hospitalized for early onset sepsis, was transferred to our hospital on day 15 of life, with an umbilical catheter in situ, with fever, respiratory distress, and persistent thrombocytopenia. Clinical examination revealed decreased oxygen saturation, crepitations in the right lung field, systolic murmur, and hepatomegaly. Management and Outcome: Baseline investigations revealed positive septic screen with thrombocytopenia with meningitis, neonatal cholestasis, and right sided consolidation on chest X ray. A two dimensional echocardiography (ECHO) revealed vegetation on the tricuspid valve, and blood culture from two sites revealed growth of Candida tropicalis and Serratia marcescens. Colistin, tigecycline, and amphotericin B therapy were initiated as per sensitivity along with low molecular weight heparin for prevention of embolization. The baby developed acute worsening in respiratory distress after 4 weeks of therapy. Repeat ECHO revealed increased size of cardiac vegetation and computed tomography of thorax with pulmonary angiography revealed pulmonary thromboembolism. Unfortunately, the baby succumbed to complications of IE. Conclusion: Invasive instrumentations such as umbilical catheterization and prolonged hospitalizations of premature newborns predispose them to develop IE, especially with unusual organisms. Such infections have a complicated course and may be fatal.

Background: Salmonella osteoarticular involvement is a rare complication, occurring in about 2% of the cases. Septic arthritis is exceedingly rare, involving only 0.2 % of all salmonellosis patients. Endocarditis is another complication that occurs in less than 0.8 % of cases. These complications are more likely to happen among immunocompromised patients. Case Presentation: We report a previously healthy 25-year-old man who presented with left limb pain. He had been treated for brucellosis ten days earlier by his primary care physician. Arthrocentesis and subsequent hip-joint biopsy confirmed septic arthritis due to Salmonella. However, he was unresponsive to the treatment. We found no underlying immunosuppression. A trans-esophageal echo was performed due to the continued fever and positive blood cultures. It revealed Salmonella endocarditis of the naïve tricuspid valve. He was treated via arthrotomy and antimicrobials for four weeks. Follow-up after 20 months showed no underlying immunosuppression. Conclusion: This case highlights that in patients with positive Salmonella blood cultures and a focus of infection compatible with Salmonellosis but unresponsive to treatment, searching for other foci of infection is necessary. Furthermore, physicians in endemic areas of brucellosis should consider other differential diagnoses in patients with fever and limping because any delay in diagnosing Salmonella septic arthritis can destroy the joint space with lifelong discomfort.

Abstract Background The tricuspid valve is an atrioventricular valve consisting of three lobes. We used the 3D transesophageal echocardiography to visualize position of the pulmonary artery catheter at the tricuspid valve annulus and examined where the catheter passed through at the level of the tricuspid annulus. Methods In this prospective and observational study, we monitored the pressure wave on patients undergoing cardiac surgery with the catheter placement by monitoring the pressure waveform for 8 months. We measured the time required for the catheter to pass through the tricuspid and pulmonary valves, respectively. We acquired the 3D image of the tricuspid valve by transesophageal echocardiography and determined the position of the pulmonary artery catheter at the level of the tricuspid annulus. The data were analyzed by Kruskal-Wallis test followed by Mann-Whitney test with Holm multiple comparisons. P < 0.05 was considered significant. Results Of the 116 cases, the pulmonary artery catheter passed through the tricuspid valve between antero-posterior leaflets in 78 cases (67.2 %), between septal-posterior leaflets in 25 cases (21.6 %), and between antero-septal leaflets in 2 cases (1.7 %) and the center in 11 cases (9.5 %), respectively. The time required for the catheter to pass through the pulmonary valves was significantly different among the catheter positions at the level of the tricuspid annulus. Conclusion The pulmonary artery catheter location at the level of the tricuspid annulus can be identified using 3D transesophageal echocardiography. The location of the catheter significantly affects the pulmonary artery catheter placement time.

Objective: Unusual clinical course Background: Stenting of the iliac vein remains one of the therapeutic options for the treatment of May-Thurner syndrome. Embolization of peripheral venous stents due to improper technique is a feared complication with an estimated incidence of 1% to 3%. Here we describe an interesting case of an embolized iliac vein stent in the right heart that was successfully extracted via a surgical approach. Case Report: A 52-year-old woman with a past medical history of hypertension, diabetes mellitus, and iliac vein stent (16×60 mm Zilver Vena) placement for May-Thurner syndrome presented for evaluation of shortness of breath, chest pain, and dizziness. A chest X-ray was performed, revealing a large stent in the cardiac silhouette. An echocardiogram showed a dense material across the tricuspid valve extending from the right atrium into the right ventricle. A percutaneous endovascular attempt to retrieve the stent was unsuccessful and led only to partial stent retrieval. An open sternotomy approach by a cardiac surgeon revealed the embolized stent across the tricuspid valve covered by endothelial tissue. The stent was successfully extracted without any need for tricuspid valve repair or replacement, followed by an uneventful postoperative recovery. Conclusions: The percutaneous approach is the preferred initial option for the extraction of embolized iliac vein stents into the heart. However, when such an approach fails, the surgical approach remains a feasible option. As reported in this case, the surgical retrieval of a stent can be done without any need for either tricuspid valve repair or replacement. [ABSTRACT FROM AUTHOR]

