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Tricuspid valvuloplasty for isolated tricuspid regurgitation in children

Published online by Cambridge University Press:  25 June 2020

Guanxi Wang Open the ORCID record for Guanxi Wang [Opens in a new window] ,
Kai Ma ,
Kunjing Pang ,
Sen Zhang ,
Lei Qi ,
Yang Yang ,
Zicong Feng ,
Fengqun Mao ,
Jianhui Yuan  and
Hao Zhang
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Guanxi Wang
Affiliation:
Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing100037, China
Kai Ma
Affiliation:
Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing100037, China
Kunjing Pang
Affiliation:
Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing100037, China
Sen Zhang
Affiliation:
Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing100037, China
Lei Qi
Affiliation:
Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing100037, China
Yang Yang
Affiliation:
Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing100037, China
Zicong Feng
Affiliation:
Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing100037, China
Fengqun Mao
Affiliation:
Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing100037, China
Jianhui Yuan
Affiliation:
Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing100037, China
Hao Zhang
Affiliation:
Heart Center and Shanghai Institute of Pediatric Congenital Heart Diseases, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai200127, China
Shoujun Li*
Affiliation:
Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Street, Xicheng District, Beijing100037, China
*
Address for correspondence: Shoujun Li, MD, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing100037, PR China. Tel: +86(10)88398855; Fax: +86(10)88398855. E-mail: drlishoujunfw@163.com
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Abstract

Background:

Isolated congenital tricuspid regurgitation other than Ebstein’s anomaly was rare especially for children. The objective of this study was to investigate the clinical characteristics and to assess the results of tricuspid valvuloplasty for children with isolated tricuspid regurgitation.

Methods:

From January 2010 to June 2019, 10 consecutive patients with isolated tricuspid regurgitation who were unresponsive to drug therapy underwent tricuspid valvuloplasty in our hospital. Patients’ clinical data were analysed retrospectively.

Results:

Mean age at operation was 48.5 ± 31.0 (range: 9–106) months and mean weight at operation was 16.1 ± 6.9 (range: 8.6–33.0) kg. All patients presented severe isolated tricuspid regurgitation. According to pathological lesions, the main causes accounted for chordae tendinea rupture (3/10), leaflet cleft (2/10), mal-connected chordal tendinea to leaflets (2/10), elongated chordae (1/10) and chordae absent (1/10), and severe anterior leaflet dysplasia (1/10). Individualised tricuspid valvuloplasty was adapted to all of them successfully. Post-operative echocardiography showed no tricuspid regurgitation in two patients and mild regurgitation in eight patients. The cardiothoracic ratios on their chest roentgenograms decreased from 0.59 ± 0.05 to 0.54 ± 0.05. At the latest follow-up (50.4 ± 47.2 months), echocardiography showed that mild to moderate tricuspid regurgitation in seven patients, moderate tricuspid regurgitation in three patients, and no patient with severe tricuspid regurgitation. All patients were in NYHA functional class I.

Conclusions:

For patients with isolated tricuspid regurgitation who were not well responsive to drug therapy, individualised tricuspid valve repair can achieve an excellent result.

