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Valvular Heart Disease and Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Kali Polytarchou, Constantina Aggeli
Treatment includes diuretics for symptomatic relief. No medication has been shown to reduce mortality for patients with severe TR and right HF. Surgical treatment includes annuloplasty ring, tricuspid valve repair (bicuspidation or double-orifice repair), and valve replacement.45 Due to increased risk of thrombosis, bioprosthetic valves are preferred over mechanical.
The cardiovascular system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Mary N Sheppard, C. Simon Herrington
Surgical repair is the procedure of choice to preserve function of the valve apparatus, which is essential for ventricular function. The aim is to excise the most dome-shaped portion of the cusp and then stitch the rest of the cusp together, thus reducing its area and ability to prolapse. An annuloplasty ring can also be inserted to restore annular function.
Cardiac surgery and percutaneous cardiac interventions
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
The MitraClip is the most successful and widely-used percutaneous delivery device for mitral regurgitation, and is the only currently available device for MR with FDA approval. Its mechanism is based around a surgical technique, referred to as the Alfieri ‘edge-to-edge’ stitch, where the middle scallops of the anterior and posterior leaflets are sutured together to allow a double-barrel opening with enough orifice area to avoid mitral stenosis.36 While the benefits of this techniques have been debated due to variable results with certain pathologies and the risk of mitral stenosis, its use combined with an annuloplasty ring has been demonstrated to have good survival and freedom from re-operations.37
Echocardiographic prediction of surgical reparability in degenerative mitral regurgitation due to leaflet prolapse: a review
Published in Expert Review of Cardiovascular Therapy, 2019
Francesca Mantovani, Francesca Bursi, Giovanna Di Giannuario, Andrea Barbieri
Three-dimensional echocardiography is the essential step to refine the pathoanatomy of the lesion(s) (Figure 3) [21]. The examination should not focus on the main lesion such as a P2 flail, but on identifying the potential secondary mechanisms that could be masked by a main dominant lesion. After a thorough 2D-TEE assessment, where the majority of these features can be identified [31], 3D-TEE has the diagnostic sensitivity to highlight potential subtle surgical pitfalls such as the coexistence of anterior mitral leaflet prolapse masked by a main posterior mitral leaflet lesion (Video 4), the presence of commissural prolapse at the medial (Video 5) or lateral location as a separate lesion (Video 6), posterior mitral leaflet clefts/indentation adjacent to the primary lesion (Video 7) or anterior mitral leaflet secondary chordal tethering resulting in lack of coaptation [32] and predictors of systolic anterior leaflet motion (coaptation-septal distance <25 mm, sharp aorto-mitral angle <120°, posterior mitral leaflet height >15 mm, small left ventricular end-diastolic cavity diameter <45 mm, nonenlarged annulus, basal septal thickness >15 mm) (Figure 4, Video 8) [33]. Therefore, avoiding under-sizing of the annuloplasty ring is very important in patients with these risk factors.
A Novel Approach to Adjusting the Length of the Neochorda Creating a Polypropylene Loop in Mitral Valve Repair: An Inexpensive and Practical Method
Published in Structural Heart, 2019
Anıl Özen, Ertekin Utku Ünal, Mehmet Hamdi Özbek, Görkem Yiğit, Hakkı Zafer İşcan
Methods: Our technique simply involves using a 3-0 Polypropylene suture to create a loop on the posterior part of the annuloplasty ring. Following resection of the redundant valve tissue and repair, annuloplasty ring is placed. 5-0 PTFE suture (neochorda) is placed onto the head of the appropriate papillary muscle. Both of the 5-0 PTFE needles are passed through the prolapsed leaflet from the ventricle to the atrial side. Both needles are then passed through the polypropylene loop from below in an upwardly direction. This is followed by passing the needles through the mitral leaflet and the Polypropylene loop once more. Both sides of the PTFE suture are pulled upwards gently to get rid of the slack. Finally, the PTFE suture is tied down onto the atrial surface of the valve. Both needles may then be tied down on the ventricular side to obtain better fixation and preventing it from slipping. The circular prolene ring is cut and removed.
Current Surgical Treatment and Outcomes for Functional Tricuspid Regurgitation
Published in Structural Heart, 2018
William B. Weir, Matthew A. Romano, Steven F. Bolling
In conclusion, concomitant surgical repair of TR at the time of mitral valve surgery should be considered, as this approach has been shown to result in improved perioperative outcomes, functional class, and potentially survival. When intervened on, the modern-day surgeon should attempt a high-quality repair with a rigid or semi-rigid annuloplasty ring over suture-based techniques and replacements. As TR does not reliably regress after successful mitral valve surgery, and reoperation for recurrent TR carries a prohibitively high risk, TR with annular dilation cannot be ignored when fixing mitral disease. When these principles are taken together, the appropriate use of tricuspid annuloplasty can be optimized.