Background: The tricuspid valve is an atrioventricular valve consisting of three lobes. We used the 3D transesophageal echocardiography to visualize position of the pulmonary artery catheter at the tricuspid valve annulus and examined where the catheter passed through at the level of the tricuspid annulus. Methods: In this prospective and observational study, we monitored the pressure wave on patients undergoing cardiac surgery with the catheter placement by monitoring the pressure waveform for 8 months. We measured the time required for the catheter to pass through the tricuspid and pulmonary valves, respectively. We acquired the 3D image of the tricuspid valve by transesophageal echocardiography and determined the position of the pulmonary artery catheter at the level of the tricuspid annulus. The data were analyzed by Kruskal-Wallis test followed by Mann-Whitney test with Holm multiple comparisons. P < 0.05 was considered significant. Results: Of the 116 cases, the pulmonary artery catheter passed through the tricuspid valve between antero-posterior leaflets in 78 cases (67.2 %), between septal-posterior leaflets in 25 cases (21.6 %), and between antero-septal leaflets in 2 cases (1.7 %) and the center in 11 cases (9.5 %), respectively. The time required for the catheter to pass through the pulmonary valves was significantly different among the catheter positions at the level of the tricuspid annulus. Conclusion: The pulmonary artery catheter location at the level of the tricuspid annulus can be identified using 3D transesophageal echocardiography. The location of the catheter significantly affects the pulmonary artery catheter placement time. [ABSTRACT FROM AUTHOR]

Tricuspid valve disease is an often underrecognized clinical problem that is associated with significant morbidity and mortality. Unfortunately, patients will often present late in their disease course with severe right-sided heart failure, pulmonary hypertension, and life-limiting symptoms that have few durable treatment options. Traditionally, the only treatment for tricuspid valve disease has been medical therapy or surgery; however, there have been increasing interest and success with the use of transcatheter tricuspid valve therapies over the past several years to treat patients with previously limited therapeutic options. The tricuspid valve is complex anatomically, lying adjacent to important anatomic structures such as the right coronary artery and the atrioventricular node, and is the passageway for permanent pacemaker leads into the right ventricle. In addition, the mechanism of tricuspid pathology varies widely between patients, which can be due to primary, secondary, or a combination of causes, meaning that it is not possible for 1 type of device to be suitable for treatment of all cases of tricuspid valve disease. To best visualize the pathology, several modalities of advanced cardiac imaging are often required, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, to best visualize the pathology. This detailed imaging provides important information for choosing the ideal transcatheter treatment options for patients with tricuspid valve disease, taking into account the need for the lifetime management of the patient. This review highlights the important background, anatomic considerations, therapeutic options, and future directions with regard to treatment of tricuspid valve disease. [ABSTRACT FROM AUTHOR]

Objective To explore the difference in left ventricular reverse remodeling (LVRR) between coarctation of aorta (CoA) complicated by bicuspid aortic valve (BAV) and that by tricuspid aortic valve (TAV) after percutaneous intervention. Methods The clinical data on 47 patients undergoing percutaneous balloon dilation and stent implantation due to CoA in Fuwai Hospital of Chinese Academy of Medical Sciences from January 2014 to December 2021 were retrospectively analyzed. According to the preoperative imaging data, there were 18 patients with BAVA and 29 with TAV. The results of echocardiography before and one year after the procedure were compared. Results CoA Vmax, CoA PG, LVEDd, LVEDdi, LVM and LVMI were significantly improved in CoA patients one year after percutaneous intervention, and 23.4% of the patients developed left ventricular reverse remodeling. AV Vmax, AV PG and LVEDdi in the patients with BAV were higher than those in the TAV group (P = 0.005 and P = 0.007; P = 0.03), and the rate of left ventricular reverse remodeling in BAV patients was lower than that in TAV patients, but there was no statistical significance. Multivariate analysis did not find any influence factors affecting left ventricular reverse remodeling one year after the procedure. Conclusions Part of the CoA patients develops left ventricular remodeling reversal one year after percutaneous intervention. LVRR in patients with BAV is lower than that in those with TAV, which still needs further clinical research. [ABSTRACT FROM AUTHOR]

Orthotopic transcatheter tricuspid valve replacement (TTVR) devices have been shown to be highly effective in reducing tricuspid regurgitation (TR), and interest in this therapy is growing with the recent commercial approval of the first orthotopic TTVR. Recent TTVR studies report preexisting cardiac implantable electronic device (CIED) transvalvular leads in ∼35% of patients, with entrapment during valve implantation. Concerns have been raised regarding the safety of entrapping leads and counterbalanced against the risks of transvenous lead extraction (TLE) when indicated. This Heart Valve Collaboratory consensus document attempts to define the patient population with CIED lead-associated or lead-induced TR, describe the risks of lead entrapment during TTVR, delineate the risks and benefits of TLE in this setting, and develop a management algorithm for patients considered for TTVR. An electrophysiologist experienced in CIED management should be part of the multidisciplinary heart team and involved in shared decision making. [Display omitted] • Implanted CIED leads in patients with severe TR face risks of entrapment or complications of extraction. • An MDT, including electrophysiologists experienced in managing CIEDs, should collaborate in decision making for patients with severe TR before TTVR. • Higher quality evidence is needed to better inform estimates of the risks of entrapment and potential risks and benefits of CIED lead extraction in patients with severe TR who are undergoing transcatheter intervention. [ABSTRACT FROM AUTHOR]

