Tricuspid valve endocarditis: Cardiovascular imaging evaluation and management

Right-sided infective endocarditis is an increasingly recognized disease entity, with tricuspid valve being most frequently involved. Risk factors for tricuspid valve endocarditis (TVIE) include intravenous drug use, cardiac implantable electronic devices and indwelling catheters. Staphylococcus aureus is the predominant causative organism in TVIE. The diagnosis of infective endocarditis (IE) is based on clinical manifestations, blood cultures, and the presence of valvular vegetations detected by echocardiography. Complementary imaging is helpful when there is ongoing clinical suspicion for IE following initially negative echocardiography. Multislice computed tomography allows for assessment of extra-cardiac complications in TVIE, including pulmonary septic emboli. 18F-fluorodeoxyglucose positron emission tomography/computed tomography and radiolabelled white blood cell, single-photon emission computed tomography provide important clinical information concerning the presence of IE in right-sided prosthetic valves or cardiac implantable electronic devices. The aim of this review is to provide an update on TVIE, discussing the role of multimodality imaging in TVIE and the management of these patients.     

Aortic valve area: meta-analysis of diagnostic performance of multi-detector computed tomography for aortic valve area measurements as compared to transthoracic echocardiography

Degenerative aortic valve stenosis (AS) has an incidence of 2–7% in the Western European and North American populations over 65 years of age. The aim of this study was to perform a meta-analysis of the published literature evaluating the accuracy of CT planimetry to measure the aortic valve area. The PUBMED and OVID databases were searched up to May 2008. Major criteria for article inclusion was the use of (a) multi-detector computed tomography as a diagnostic test for the assessment of AVA in patients with AS, and (b) TTE as the reference standard. Nine studies were included in the analysis with 175 women and 262 men. The mean AVA as measured by CT was 1.0 ± 0.1. The mean AVA measured by TTE was 0.9 ± 0.1. The correlation between CT and TTE AVA measurements was r = 1.45. The mean difference was 0.03 ± 0.05. The results of our meta-analysis suggest that multi-detector CT is an accurate method for obtaining AVA measurements in patients with AS.     

经胸与经食管超声测量心脏瓣环大小的研究

对６６例不同类型的人工心脏瓣膜置换术患者，采用超声检测法，于入院时及术前一周内进行经胸超声心动图（ＴＴＥ）检查，术中进行经食管超声心动图（ＴＥＥ）检查，分别测量瓣环直径与实际置换瓣膜进行比较。结果显示：实际置换瓣膜与入院时ＴＴＥ比较差异有显著性（Ｐ＜０．０５）；与术中ＴＥＥ比较差异无显著性（Ｐ＞０．０５）；与术前一周ＴＴＥ比较差异也无显著性，但Ｘ２值比术中ＴＥＥ大。表明术中ＴＥＥ测量的瓣环大小与置换瓣十分匹配，为减少瓣周漏及术后并发症提供了高度可靠的新技术。在无条件进行ＴＥＥ检查时，也可于术前一周内采用ＴＴＥ测量瓣环大小     

二尖瓣关闭不全与左房血栓关系的TEE研究

本文研究目的是为了探讨风湿性二尖瓣疾病患者二尖瓣关闭不全（ＭＲ）对左房血栓形成的影响。经食道超声心动图（ＴＥＥ）检查了６８例风湿性二尖瓣疾病患者。２３例被发现有左房血栓，有血栓组与无血栓组相比，二尖瓣关闭不全的发生率较低（Ｐ＜０．０２），返流束面积较小（Ｐ＜０．０５）。没有明显二尖瓣关闭不全的患者发生左房血栓的风险性较高，因此需要进行抗凝治疗。     

Tricuspid regurgitation: when is it time for surgery?

ABSTRACT

Introduction: The interest in tricuspid regurgitation (TR) surgical treatment has grown in the last years, mostly motivated by the trend for early intervention and the development of minimally invasive surgical techniques. Despite this, there is still a lack of evidence regarding when to intervene in functional tricuspid regurgitation outside the context of left-sided valve surgery and when is the best time to approach primary tricuspid regurgitation.

