Traumatic ventricular septal defect with tricuspid incompetence. Surgical treatment

The authors report a case of traumatic ventricular septal defect associated with tricuspid incompetence after blunt injury of the chest. This case is the third one described in the literature. This case includes several unusual features: (1) the patient was a 52 year old man. Wounds of the heart usually happen to younger people; (2) clinical manifestations were immediately important; (3) there was a left bundle branch block on the electrocardiogram; (4) surgical treatment was performed as an emergency (less than a fortnight after the accident).     

A case of ventricular septal defect with tricuspid regurgitation complicating infective endocarditis

A unique case of 52-year-old woman with a ventricular septal defect associated with tricuspid regurgitation complicating infective endocarditis was reported. Under cardiopulmonary bypass, the VSD was closed directly and tricuspid valve was replaced with a Carpentier-Edwards valve. Intraoperative examination showed that the VSD was perimembranous type (5 mm in diameter), all three leaflets were destroyed and one chordae of anterior leaflet was ruptured. Her postoperative course was uneventful and she has been well.     

Tricuspid endocarditis related to a residual ventricular septal defect: a case report of successful tricuspid valvuloplasty

A 5-year-old girl presented infected tricuspid valve related to a residual ventricular septal defect. Antibiotic therapy produced a satisfactory initial improvement. However, subsequent deterioration with uncontrolled infection, in spite of alterations of the antibiotic regime, necessitated surgical intervention. Because the lesion was localized to the anterior leaflet of the tricuspid valve, partial excision of this leaflet and patch was undergone with a sustained clinical improvement with minimum residual valvular incompetence. This experience supports the concept that tricuspid valvuloplasty is the method of choice in the treatment of patient with regional right-sided infective endocarditis.     

Liberal use of tricuspid valve detachment for transatrial ventricular septal defect closure

BACKGROUND: Although temporary tricuspid valve detachment is useful for improved visualization of ventricular septal defect through right atriotomy, liberal use of this adjunct is not widely supported, mainly because of concerns about iatrogenic complications such as heart blocks and tricuspid valve dysfunction. The objective of this study was to determine whether liberal use of this adjunct can improve operative outcome. METHODS: Between January 1997 and March 2002, trans-atrial closure of isolated ventricular septal defect (conoventricular or canal type) was performed in 87 consecutive patients. Tricuspid valve detachment was used in 4 out of 44 patients (prudent-use group) and 19 out of 43 patients (liberal-use group) in the first and second half of this period, respectively (p = 0.0002). Patient demographics and use of other surgical and cardiopulmonary bypass techniques remained virtually unchanged during this period. RESULTS: In the prudent-use group, there was one operative death with prolonged bypass time and one residual defect that required reoperation; neither of these patients underwent tricuspid valve detachment. All other patients (both groups) were free from mortality and clinically significant complications, including heart block, tricuspid regurgitation, and residual defect. The liberal-use group had shorter cardiopulmonary bypass time than the prudent-use group (59 +/- 14 vs 67 +/- 22 minutes, p = 0.037). CONCLUSIONS: Tricuspid valve detachment should be used liberally for moderate- or even low-difficulty exposure of ventricular septal defect, regardless of patient background, because it is a safe and effective adjunct that can improve speed, programmability, reproducibility, and reliability.     

Combined approach for postinfarction ventricular septal defect treatment: a case report

Postinfarction ventricular septal defect is an uncommon condition with a poor prognosis. We report a case of successful early percutaneous closure of postinfarction ventricular septal defect using an occluder device followed by delayed off-pump revascularization.     

Isolated infective endocarditis located in the tricuspid valve; report of a case

We report surgically treated case of tricuspid valve endocarditis in a non-drug addict. A 74-year-old man with no history of cardiac disease was admitted to our hospital for persistent pyrexia. The blood culture was negative. Echocardiography showed vegetations attached to the tricuspid valve with mild tricuspid regurgitation. Intravenous antibiotics therapy was unable to control the infection. So we performed tricuspid valve repair and annuloplasty using an artificial ring. The postoperative course was uneventful. After prophylactic antibiotic administration for 15 weeks, he was afebrile for 1 week without any medication. Thereafter he was discharged and has been free from any complication for over 16 months.     

心肌梗死后室间隔穿孔的外科治疗

目的 总结心肌梗死（心梗）后室间隔穿孔的外科治疗方法.方法 自1990年至2004年,外科治疗22例心梗后室间隔穿孔病人,其中前室间隔穿孔19例,后室间隔穿孔3例;合并室壁瘤18例.结果 全组手术死亡8例,其中1999年前13例中死亡7例,1999年后9例中仅死亡1例.余者症状消失,治愈出院.出院时心功能均为Ⅰ～Ⅱ级.结论 心梗后室间隔穿孔是少见而严重的并发症,手术为最佳治疗方法.术前应行冠状动脉造影,如有狭窄,术中应充分进行冠状动脉再血管化.     

Traumatic ventricular septal defect: a case report

A case of traumatic ventricular septal defect is reported to illustrate the important clinical features of this uncommon condition.     

Infectious tricuspid valve endocarditis in a chronic hemodialysis patient; report of a case

We report a rare case of isolated infectious tricuspid valve endocarditis. A 67-year-old male patient with chronic renal failure complained of fever up to 38 degrees C after hemodialysis. WBC was not elevated, but CRP was increased. Transthoracic and transesophageal echocardiography for investigating his chest discomfort demonstrated a large 13 x 25 mm vegetation on the tricuspid valve. Blood culture was negative. The tricuspid valve was replaced with a bioprosthetic valve. The extensive vegetation was found in the anterior, septal and posterior cusps and diagnosed as infectious endocarditis pathologically. The postoperative course was uneventful. WBC and CRP remained normal 9 months after surgery and no signs of recurrence were observed. The cause of the infectious endocarditis seemed to be the insertion of a double lumen catheter for dialysis or the puncture of the arteriovenous shunt.     

Surgical treatment of pulmonary atresia with ventricular septal defect

Pulmonary atresia with ventricular septal defect (PAVSD) is a complex cardiopathy represented by a complete obstruction between the right ventricle outflow and the pulmonary trunk associated with a ventricular septal defect (VSD) and major aortopulmonary collaterals (MAPCA). The goal of the unifocalization in the PAVSD is to prepare the pulmonary tree for the complete repair by connecting the MAPCAs to the central pulmonary arteries that should be enlarged. After that we can made the VSD or other intracardiac repair. This is a retrospective study on 31 patients. We report our results discussing the PAVSD classification and the strategy of the complete repair in comparison with other reported results.     

Bicuspidization of the tricuspid valve for the treatment of posterior leaflet endocarditis: a case report

Patients who require surgical therapy for the treatment of tricuspid valve regurgitation can avoid undergoing tricuspid valve replacement if valve-sparing repair techniques are employed. Tricuspid valvular endocarditis frequently requires valvectomy, leaving the right side of the heart and pulmonary system vulnerable to unregulated blood flow. We present a case of complete posterior leaflet excision and plication of the involved portion of the tricuspid annulus, which resulted in "bicuspidization" of the valve, for the treatment of tricuspid valve endocarditis localized to the posterior leaflet.