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Van Praagh R. Tricuspid Valve Anomalies. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zubarevich A, Szczechowicz M, Brcic A, Osswald A, Tsagakis K, Wendt D, Schmack B, Sá MPBO, Van den Eynde J, Ruhparwar A, Zhigalov K. Tricuspid valve repair in isolated tricuspid pathology: a 12-year single center experience. J Cardiothorac Surg 2020; 15:330. [PMID: 33198774 PMCID: PMC7670779 DOI: 10.1186/s13019-020-01369-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives Long-term data on isolated surgical tricuspid valve procedures is limited. Current guidelines on heart valve disease recommend valve repair over valve replacement. In this study we report our 12-year single-center experience with isolated surgical tricuspid valve repair in patients with various tricuspid valve pathologies. Methods Between May 2007 and December 2019, 26 consecutive patients underwent isolated tricuspid valve annuloplasty/repair for various indications. In 18 patients (69.2%) an open ring or band annuloplasty (26.9 and 42.3%, respectively) was performed, 5 patients (19.2%) underwent a tightening of the annulus using the DeVega technique, 5 patients (19.2%) had a leaflet reconstruction with patch or bicuspidalization and in 3 patients (11.5%) a leaflet debridement was performed. In 15.4% of the cohort a combination of the techniques was utilized. Results The mean follow-up time was 2.1 (0.3–5.0) years. Early survival at 30 days after surgery was 84.6%. Mean hospital stay was 11 (6.7–16) days. One-year survival was 73%. No patient required a redo procedure on the tricuspid valve during follow-up. Conclusion Tricuspid valve repair is suggested as a treatment of choice according to recent guidelines on heart valve disease. If chosen correctly, various repair techniques provide good long-term results. Tricuspid valve repair may be safely applied in patients undergoing surgical isolated tricuspid valve procedures.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
| | - Marcin Szczechowicz
- Department of Cardiovascular Surgery Essen-Huttrop, University Hospital Essen, Essen, Germany
| | - Andreas Brcic
- Department of Anesthesiology, University Hospital Essen, Essen, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Michel Pompeu B O Sá
- Department of Cardiovascular Surgery at the Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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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.
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Abstract
The deceased was a 44-year-old male who was treated for a suspected Ebstein's anomaly observed using transthoracic echocardiogram. He was found dead in his bed at home. Autopsy revealed that the septal tricuspid leaflet was intact; however, a large anterior tricuspid leaflet cleft and right atrioventricular cavity dilation were observed. Pathological examination revealed a normal tricuspid valve, except for the presence of a cleft with local fibrosis of the left ventricle papillary muscle and hemosiderin-containing macrophages at both lungs. There were no other abnormalities that may have led to death. It was concluded that he died a cardiac death based on the right heart overload associated with the anterior tricuspid leaflet cleft. This case indicates the possibility that the anterior tricuspid leaflet cleft can cause death and also highlights the necessity of a detailed autopsy to accurately diagnose the cause of death.
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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. [DOI: 10.1177/0218492319847365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A cleft in the tricuspid valve, classified as congenital dysplasia, is a rare disease. Here, we report the case of a 79-year-old man with tricuspid regurgitation due to a cleft in the anterior leaflet. The patient underwent successful tricuspid valve repair with cleft closure, chordal reconstruction, and tricuspid annuloplasty.
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Affiliation(s)
- Kosuke Saku
- Department of Cardiovascular Surgery, Tenyokai Central Hospital and Central Clinic, Kagoshima, Japan
| | - Hironori Inoue
- Department of Cardiovascular Surgery, Tenyokai Central Hospital and Central Clinic, Kagoshima, Japan
| | - Keisuke Yamamoto
- Department of Cardiovascular Surgery, Tenyokai Central Hospital and Central Clinic, Kagoshima, Japan
| | - Masahiro Ueno
- Department of Cardiovascular Surgery, Tenyokai Central Hospital and Central Clinic, Kagoshima, Japan
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Hamandi M, Al-Azizi K, Crawford A, Fan J, DiMaio JM, Smith RL. Robotic Repair of a Congenital Isolated Cleft of Anterior Tricuspid Valve Leaflet. J Investig Med High Impact Case Rep 2019; 7:2324709618823809. [PMID: 30791722 PMCID: PMC6350157 DOI: 10.1177/2324709618823809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Congenital isolated tricuspid valve (TV) cleft in the anterior leaflet is a rare
occurrence, while clefts of the mitral valve leaflets are more common and are
usually associated with other congenital heart diseases. In this article, we
report a case of TV regurgitation in a young adult female due to an isolated
congenital cleft in the anterior TV leaflet, which was surgically repaired using
a minimally invasive robotic approach.