Areas covered: Herein, we present the state-of-the-art in tricuspid regurgitation surgical intervention, covering indications, optimum time, surgical options, and outcomes, as well as the role of transcatheter tricuspid valve intervention in the current era.

Expert opinion: Current evidence support that the indications and timing of tricuspid valve invasive management should be centered on a range of factors, including patients’ characteristics, disease stage, and anatomical considerations. Early intervention, before severe right ventricle dysfunction and pulmonary hypertension, seems to results in better postoperative outcomes. Transcatheter techniques are arising as potential alternatives for inoperable and high-risk patients.     

Detection of prosthetic mitral valve leak: a comparative study using transesophageal echocardiography, transthoracic echocardiography, and auscultation

Paravalvular leakage is a major complication of prosthetic valve dysfunction. Sixty-one subjects with valvular heart disease who had received prosthetic mitral valve replacement 5 months to 5 years before (43 received a porcine prosthesis and 18 received Bjork-Shiley valve prostheses) were evaluated for this complication. Careful auscultation was performed by two experienced cardiologists followed by transthoracic and transesophageal echocardiography. Physiologic leaks were detected in all Bjork-Shiley valves, but in only 30% of porcine valves using transesophageal echocardiography. These regurgitant jets were flame-like, with mean low velocities of 50 +/- 12.3 cm/sec and 48 +/- 18.2 cm/sec in the two types of valves. Neither transthoracic echocardiography nor auscultation could detect physiological regurgitant jets. Ten cases with paravalvular leak were detected by transesophageal echocardiography and subsequently demonstrated by left ventriculography (7 porcine, 3 Bjork-Shiley valves). Pathologic regurgitant jets were seen as high-velocity, systolic-retrograde turbulent flow across the prosthesis. However, only 6 cases of prosthetic valve dysfunction were detected by transthoracic echocardiography, 4 cases of mild paravalvular leakage went undetected. Thirteen of the 61 subjects had an apical systolic murmur and suspected prosthetic valve leakage; in 10 of the 13 cases the findings corresponded to those obtained by transesophageal echocardiography. In 3 cases of double valve replacement with Bjork-Shiley valves the magnitude of the leakage was overestimated by auscultation.     

非器质性三尖瓣中重度反流的产前病因诊断及预后分析

目的探讨非器质性三尖瓣中重度反流的产前病因并评价预后。方法回顾性分析非器质性三尖瓣中重度反流胎儿63例,(1)总结反流病因;(2)对比产前产后反流程度变化。结果 (1)63例胎儿中,单纯三尖瓣反流28例,动脉导管提前收缩及早闭18例,卵圆孔血流受限及早闭12例,永存左上腔静脉1例,双胎输血综合征3例,胎盘绒毛膜血管瘤1例;(2)生后随访示除2例胎儿反流程度未恢复外,其余胎儿均恢复至轻度或轻度以下。结论非器质性三尖瓣反流胎儿,出生后大多数反流恢复,预后较好。     

改良De Vega环缩术治疗重度三尖瓣返流的疗效分析

目的:探讨改良De Vega环缩术与经典De Vega环缩术相比对于治疗重度三尖瓣返流是否具有更好的成形效果。方法:2007年12月至2009年3月对29例重度三尖瓣返流的患者行De Vega环缩术。其中16例行改良De Vega环缩术,13例行经典De Vega环缩术,随访比较两组患者三尖瓣返流程度,右心室舒张期末内径,EF值及心功能分级。以秩和检验分析研究两组患者三尖瓣返流程度和心功能分级的差异,以t检验研究两组患者右心室舒张末期内径及EF值变化。结果:术前两组患者一般指标无显著差异。两组患者随访时间无显著差异。随访经典DeVega组重度返流1例,中度返流5例,轻度返流5例,微量及无返流2例;改良De Vega组无中、重度返流,轻度返流8例,微量及无返流8例。经分析显示两组患者三尖瓣返流程度结果差异有统计学意义(P<0.05)。经典De Vega组心功能分级I级5例,II级7例,III级1例;改良De Vega组I级7例,II级8例,III级1例,两组患者心功能差异无统计学意义(P>0.05)。两组患者右室舒张期末内径及EF值组内比较随访与术前差异均有统计学意义(P<0.05),随访时组间比较差异有统计学...