Comparison of 2-Dimensional, 3-Dimensional, and Surgical Measurements of the Tricuspid Annulus Size: Clinical Implications.

Background: Associated tricuspid annuloplasty is recommended during left-heart valve surgery when the tricuspid annulus (TA) is dilated but methodology for the measurement of TA size and thresholds for TA enlargement are not clearly defined.

Methods And Results: Measurement of the TA diameter (TAD) was prospectively performed using 2-dimensional transthoracic echocardiography (2D-TTE) in 282 patients in 4 different views (parasternal long axis, parasternal short axis, apical 4-chamber [A4C], and subcostal). TAD was also measured using 3D-transesophageal echocardiography in 183 patients (long axis), peroperatively in 120 patients who underwent a tricuspid valve surgery and using TTE (A4C) in 66 healthy volunteers.

How should I treat prosthetic tricuspid stenosis in an extreme surgical risk patient?

Background: A 64-year-old female with rheumatic heart disease and multiple prior valve replacements presented with progressive oedema, ascites and dyspnoea on exertion.

Investigation: Physical examination, transthoracic echocardiography, intracardiac echocardiography, transoesophageal echocardiography, right heart cathetherisation, computed tomography.

Diagnosis: She had a mitral homograft and Physio ring in the tricuspid position, and presented with severe bioprosthetic tricuspid valve stenosis (mean gradient 16 mmHg) and right-sided heart failure.

Role of radiolabelled leucocyte scintigraphy in patients with a suspicion of prosthetic valve endocarditis and inconclusive echocardiography.

Aims: In patients with a suspicion of prosthetic valve endocarditis (PVE), detection of perivalvular infection can be difficult based only on echocardiography. The aim of this retrospective study was to test the interest of radiolabelled leucocyte scintigraphy (LS) for the detection of perivalvular infection in patients with a suspicion of PVE and inconclusive transoesophageal echocardiography (TEE).

Methods And Results: LS was performed in 42 patients.

Right papillary muscle sling: proof of concept and pilot clinical experience.

Objectives: Left-sided intraventricular remodelling by papillary muscle approximation associated with annuloplasty of the mitral valve improved outcomes for severe functional mitral regurgitation compared with annuloplasty alone. We conceived of, and studied, a papillary muscle sling on the right side of the heart associated with annuloplasty, seeking to reduce tricuspid valve tethering and right ventricular volumes and to preserve ventricular function.

Methods: An experimental model on ex vivo porcine hearts established the anatomical feasibility of the procedure.