Background/Objective: Cardiac magnetic resonance (CMR) is the reference method for right ventricular (RV) volume and function analysis, but time-consuming manual segmentation and corrections of imperfect automatic segmentations are needed. This study sought to evaluate the applicability of an echocardiographically established truncated cone–rhomboid pyramid formula (CPF) for simplified RV quantification using CMR. Methods: A total of 70 consecutive patients assigned to RV analysis using CMR were included. As standard method, the manual contouring of RV-short axis planes was performed for the measurement of end-diastolic volume (EDV) and end-systolic volume (ESV). Additionally, two linear measurements in four-chamber views were obtained in systole and diastole: basal diameters at the level of tricuspid valve (Dd and Ds) and baso-apical lengths from the center of tricuspid valve to the RV apex (Ld and Ls) were measured for the calculation of RV-EDV = 1.21 × Dd2 × Ld and RV-ESV = 1.21 × Ds 2 × Ls using CPF. Results: RV volumes using CPF were slightly higher than those using standard CMR analysis (RV-EDV index: 86.2 ± 29.4 mL/m2 and RV-ESV index: 51.5 ± 22.5 mL/m2 vs. RV-EDV index: 81.7 ± 24.1 mL/m2 and RV-ESV index: 44.5 ± 23.2 mL/m2) and RV-EF was lower (RV-EF: 41.1 ± 13.5% vs. 48.4 ± 13.7%). Both methods had a strong correlation of RV volumes (ΔRV-EDV index = −4.5 ± 19.0 mL/m2; r = 0.765, p < 0.0001; ΔRV-ESV index = −7.0 ± 14.4 mL/m2; r = 0.801, p < 0.0001). Conclusions: Calculations of RV volumes and function using CPF assuming the geometrical model of a truncated cone–rhomboid pyramid anatomy of RV is feasible, with a strong correlation to measurements using standard CMR analysis, and only two systolic and diastolic linear measurements in four-chamber views are needed. [ABSTRACT FROM AUTHOR]

Background: Transcatheter edge-to-edge tricuspid valve repair (T-TEER) for tricuspid regurgitation (TR) is always guided by transesophageal echocardiography (TEE). As each patient has unique anatomy and acoustic window, adding transthoracic echocardiography (TTE) and cardiac CT could improve procedural planning and guidance. Objectives: We aimed to assess T-TEER success and outcomes of a personalized guidance approach, based on multimodality imaging (MMI) of patient-tailored four right-sided chamber views (four-right-ch), as depicted by CT, TTE, TEE and fluoroscopy. Methods: Patients were assigned to MMI or classical TEE guidance, depending on TTE acoustic window. In MMI patients, planning included cardiac CT, which determined the fluoroscopic angulations of the specific four-right-ch, while guidance relied heavily on TTE, with minimal intermittent TEE for leaflet grasping and result confirmation. Both TTE and TEE were matched to respective CT and fluoroscopy four-right-ch. TR severity and quality of life (QoL) parameters were assessed from baseline to 12 months. Results: A total of 40 T-TEER patients were included, with 17 procedures guided by MMI and 23 solely by TEE. Baseline characteristics were similar between groups, e.g., age (83.1 ± 4.1 vs. 81 ± 5.3, p = 0.182) or STS-Score (11.1 ± 7.4% vs. 10.6 ± 5.9%, p = 0.813). The primary efficacy endpoint of ≥one-grade TR reduction at 30 days was 94% (16/17) in MMI vs. 91% (21/23) in TEE patients, with two or more TR grade reduction in 65% vs. 52% (p = 0.793). Device success was overall 100%, with no device-related complications, but three TEE-associated cases of gastrointestinal bleeding in the TEE-only group. By 12 months, all 15 MMI and 19 TEE survivors improved NYHA functional class and QoL, e.g., Kansas City Cardiomyopathy Questionnaire Score Δ29.6 ± 6.7 vs. 21.9 ± 5.8 (p = 0.441) pts., 6-min walk distance Δ101.5 ± 36.4 vs. 85.7 ± 32.1 (p = 0.541) meters. Conclusions: In a subset of patients with good TTE acoustic window, MMI guidance of T-TEER is effective and seems to avoid gastroesophageal injuries caused by TEE probe manipulation. TR reduction, irrespective of guidance method, impacts long-term QoL. [ABSTRACT FROM AUTHOR]

Purpose: There is currently limited information on the utility of transthoracic echocardiography (TTE)‐derived Doppler parameters for assessing bioprosthetic tricuspid valve (BTV) dysfunction. Our study aimed to establish the precision and appropriate reference ranges for routinely collected transthoracic Doppler parameters in the assessment of BTV dysfunction. Methods: We retrospectively evaluated 100 BTV patients who underwent TTE. Based on redo surgical confirmation or more than 2 repeat TTE or transesophageal echocardiography (TEE) examinations, patients were allocated to normal (n = 61), regurgitant (n = 24), or stenotic (n = 15) BTV group. Univariate and multivariate binary logistic regression were performed to identify TTE Doppler parameters that detected BTV dysfunction. Results: The VTI ratio (VTITV/VTILVOT) was the most accurate Doppler parameter for detecting BTV dysfunction, with a ratio of >2.8 showing 84.6% sensitivity and 90.2% specificity. VTI ratio > 3.2, mean gradient (MGTV) > 6.2 mmHg and pressure half‐time > 218 ms detected significant BTV stenosis, with sensitivities of 100%, 93.3% and 93.3% and specificities of 82.4%, 75.3% and 87.1%, respectively. After multivariate analysis, the VTI ratio > 2.8 (OR = 9.00, 95% CI = 2.13–41.61, p =.003) and MGTV > 5.1 mmHg (OR = 6.50, 95% CI = 1.69–27.78, p =.008) were the independent associations of BTV dysfunction. With these cutoff values, 75.0%–92.2% of normal and 62.5%–96.0% of dysfunctional BTV were identified. Conclusions: Doppler parameters from TTE can accurately identify BTV dysfunction, particularly with VTI ratio > 2.8 and MGTV > 5.1 mmHg, to assess the need for additional testing with TEE. [ABSTRACT FROM AUTHOR]