Keywords

Tricuspid regurgitationtricuspid valvuloplastyleaflet cleftCHDs
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 8 , August 2020 , pp. 1076 - 1080
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Schwartz, ML, Gauvreau, K, del Nido, P, Mayer, JE, Colan, SD.Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation. Circulation 2004; 110: II128–132.CrossRefGoogle ScholarPubMed
Emani, SM, Beroukhim, R, Zurakowski, Det al.Outcomes after anatomic repair for d-transposition of the great arteries with left ventricular outflow tract obstruction. Circulation 2009; 120: S53–S58.CrossRefGoogle ScholarPubMed
Jaquiss, RD, Imamura, M.Management of Ebstein’s anomaly and pure tricuspid insufficiency in the neonate. Semin Thorac Cardiovasc Surg 2007; 19: 258–263.CrossRefGoogle ScholarPubMed
Patane, S, Marte, F, Di Bella, G, Di Tommaso, E, Pagano, GT, Chiribiri, A.Isolated tricuspid prolapse in young child. Int J Cardiol 2009; 136: e37–e38.CrossRefGoogle ScholarPubMed
Seguela, PE, Roubertie, F, Tafer, N, Thambo, JB, Iriart, X.Congenital isolated cleft of the tricuspid valve. Eur Heart J Cardiovasc Imaging 2014; 15: 1425.CrossRefGoogle ScholarPubMed
Aaron, BL, Mills, M, Lower, RR.Congenital tricuspid insufficiency. Definition and review. Chest 1976; 69: 637–641.CrossRefGoogle ScholarPubMed
Morgan, JR, Forker, AD. Isolated tricuspid insufficiency. Circulation 1971; 43: 559–564.CrossRefGoogle ScholarPubMed
Katogi, T, Aeba, R, Ito, T, Goto, T, Cho, Y, Ueda, T, Kawada, S. Surgical management of isolated congenital tricuspid regurgitation. Ann Thorac Surg 1998; 66: 1571–1574.CrossRefGoogle ScholarPubMed
Lee, JW, Song, JM, Park, JP, Lee, JW, Kang, DH, Song, JK.Long-term prognosis of isolated significant tricuspid regurgitation. Circ J 2010; 74: 375–380.CrossRefGoogle ScholarPubMed
Fender, EA, Zack, CJ, Nishimura, RA.Isolated tricuspid regurgitation: outcomes and therapeutic interventions. Heart 2018; 104: 798–806.CrossRefGoogle ScholarPubMed
Hamandi, M, Smith, RL, Ryan, WH, et al.Outcomes of isolated tricuspid valve surgery have improved in the modern era. Ann Thorac Surg 2019; 108: 11–15.CrossRefGoogle ScholarPubMed
Lim, KA, Huh, J, Jun, T-G. Successful repair of critical tricuspid regurgitation secondary to ruptured papillary muscle in a newborn. Cardiol Young 2004; 14: 450–452.CrossRefGoogle Scholar
Lancellotti, P, Moura, L, Pierard, LA, et al.European association of echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 2010; 11: 307–332.CrossRefGoogle Scholar
Mizuno, M, Hoashi, T, Sakaguchi, H, et al.Application of cone reconstruction for neonatal ebstein anomaly or tricuspid valve dysplasia. Ann Thorac Surg 2016; 101: 1811–1817.CrossRefGoogle ScholarPubMed
Beckhoff, F, Alushi, B, Jung, C, et al.Tricuspid regurgitation – medical management and evolving interventional concepts. Front Cardiovasc Med 2018; 5: 49.CrossRefGoogle ScholarPubMed
Bartlett, HL, Atkins, DL, Burns, TL, et al.Early outcomes of tricuspid valve replacement in young children. Circulation 2007; 115: 319–325.CrossRefGoogle ScholarPubMed
Antunes, MJ, Rodriguez-Palomares, J, Prendergast, B, et al.Management of tricuspid valve regurgitation: position statement of the European society of cardiology working groups of cardiovascular surgery and Valvular heart disease. Eur J Cardiothorac Surg 2017; 52: 1022–1030.CrossRefGoogle Scholar
Sachdeva, R, Fiser, RT, Morrow, WR, Cava, JR, Ghanayem, NS, Jaquiss, RD.Ruptured tricuspid valve papillary muscle: a treatable cause of neonatal cyanosis. Ann Thorac Surg 2007; 83: 680–682.CrossRefGoogle ScholarPubMed
Boon, R, Hazekamp, M, Hoohenkerk, G, et al.Artificial chordae for pediatric mitral and tricuspid valve repair. Eur J Cardiothorac Surg 2007; 32: 143–148.CrossRefGoogle ScholarPubMed
Kluin, J, Sojak, V, Koolbergen, DR, Boon, R, Bokenkamp, R, Hazekamp, MG.Fifteen years’ experience with the use of artificial chords for valve reconstruction in children. Eur J Cardiothorac Surg 2017; 52: 1155–1160.CrossRefGoogle ScholarPubMed
Kobza, R, Kurz, DJ, Oechslin, EN, et al.Aberrant tendinous chords with tethering of the tricuspid leaflets: a congenital anomaly causing severe tricuspid regurgitation. Heart 2004; 90: 319–323.CrossRefGoogle ScholarPubMed
Eichhorn, P RM, Suetsch, G, von Segesser, LK, Turina, M, Jenni, R.Congenital cleft of the anterior tricuspid leaflet with severe tricuspid regurgitation in adults. J Am Coll Cardiol 1992; 20: 1175–1179.CrossRefGoogle ScholarPubMed
Motoyoshi, N, Tofukuji, M, Sakurai, M, Ohmi, M, Tabayashi, K. Cleft on tricuspid anterior leaflet. Ann Thorac Surg 2001; 71: 1350–1351.CrossRefGoogle ScholarPubMed
Saku, K, Inoue, H, Yamamoto, K, Ueno, M.Repair of tricuspid valve regurgitation due to a tricuspid valve cleft. Asian Cardiovasc Thorac Ann 2019; 27: 688–690.CrossRefGoogle ScholarPubMed
Dreyfus, GD, Raja, SG, John Chan, KM.Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardio-Thoracic Surg 2008; 34: 908–910.CrossRefGoogle ScholarPubMed