Patricia Mahia

Tricuspid annular plane systolic excursion inaccuracy to assess right ventricular function in patients with previous tricuspid annulopasty

OBJETIVES The clinical and prognostic usefulness of tricuspid annular plane systolic excursion (TAPSE) is well established. However, the ability of TAPSE to assess right ventricular (RV) function in patients with previous tricuspid valve annulopasty is controversial. This study examined the TAPSE suitability in patients with previous tricuspid valve annuloplasty using right ventricular fractional area change (RVFAC) as reference method. METHODS We retrospectively analyzed 53 patients who underwent tricuspid valve annuloplasty at our hospital between 2013 and 2016. TAPSE and RVFAC were obtained in preoperative and postoperative periods using standard methodology. RESULTS Mean age was 68±12years and 34 patients (64.1%) were women. TAPSE decreased significantly after surgery in comparison with pre-surgical values (17±4.2 Vs 12.9±4.1mm, p<0.001). On the contrary, RVFAC did not change significantly after surgery (37±9.2 Vs 36.2.9, p=0.25). The correlation between RVFAC and TAPSE was better in the preoperative (r=0.63, p<0.0001) than in the postoperative period (r=0.38, P=0.005). Good intra- and interobserver agreement for TAPSE and RVFAC was obtained, with intraclass correlation coefficients of 0.97 and 0.92 for TAPSE; and 0.90 and 0.85 for RVFAC, respectively. CONCLUSIONS These findings suggest that TAPSE is not suitable after tricuspid valve annuloplasty and it leads to an underestimation of RV systolic function. It seems to be appropriate to rely on echocardiographic parameters of global RV function such as RVFAC in this context.

Descending Aorta Rupture During Transcatheter Aortic Valve Replacement

A 88-year-old woman with a permanent VDD pacemaker and severe aortic stenosis underwent elective transcatheter aortic valve replacement because of high surgical risk (logistic Euroscore of 35.3%). Aortic valve area was 0.5 cm2, mean gradient was 86 mm Hg, and left ventricular ejection fraction was 64% on transthoracic echocardiography. Aortic annulus sizing was 23.5 and 23.7 mm by transesophageal echocardiography and multidetector computed tomography, respectively. Femoral and iliac arteries evaluated by angiography and computed tomography were straight with mild calcification and had adequate internal diameters. Great tortuosity of the aorta was also observed in computed tomography, with the presence of a double angle in the descending thoracic aorta and a very pronounced curve in the distal part of the aortic arch (Figure 1). The procedure took place via right transfemoral access with the use of a percutaneous closure device. A self-expandable 29-mm Core Valve prosthesis (Medtronic, Inc., Minneapolis, MN) was advanced, encountering a high resistance at the level of the distal part of the aortic arch that precluded the progress. When advancement …