Introduction: Transvenous leads have been implicated in tricuspid valve (TV) dysfunction, but limited data are available regarding the effect of extracting leads across the TV on valve regurgitation. The aim of this study is to quantify tricuspid regurgitation (TR) before and after lead extraction and identify predictors of worsening TR. Methods: We studied 321 patients who had echocardiographic data before and after lead extraction. TR was graded on a scale (0 = none/trivial, 1 = mild, 2 = moderate, 3 = severe). A change of >1 grade following extraction was considered significant. Results: A total of 321 patients underwent extraction of a total of 338 leads across the TV (1.05 ± 0.31 leads across the TV per patient). There was no significant difference on average TR grade pre‐ and postextraction (1.18 ± 0.91 vs. 1.15 ± 0.87; p = 0.79). TR severity increased after extraction in 84 patients, but was classified as significantly worse (i.e., >1 grade change in severity) in only 8 patients (2.5%). Use of laser lead extraction was associated with a higher rate of worsening TR postextraction (44.0% vs. 31.6%, p = 0.04). Conclusion: In our single‐center analysis, extraction of leads across the TV did not significantly affect the extent of TR in most patients. Laser lead extraction was associated with a higher rate of worsening TR after extraction. [ABSTRACT FROM AUTHOR]

Considering the worsening opioid epidemic, complicated infective endocarditis (IE) secondary to intravenous drug use (IVDU) that fails medical management is increasingly common. We present a 31-year-old patient post tricuspid valve replacement who relapsed with recurrent IE and secondary complications of severe tricuspid stenosis and regurgitation, ventricular septal defect (VSD), pulmonary emboli, right-sided heart failure with severe hepatic congestion, and cardiogenic shock. Despite maximal medical management, the patient remained in septic and cardiogenic shock with a potential disposition to hospice care. Upon consulting cardiothoracic surgery, she underwent a first-stage valvectomy with central Extracorporeal Membrane Oxygenation (ECMO) as a bridge to definitive treatment. After clearance of infection, she underwent a second-stage valve replacement, VSD repair, and final ECMO decannulation. Our case alludes to ECMO as a potential bridge for patients with complicated infective endocarditis who fail medical management and are high-risk candidates for immediate definitive surgical management. [ABSTRACT FROM AUTHOR]

Objective Pregnancy-related infective endocarditis (IE) caries a high risk of morbidity and mortality. With increasing intravenous drug abuse (IVDA) amid the opioid epidemic, the risk factor profile may be shifting. In this case series, we aimed to describe risk factors and outcomes for peripartum IE in a contemporary cohort. Study Design We identified patients with IE diagnosed during pregnancy or up to 6 weeks' postpartum from 2015 through 2018 at a single tertiary care center. We abstracted detailed medical history and clinical outcome measures from the electronic medical record. The diagnosis of IE was supported by the modified Duke Criteria. Results Nine patients had peripartum IE: eight (89%) with a history of IVDA, one with an indwelling central venous catheter (11%), and one with prior IE (11%). None had preexisting congenital or valvular heart disease. Six (67%) had comorbid hepatitis C. Eight cases (89%) had gram-positive cocci with vegetations involving the tricuspid valve (56%) and both mitral and tricuspid valves (22%). Major complications included shock (33%), mechanical ventilation (44%), septic emboli (67%), and noncardiac abscesses (33%). Two patients underwent valve surgery, and there were two cases of postpartum maternal mortality (22%), one from septic shock and one from intracerebral hemorrhage. While four patients (44%) delivered preterm (average gestational age 35 weeks), most delivered vaginally (89%) with only one requiring an emergent caesarean section. There was no fetal mortality, although three newborns (43%) required admission to the neonatal intensive care unit. Two patients were initiated on medication-assisted treatment for opioid use disorder. Consultants included infectious disease, cardiology, cardiac surgery, maternal-fetal medicine, and psychiatry. Conclusion These findings confirm that IVDA is a growing risk factor for pregnancy-related IE. Peripartum IE carries a high risk of complications, including maternal mortality, and warrants management with a multidisciplinary care team at a tertiary center. Key Points Intravenous drug use was the most common risk factor for IE in pregnancy. IE in pregnancy carries a high morbidity and mortality with complications including septic emboli, septic shock, and need for mechanical ventilation. A multidisciplinary team approach can assure the best possible maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

Background: According to the current literature, there is no difference between left bundle brunch area pacing (LBBAP) and right ventricular apical pacing in terms of lead dislodgement and capture threshold elevation. However, there are no large‐scale studies reporting the data about long‐term lead stability in patients with severe tricuspid regurgitation. Methods and Results: We present a case of lead dislodgement with possible infective endocarditis six months after implantation in a patient with severe tricuspid regurgitation who underwent LBBAP. Conclusions: We concluded that severe preoperative tricuspid regurgitation may cause lead dislodgement, and infective endocarditis may be a facilitator or main reason of lead dislodgement in cases of LBBAP. [ABSTRACT FROM AUTHOR]

