Total root remodelling by the Sleeve technique for aortic regurgitation in patients with repaired tetralogy of Fallot

We report the case of a 15-year-old male patient who had developed aortic regurgitation primarily because of aortic annulus dilatation late after definitive repair of tetralogy of Fallot. Valsalva sinus dilatation was not remarkable enough for root replacement. For the purpose of total root remodelling, the Sleeve procedure was employed. This procedure not only reduced the root diameters but also augmented commissure heights. With concomitant non-coronary cusp plication, aortic regurgitation was effectively controlled. Thus, the Sleeve technique may be a preferable option for patients who develop aortic regurgitation, due to dilatation of the annulus or sinotubular junction without significant dilatation of the sinus of Valsalva, after congenital heart surgery

Risk factors of recurrent tricuspid regurgitation after valve repair with three-dimensional ring

Objective: The purpose of this study was to investigate the results of tricuspid valve (TV) repair with three-dimensional ring (3DR) and risk factors of recurrent tricuspid regurgitation (TR).Methods: We retrospectively investigated 171 patients who underwent TV repair with a 3DR for TR from 2007 to 2016 at our institution. The patients were divided into the non-Recurrence group (<2+ TR) and Recurrence group (≥2+ TR), and compared to identify the cause of recurrent TR. The mean follow-up period was 58±35 months.Results: The preoperative TR grade was 3.0±0.8. A total of 22 patients had at least ≥2+ TR in the follow-up period. Freedom from ≥2+ TR and re-operation at 5 years were 83.6±3.3% and 97.9±2.1%. Comparison of the non-Recurrence and Recurrence groups revealed significant differences in the preoperative TR grade (2.9±0.8 and 3.4±0.6, p=0.008), proportion of the patients with left ventricular ejection fraction (LVEF) <40% (9% and 32%, p=0.003) and right ventricular end-systolic dimension (RVDs, 22.8±7.1 mm and 31.1±12.3 mm, P=0.001). In the multivariate analysis, LVEF <40% (hazard ratio: 12.65, 95% confidence interval: 2.66–60.18; p=0.002) and RVDs (hazard ratio: 1.08, 95% confidence interval: 1.02–1.14; p=0.02) were identified as risk factors for recurrent TR.Conclusion: Our results of TV repair with 3DR were of satisfactory. However, patients with preoperative lower LVEF and larger RVDs were identified at risk of recurrent TR. This result suggests the limitation to use of 3DR alone for TV repair and need for additional procedure

Decreasing the Pressure Gradient of the Left Ventricular Outflow Tract by Single-lead VDD Pacing in a Patient with Hypertrophic Obstructive Cardiomyopathy

A 59-year-old woman with hypertrophic cardiomyopathy of 8 years duration, who had been taking ﾎｲ-blocker, was admitted to our hospital for exertional dyspnea and previous syncope. Cardiac catheterization showed a prominent left-ventricular outflow tract (LVOT) pressure gradient, and hypertrophic obstructive cardiomyopathy (HOCM) was diagnosed. To reduce LVOT obstruction, we implanted a single-lead VDD-mode pacemaker. Cardiac catheterization after the implantation revealed a remarkable decrease in the LVOT pressure gradient with short atrioventricular delay, 80 msec, and her symptoms disappeared. A singlelead VDD pacemaker is also a useful treatment for an HOCM patient due to the relative ease with which it can be implanted

Quality of life following aortic valve replacement in octogenarians

【Purpose】We aimed to evaluate the outcomes of and the quality of life (QOL) after conventional aortic valve replacement (AVR) amongst octogenarians.【Methods】We enrolled 48 patients aged ≥80 years who underwent conventional aortic valve replacement between May 1999 and November 2012. Patient conditions were assessed before surgery, at 6 and 12 months after surgery, and during the late period regarding the need for nursing care, degree of independent living, and living willingness.【Results】The follow-up rate was 100% with 45.6 ± 41.3 months follow-up. Two patients (4%) died during hospitalization and 11 (23%) died during the follow-up period. The 1-, 5-, and 10-year survival rates were 84.9, 76.9, and 39.6%, respectively. During the late period, of 35 surviving patients, 31 (88%) were living at home. The degree of independent living score decreased after surgery. However, scores of the need for nursing care and living willingness remained preoperative level.【Conclusions】QOL following conventional aortic valve replacement for elderly patients aged ≥80 years who showed independence in activities of daily living (ADL) before surgery were satisfactory. Therefore, aortic valve replacement could be a viable option for elderly patients aged ≥80 years after accounting for preoperative ADL levels

