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Our mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our mission is to reduce the burden of cardiovascular disease through percutaneous cardiovascular interventions.
Improving the quality of life and reducing sudden cardiac death by limiting the impact of heart rhythm disturbances.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
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55 year old female
No cardiovascular risk factors
Rheumatic mitral stenosis
Repeat percutaneous mitral commissurotomy
Isolated mitral valve replacement
Combined mitral valve replacement + tricuspid surgery (repair or replacement)
More echocardiographic information is needed
Repeat percutaneous mitral commissurotomyOne commissure is completely open and MR grade is > 2 - mitral commissurotomy should no be performed
Isolated mitral valve replacementSevere tricuspid valve disease. Correction of left-sided disease does not cure the right side
1. After isolated mitral valve replacement, 30-50% of patients develop moderate or severe late TR despite absent or mild TR at baseline
2. Occurrence of moderate / severe late TR is associated with increased morbidity (congestive heart failure) and mortality3. Surgery for isolated severe TR carries high morbidity and high mortality
2. Occurrence of moderate / severe late TR is associated with increased morbidity (congestive heart failure) and mortality
3. Surgery for isolated severe TR carries high morbidity and high mortality
Tricuspid annular diameter has been proposed as a more sensitive parameter to guide surgical indications for associated tricuspid valve surgery and to improve long-term morbidity and mortality
Dreyfus GD et al. Ann Thorac Surg 2005; 79:127-32
First cohort: 2002-2004. Associated TR surgery if TR ≥ grade 3
Second cohort: 2004-2006. Associated TR surgery if TR ≥ grade 3 OR annular diameter ≥ 40 mm
Associated tricuspid annuloplasty during mitral valve repair / replacement should be considered in patients with tricuspid annular dilatation despite the absence of significant TR to prevent the occurrence of right ventricular dysfunction and advanced heart failure. TV annuloplasty adds little time to the surgery and is associated with very few complications.
Vahanian et al. European Heart Journal 2012; 33(19):2451-2496
The best projection in which tricuspid annular diameter should be assessed remains debated but measurements are usually performed in the apical 4-chamber view.
Our mission: To reduce the burden of cardiovascular disease
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