This report reviews an Ethiopian patient who underwent cardiac surgery and had a mechanical heart valve implanted on the mitral valve with tricuspid valve repair for rheumatic heart disease via a local non-profit organization donation later complicated by cardio-embolic stroke, and aims to describe the challenges faced by patients from rural Ethiopia who require cardiac surgery for rheumatic heart disease and narrate the importance of careful follow-up. The lessons to be drawn from this case are that careful follow-up and adherence to prescribed Vitamin K antagonists after surgery for mechanical heart valves are critical and, when such patients are lost to follow-up as was witnessed in this case, it can induce lifelong morbidity. Morbidity that could have been avoided with strict and meticulous follow-up and with standardized patient tracing or contact systems. When patients are lost to follow-up it needs to be top priority to trace them after cardiac surgery and this report highlights the pivotal role of the health education in such populations. Unless we utilize this opportunity to unlock the door and embrace a systemic approach to reforming our risk assessment, referral chain system, and integration of various healthcare professionals in patient follow-up, as well as enhancing health education among our patients in rural Ethiopia and other low-income countries, the consequences could prove to be significant. Preventing such fatal complications is far superior to managing them afterwards, as it not only saves on expenses but also saves lives and enhances quality-of-life. [ABSTRACT FROM AUTHOR]

Infective endocarditis represents a challenging and life-threatening clinical condition affecting native and prosthetic heart valves, endocardium, and implanted cardiac devices. Right-sided infective endocarditis account for approximately 5–10% of all infective endocarditis and are often associated with intravenous drug use, intracardiac devices, central venous catheters, and congenital heart disease. The tricuspid valve is involved in 90% of right-side infective endocarditis. The primary treatment of tricuspid valve infective endocarditis is based on long-term intravenous antibiotics. When surgery is required, different interventions have been proposed, ranging from valvectomy to various types of valve repair to complete replacement of the valve. Percutaneous removal of vegetations using the AngioVac system has also been proposed in these patients. The aim of this narrative review is to provide an overview of the current surgical options and to discuss the results of the different surgical strategies in patients with tricuspid valve infective endocarditis. [ABSTRACT FROM AUTHOR]

Background: Novel ultrasound technology and software processing allow offline evaluation of tricuspid annular plane systolic excursion and mitral annular plane systolic excursion measurements. We wished to compare both novel 4D matrix (eM6C) and conventional (RAB6-D) transducers with variable settings (electronic spatiotemporal image correlation, spatiotemporal image correlation and four-dimensional real time) to determine if there was a significant difference in absolute value, quality and repeatability of the resultant reconstructed image and M-mode trace. Methods: A blinded prospective cross-sectional study of normal fetuses from 23 to 38 weeks' gestation were recruited. After routine sonography, four-dimensional volumes were stored and analysed using GE 4DView™ software. Statistical analysis explored variability, correlations and repeatability of the measurements with chi-square analysis, intraclass correlations and the Bland–Altman comparison plots. A scoring system was devised for image quality. Results: Eighteen participants generated 282 data volumes. Absolute values demonstrated some inconsistencies for both tricuspid annular plane systolic excursion and mitral annular plane systolic excursion measurements with variations between transducers: the highest for the RAB6-D/spatiotemporal image correlation setting and the lowest for the four-dimensional real-time settings. The RAB6-D/spatiotemporal image correlation setting was the most repeatable combination (intraclass correlation coefficient = 0.85). Poorest image quality (M-mode trace, four-chamber view, annuli) came from the RAB6-D/four-dimensional real-time combination with the eM6C/electronic spatiotemporal image correlation and RAB6-D/spatiotemporal image correlation settings being nearly identical. Conclusion: We show that transducer and setting combinations influence absolute tricuspid annular plane systolic excursion/mitral annular plane systolic excursion measurements, so need to be articulated in future research. The transducer setting (electronic spatiotemporal image correlation/spatiotemporal image correlation/four-dimensional real time) was a more significant factor than the type of transducer (conventional vs matrix). Subjective image evaluation does not correlate well with repeatability of image acquisition. Further studies are needed to compare measurements using four-dimensional post-processing tools against conventional real-time measurements. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation, once considered a relatively benign condition, has now gathered significant attention due to new evidence showing its impact on both short- and long-term follow-up. While surgical intervention remains the established standard approach for treating severe tricuspid regurgitation, current guidelines provide Class I indication for intervention in only a limited set of scenarios. This review delves into the present and future perspectives of surgical tricuspid regurgitation management, examining aspects such as disease prognosis, surgical indications, outcomes, and a comprehensive overview of past and upcoming clinical trials. [ABSTRACT FROM AUTHOR]

Functional tricuspid regurgitation (FTR) is a common type of tricuspid regurgitation (TR), particularly in cases of left heart valve disease. Historically, cardiac surgeons have not placed much emphasis on FTR and instead focused primarily on managing left heart valve disease. However, as research has progressed, it has become evident that severe TR significantly impacts the prognosis of heart valve surgery. Furthermore, significant improvements in postoperative cardiac function and quality of life have been observed when addressing the tricuspid valve alongside left heart disease management. This article aims to review current approaches for and timing of the surgical management of FTR while also analyzing the limitations of existing tricuspid surgical strategies. [ABSTRACT FROM AUTHOR]