Diagnosis of Myocardial Viability by Fluorodeoxyglucose Distribution at the Border Zone of a Low Uptake Region

Purpose: In cardiac 2-[F-18]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) examination, interpretation of myocardial viability in the low uptake region (LUR) has been difficult without additional perfusion imaging. We evaluated distribution patterns of FDG at the border zone of the LUR in the cardiac FDG-PET and established a novel parameter for diagnosing myocardial viability and for discriminating the LUR of normal variants. Materials and Methods: Cardiac FDG-PET was performed in patients with a myocardial ischemic event (n = 22) and in healthy volunteers (n = 22). Whether the myocardium was not a viable myocardium (not-VM) or an ischemic but viable myocardium (isch-VM) was defined by an echocardiogram under a low dose of dobutamine infusion as the gold standard. FDG images were displayed as gray scaled-bull’s eye mappings. FDG-plot profiles for LUR ( = true ischemic region in the patients or normal variant region in healthy subjects) were calculated. Maximal values of FDG change at the LUR border zone (a steepness index; Smax scale/pixel) were compared among not-VM, isch-VM, and normal myocardium. Results: Smax was significantly higher for n-VM compared to those with isch-VM or normal myocardium (ANOVA). A cut-off value of 0.30 in Smax demonstrated 100 % sensitivity and 83 % specificity for diagnosing n-VM and isch-VM. Smax less than 0.23 discriminated LUR in normal myocardium from the LUR in patients with both n-VM and isch-VM with a 94 % sensitivity and a 93 % specificity. Conclusion: Smax of the LUR in cardiac FDG-PET is a simple and useful parameter to diagnose n-VM and isch

Influence of Chronic Tethering of the Mitral Valve on Mitral Leaflet Size and Coaptation in Functional Mitral Regurgitation

ObjectivesThe purposes of this study were to examine whether tethering of the mitral leaflets affects coaptation in patients with functional mitral regurgitation (FMR) and to assess the interaction between the mitral coaptation and mitral regurgitation severity.BackgroundFunctional mitral regurgitation causes restriction of leaflet closure as a result of enhanced tethering of the mitral leaflets and papillary muscle (PM) displacement.MethodsThree-dimensional transesophageal echocardiography was performed in 44 patients with FMR related to the bilateral PM displacement and in 56 controls. The distance between the tip of the anterior or posterior PM and the intervalvular fibrosa were measured as the lateral or medial tethering length (TL) in midsystole. To evaluate the degree of coaptation, coaptation length (CL) at medial, middle, and lateral sites of mitral valve and an estimate of coaptation area (CA) were measured.ResultsThe FMR group showed the significantly decreased CA (1.3 ± 0.4 cm2 vs. 1.6 ± 0.4 cm2, p = 0.005) and CL (medial 3.2 ± 0.9 mm vs. 4.8 ± 0.6 mm, middle 3.8 ± 1.3 mm vs. 5.8 ± 0.7 mm, lateral 3.3 ± 0.9 mm vs. 4.8 ± 0.6 mm; all p < 0.0001) compared with the controls. Each CL correlated negatively and significantly with both medial and lateral TL (all p < 0.0001). Annular area (p = 0.004) was significantly smaller and leaflet-to-annular area ratio (p < 0.0001) was significantly larger in patients with nonsignificant FMR than in the patients with significant (moderate to severe) FMR. Significant correlations were found between effective regurgitant orifice area and CA or each CL (all p < 0.0001).ConclusionsCoaptation decreased significantly in patients with FMR. The CL at each region was related to PM displacement and the indexes of coaptation were associated with mitral regurgitation severity