Background: Infective endocarditis (IE) continues to be a disease with high mortality despite medical advances. Objective: The objective of this study was to investigate the characteristics and prognosis of IE according to the affected valves. Materials and methods: This study was retrospective and single-centered, and it included 270 patients with a diagnosis of IE, for the period 2005–2021, who received treatment at the University Hospital "St. Georgi" in Plovdiv, Bulgaria. Results: Single-valve IE (SIE) was found in 82.6% (n-223), multivalvular IE (MIE) in 16.66% (n = 45) and device IE (CDRIE) in 0.74% (n = 2) of patients. The most commonly affected valve was the aortic valve, in 44.8% (n = 121). The predominant multivalvular involvement was aortic–mitral valves (AV-MV) (13.7%, n = 37). The patients with tricuspid valve (TV) IE were significantly younger, at 39 (30) years, and were more frequently male (80.8%). Mortality was higher in MIE than in SIE (31.1% vs. 23.8%) and was the highest in multivalve aortic–tricuspid (AV-TV) IE (75%). Early surgery was performed most in AV-MV IE, in 29.7% (n = 11). The Charlson comorbidity index (CCI) was significantly higher in MV 4 (4) and AV 3 (3) vs. TV IE 1 (5) (p = 0.048 and p = 0.011, respectively). Septic shock occurred most frequently in AV-TV involvement (75%; p = 0.0001). The most common causative agents were of the Staphylococcus group. Staphylococcus aureus more often affected TV alone (46.2%, n = 124) vs. AV (9.9%, n = 14; p = 0.0001) and vs. MV (22.6%, n = 17; p = 0.022); Staphylococcus coagulase-negative (CNG) was the prevalent cause of MV IE (22.7%, n = 17) vs. AV-MV (2.7%, n = 1; p = 0.007). Streptococci were represented in a low percentage and only in left-sided IE, more frequently in AV-MV (18.9%, n = 7) vs. AV (6.6%, n = 8; p = 0.025). Conclusions: The aortic valve is the most frequently affected valve, as single-valve IE or as multivalve AV-MV, with the predominant causative agents being of the Staphylococcus group. AV-TV IE has the worst prognosis, with the most common complication of septic shock and the highest in-hospital mortality. [ABSTRACT FROM AUTHOR]

Tricuspid valve annuloplasty (TA) during mitral valve repair (MVr) is associated with increased risk of permanent pacemaker (PPM) implantation, but the magnitude of risk and long-term clinical consequences have not been firmly established. This study assesses the incidence rates of PPM implantation after isolated MVr and following MVr with TA as well as the associated long-term clinical consequences of PPM implantation. State-mandated hospital discharge databases of New York and California were queried for patients undergoing MVr (isolated or with concomitant TA) between 2004 and 2019. Patients were stratified by whether or not they received a PPM within 90 days of index surgery. After weighting by propensity score, survival, heart failure hospitalizations (HFHs), endocarditis, stroke, and reoperation were compared between patients with or without PPM. A total of 32,736 patients underwent isolated MVr (n = 28,003) or MVr + TA (n = 4,733). Annual MVr + TA volumes increased throughout the study period (P < 0.001, trend), and PPM rates decreased (P < 0.001, trend). The incidence of PPM implantation <90 days after surgery was 7.7% for MVr and 14.0% for MVr + TA. In 90-day conditional landmark-weighted analyses, PPMs were associated with reduced long-term survival among MVr (HR: 1.96; 95% CI: 1.75-2.19; P < 0.001) and MVr + TA recipients (HR: 1.65; 95% CI: 1.28-2.14; P < 0.001). In both surgical groups, PPMs were also associated with an increased risk of HFH (HR: 1.56; 95% CI: 1.27-1.90; P < 0.001) and endocarditis (HR: 1.95; 95% CI: 1.52-2.51; P < 0.001), but not with stroke or reoperation. Compared to isolated MVr, adding TA to MVr was associated with a higher risk of 90-day PPM implantation. In both surgical groups, PPM implantation was associated with an increase in mortality, HFH, and endocarditis. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Alpha-gal syndrome is an allergic condition in which individuals develop an immune-mediated hypersensitivity response when consuming red meat and its derived products. Its diagnosis is important in individuals undergoing cardiac surgery, as patients frequently require large doses of unfractionated heparin or the insertion of surgical implants, both of which are porcine or bovine in origin. There are currently no guidelines for heparin administration in alpha-gal patients, with even less knowledge regarding the long-term clinical implications of these patients after receiving bioprosthetic valve replacements or other prostheses. Case presentation: We present the case of a 31-year-old male who underwent cardiac surgery in the setting of alpha-gal syndrome for a large atrial septal defect (ASD) and mitral valve prolapse (MVP). The patient continues to do well one year after undergoing a mitral valve repair, tricuspid valve repair and an ASD closure using bovine pericardium. He sustained no adverse reaction to the use of heparin products or the presence of a bovine pericardial patch. This rare case was managed by a multidisciplinary team consisting of cardiothoracic surgery, cardiac anesthesiology, and allergy/immunology that led to an optimal outcome despite the patient's pertinent allergic history. Conclusions: This case highlights that the use of bovine pericardium and porcine heparin to close septal defects in patients with milder forms of alpha-gal allergy can be considered if other options are not available. Further studies are warranted to investigate the long-term outcomes of such potential alpha-gal containing prostheses and heparin exposure and establish the optimal decision making algorithm and prophylactic regimen. [ABSTRACT FROM AUTHOR]

Featured Application: This work specifically applies to the development and validation of a cardiac simulation model that will facilitate the understanding of and mitigate tricuspid regurgitation (TR). The model employs diagnostic tools and a computational analysis to identify the medical conditions under which TR occurs and assesses the efficacy of potential interventions, notably the Pivot-TR device, in restoring normal heart valve function. Tricuspid regurgitation (TR) resulting from valve abnormalities necessitates precise diagnostic tools and interventions. We employed a simulated heart movement device to examine the performance of heart valve functions and analyzed internal pressure changes to provide a quantitative guide for TR treatment. We developed a simulator capable of replicating the flow profile, mimicking natural heart movements, with sensors installed for measuring internal pressure changes. We conducted an ex vivo experiment on a porcine heart to assess tricuspid valve functionality. An endoscope was installed, with a sensor and endoscopic images to detect abnormalities. TR became evident when the heart rate spectrum exceeded an average of 85.2 bpm (standard deviation, 1.3 bpm) and showed an amplitude higher than an average of 12.3 mmHg (standard deviation, 3.2 mmHg). This critical threshold consistently indicated TR onset. The application of the Pivot-TR attenuated this specific spectral area. We confirmed TR disappearance by reducing the intensity of the Tricuspid Regurgitation Generator or employing the Pivot-TR. The Pivot-TR's ability to attenuate specific spectral areas associated with TR onset and its effectiveness in restoring normal heart functionality has implications for managing and treating TR, particularly that resulting from age-related structural changes in the heart. [ABSTRACT FROM AUTHOR]

Severe tricuspid regurgitation (TR) is a progressive condition associated with substantial morbidity, poor quality of life, and increased mortality. Patients with TR commonly have coexisting conditions including congestive heart failure, pulmonary hypertension, chronic lung disease, atrial fibrillation, and cardiovascular implantable electronic devices, which can increase the complexity of medical and surgical TR management. As such, the optimal timing of referral for isolated tricuspid valve (TV) intervention is undefined, and TV surgery has been associated with elevated risk of morbidity and mortality. More recently, an unprecedented growth in TR treatment options, namely the development of a wide range of transcatheter TV interventions (TTVI) is stimulating increased interest and referral for TV intervention across the entire medical community. However, there are no stepwise algorithms for the optimal management of symptomatic severe TR before TTVI. This article reviews the contemporary assessment and management of TR with addition of a medical framework to optimize TR before referral for TTVI. [Display omitted] • Severe TR is common and is associated with increased mortality. • Medical optimization and multidisciplinary expertise are often required before TTVI. • Comprehensive evidence is needed to discern the ideal timing of TTVI. [ABSTRACT FROM AUTHOR]

Background: Mechanical heart valve replacement is a standard treatment for severe valvular disorders. The use of mono-leaflet valves has decreased recently. Recognizing the echocardiographic features of mono-leaflet and bileaflet valves is crucial for accurate complication diagnosis and proper management. Case Presentation: A 65-year-old female with mono-leaflet mitral and bileaflet tricuspid valves underwent an echocardiographic assessment. This simple educational case provides a unique opportunity to compare the echocardiographic features of these valves within a single patient. Conclusion: There is a crucial need for clinicians, particularly those in training, to differentiate between mono-leaflet and bileaflet mechanical heart valves adeptly. With mono-leaflet valves decreasing in prevalence, proficiency in recognizing the echocardiographic nuances of each type is imperative. Failure to do so may result in misdiagnoses and inappropriate management. This underscores the significance of continuous education and vigilance in echocardiographic assessments to ensure optimal patient care. [ABSTRACT FROM AUTHOR]

Background: Elevated central venous pressure (CVP) is deemed as a sign of right ventricular (RV) dysfunction. We aimed to characterize the echocardiographic features of RV in septic patients with elevated CVP, and quantify associations between RV function parameters and 30-day mortality. Methods: We retrospectively reviewed a cohort of septic patients with CVP ≥ 8 mmHg in a tertiary hospital intensive care unit. General characteristics and echocardiographic parameters including tricuspid annular plane systolic excursion (TAPSE), pulmonary vascular resistance (PVR) as well as prognostic data were collected. Associations between RV function parameters and 30-day mortality were assessed using Cox regression models. Results: Echocardiography was performed in 244 septic patients with CVP ≥ 8 mmHg. Echocardiographic findings revealed that various types of abnormal RV function can occur individually or collectively. Prevalence of RV systolic dysfunction was 46%, prevalence of RV enlargement was 34%, and prevalence of PVR increase was 14%. In addition, we collected haemodynamic consequences and found that prevalence of systemic venous congestion was 16%, prevalence of RV-pulmonary artery decoupling was 34%, and prevalence of low cardiac index (CI) was 23%. The 30-day mortality of the enrolled population was 24.2%. In a Cox regression analysis, TAPSE (HR:0.542, 95% CI:0.302–0.972, p = 0.040) and PVR (HR:1.384, 95% CI:1.007–1.903, p = 0.045) were independently associated with 30-day mortality. Conclusions: Echocardiographic findings demonstrated a high prevalence of RV-related abnormalities (RV enlargement, RV systolic dysfunction and PVR increase) in septic patients with elevated CVP. Among those echocardiographic parameters, TAPSE and PVR were independently associated with 30-day mortality in these patients. [ABSTRACT FROM AUTHOR]

Primary ovarian carcinoid tumors, an extremely rare subset of ovarian malignancies (<0.1% of cases), typically manifest with abdominal pain and bloating. The occurrence of carcinoid heart disease (CHD) without classic carcinoid syndrome features is exceptionally uncommon. We report a 54-year-old female presenting with dyspnea and edema over months, lacking typical carcinoid syndrome signs. Initial assessments diagnosed heart failure, supported by elevated NT-Pro BNP, echocardiographic right ventricular dilation, and pulmonary/tricuspid valve regurgitation (normal left ventricular function). Right heart catheterization showed normal pulmonary/right ventricular pressures. Subsequent investigations (computed tomography thorax abdomen pelvis, 5-hydroxyindole acetic acid levels) strongly suggested carcinoid disease, confirmed by an octreotide scan revealing an octreotide-secreting ovarian carcinoid tumor. Surgical intervention included tricuspid and pulmonary valve repair, total abdominal hysterectomy, and bilateral salpingo-oophorectomy. Primary ovarian carcinoid tumors, though rare, may lead to unexpected complications like CHD. Timely diagnosis and intervention are pivotal for optimizing patient outcomes in such cases. [ABSTRACT FROM AUTHOR]

Aims: While invasively determined congestion holds mechanistic and prognostic significance in acute heart failure (HF), its role in patients with tricuspid regurgitation (TR)‐related right‐ heart failure (HF) undergoing transcatheter tricuspid valve intervention (TTVI) is less well established. A comprehensive understanding of congestion patterns might aid in procedural planning, risk stratification, and the identification of patients who may benefit from adjunctive therapies before undergoing TTVI. The aim of this study was to investigate the role of congestion patterns in patients with severe TR and its implications for TTVI. Methods and results: Within a multicentre, international TTVI registry, 813 patients underwent right heart catheterization (RHC) prior to TTVI and were followed up to 24 months. The median age was 80 (interquartile range 76–83) years and 54% were women. Both mean right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were associated with 2‐year mortality on Cox regression analyses with Youden index‐derived cut‐offs of 17 mmHg and 19 mmHg, respectively (p < 0.01 for all). However, RAP emerged as an independent predictor of outcomes following multivariable adjustments. Pre‐interventionally, 42% of patients were classified as euvolaemic (RAP <17 mmHg, PCWP <19 mmHg), 23% as having left‐sided congestion (RAP <17 mmHg, PCWP ≥19 mmHg), 8% as right‐sided congestion (RAP ≥17 mmHg, PCWP <19 mmHg), and 27% as bilateral congestion (RAP ≥17 mmHg, PCWP ≥19 mmHg). Patients with right‐sided or bilateral congestion had the lowest procedural success rates and shortest survival times. Congestion patterns allowed for discerning specific patient's physiology and specifying prognostic implications of right ventricular to pulmonary artery coupling surrogates. Conclusion: In this large cohort of invasively characterized patients undergoing TTVI, congestion patterns involving right‐sided congestion were associated with low procedural success and higher mortality rates after TTVI. Whether pre‐interventional reduction of right‐sided congestion can improve outcomes after TTVI should be established in dedicated studies. [ABSTRACT FROM AUTHOR]

Objective: Ebstein’s anomaly (EA) is a rare congenital malformation associated with high perinatal mortality. In this study, we aimed to assess perinatal outcomes and factors associated with mortality in fetuses with EA. Material and Method: In this study, fetuses diagnosed with EA from 2016 to 2022 were included. Clinical information, ultrasonographic findings, and Doppler parameters were collected retrospectively. Result: A total of 14 fetuses with EA were included. Twelve patients had isolated EA, while one had unilateral renal agenesis and the other had mega cisterna magna. Amniocentesis was performed in six cases and normal results were obtained. Nine fetuses reached term pregnancy. All fetuses survived to birth. Three cases died in the first week after birth. Survivors were found to have lower tricuspid valve annulus diameter z score when compared with non-survivors (4.81±3.05 vs 6.97±1.26, respectively, p=0.05). Reversal pulmonary artery flow (2/11 vs 4/4 in survivors and non-survivors, respectively, p=0.01) and pulmonary atresia (1/11 vs 4/4 in survivors and non-survivors, respectively, p<0.01) were significantly more frequent in non-survivors. Conclusion: Perinatal mortality remains high in EA. Higher tricuspid valve annulus diameter z score, presence of reversal pulmonary artery flow, and pulmonary atresia during prenatal diagnosis are associated with poorer diagnosis. Future multicenter studies are warranted to identify risk factors and guide perinatal management. [ABSTRACT FROM AUTHOR]

OBJECTIVES To evaluate the precise dimensions of the normal aortic root, especially the true aortic annulus, during the cardiac cycle using an innovative reconstruction method based on multiphase cardiac computed tomography and to assess the feasibility and the reproducibility of this method for aortic root analysis. METHODS Between January 2019 and June 2021, 30 optimal consecutive ECG-gated multiphase cardiac computed tomography of patients with normal tricuspid aortic valve were analysed using an in-house software. Aortic annulus border was pinpointed on 9 reconstructed planes and the 3D coordinates of the 18 consecutive points were interpolated into a 3D curve using a cubic spline. Three additional planes were generated at the level of the left ventricular outflow tract, the level of the Valsalva sinus and the level of the sinotubular junction. This procedure was repeated for all the 10 temporal phases of the RR interval. RESULTS The aortic annulus mean 3D and 2D areas were 7.67 ± 1.51 and 5.16 ± 1.40 cm2, respectively. The mean 2D diameter was 2.51 ± 0.23 cm. The mean global area expansion was 11.8 ± 3.5% and the mean perimeter expansion of 7.1 ± 2.6%. During the cardiac cycle, the left ventricle outflow tract expands, reaching its maximum surface at the end of diastole, followed by the aortic annulus, the Valsalva sinuses and the sinotubular junction. The aorta changes from a clover-shaped cone during diastole to more cylindrical shape during systole. Compared to the 3D measurements, the analysis of the virtual basal ring significantly underestimates the annulus area, perimeter, and mean diameter. CONCLUSIONS 4D morphometric analysis enables to have a precise and reproducible evaluation of the aortic annulus. The aortic annulus and root are deformable structures that undergo a unique expansion sequence during the cardiac cycle which should be considered for procedural planning. [ABSTRACT FROM AUTHOR]