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Affiliation(s)
- Mohanad Hamandi
- 1 Baylor Scott& White Research Institute at the Heart Hospital, Plano, TX, USA
| | - Karim Al-Azizi
- 1 Baylor Scott& White Research Institute at the Heart Hospital, Plano, TX, USA
| | - Alexander Crawford
- 1 Baylor Scott& White Research Institute at the Heart Hospital, Plano, TX, USA
| | - Joy Fan
- 1 Baylor Scott& White Research Institute at the Heart Hospital, Plano, TX, USA
| | - J Michael DiMaio
- 1 Baylor Scott& White Research Institute at the Heart Hospital, Plano, TX, USA
| | - Robert L Smith
- 1 Baylor Scott& White Research Institute at the Heart Hospital, Plano, TX, USA
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Fam NP, Ho EC, Edwards J, Connelly KA. Edge-to-edge repair of a large anterior leaflet notch with severe tricuspid regurgitation. EUROINTERVENTION 2018; 14:654-655. [DOI: 10.4244/eij-d-17-00814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ho EC, Fam NP. Transcatheter therapies for tricuspid regurgitation: coaptation augmentation devices. Minerva Cardioangiol 2018; 66:718-728. [PMID: 29546746 DOI: 10.23736/s0026-4725.18.04657-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advancements in transcatheter technology has increased the number of therapeutic options for patients with tricuspid regurgitation. One category of repair devices attempts to augment leaflet coaptation by either leaflet plication or by functioning as a space occupying device. These include the MitraClip (Abbott, Santa Clara, CA, USA), PASCAL (Edwards Lifesciences, Irvine, CA, USA) and FORMA (Edwards Lifesciences, Irvine, CA, USA) devices. All three have been successfully implanted with promising short-term echocardiographic and clinical outcomes. Improvements in patient selection, device design and procedural technique will lead to more effective tricuspid regurgitation reduction. Further research to assess efficacy, safety and durability of these devices is needed, along with determination of long-term clinical outcomes.
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Affiliation(s)
- Edwin C Ho
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Neil P Fam
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada -
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Kuroda M, Ohta J, Mita N, Miyoshi S, Kadoi Y, Saito S. Notch of the Anterior Leaflet of the Tricuspid Valve with Severe Tricuspid Regurgitation. Anesth Analg 2015; 120:576-579. [DOI: 10.1213/ane.0000000000000570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
BACKGROUND AND AIM Congenital tricuspid regurgitation is an extremely rare condition. The morphologic heterogeneity makes it difficult to derive any conclusions regarding the best strategy for management of this condition. METHODS We analysed the published literature on "congenital tricuspid regurgitation" using MEDLINE. In addition, the reference sections of all relevant articles were searched to identify additional cases. Studies published till June 2009 are included. RESULTS As far as we could establish, there were 123 cases of congenital tricuspid regurgitation. Of these, 63 were documented during surgery, 38 during autopsy, and 22 were diagnosed by echocardiography or cardiac catheterisation. The mean age was 22.57 years, with a standard deviation of 23.42 years, and the age ranged from 1 day to 80 years, with a median of 16 years. There was a male predominance, with a male-to-female ratio of approximately 3:2. CONCLUSION Congenital tricuspid regurgitation is an uncommon clinical entity with wide anatomical variations. The severity of disease dictates the presentation in infancy, childhood, or adulthood. Tricuspid valve repair is the ideal treatment whenever feasible, especially in children. We propose a new classification for congenital tricuspid regurgitation, which not only includes the anatomical variations, but can also help the surgeon in deciding on the best strategy for management.
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Kobza R, Kurz DJ, Oechslin EN, Prêtre R, Zuber M, Vogt P, Jenni R. Aberrant tendinous chords with tethering of the tricuspid leaflets: a congenital anomaly causing severe tricuspid regurgitation. Heart 2004; 90:319-23. [PMID: 14966058 PMCID: PMC1768112 DOI: 10.1136/hrt.2002.006254] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To define the entity of tricuspid regurgitation caused by tethering of the tricuspid valve leaflets by aberrant tendinous chords. DESIGN Retrospective study. SETTING Tertiary care centre (university teaching hospital). PATIENTS 10 patients with unexplained severe tricuspid regurgitation. METHODS The last 13 500 echocardiographic studies from our facility were reviewed to identify patients with severe unexplained tricuspid regurgitation. Tethering was defined by the presence of aberrant tendinous chords to the tricuspid valve leaflets limiting the mobility of the tricuspid leaflet and resulting in incomplete coaptation and apical displacement of the regurgitant jet origin. Aberrant tendinous chords were defined as those inserting at the clear zone of the tricuspid leaflet and not originating from the papillary muscle. Patients fulfilling the diagnostic criteria for Ebstein's anomaly were excluded. RESULTS 10 patients with aberrant tendinous chords tethering one or more tricuspid valve leaflets were identified. There were short non-aberrant tendinous chords in seven patients, five of whom also had right ventricular or tricuspid annulus dilatation. CONCLUSIONS Tethering of the tricuspid valve leaflets by aberrant tendinous chords can be the sole mechanism of congenital tricuspid regurgitation. It is often associated with short non-aberrant tendinous chords, which may develop secondary to right ventricular or tricuspid annulus dilatation. Awareness of tethering as a cause of tricuspid regurgitation may be important in planning reconstructive surgery.
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Affiliation(s)
- R Kobza
- Echocardiography, Cardiovascular Centre, University Hospital Zurich, Zurich, Switzerland
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Nekkanti R, Nanda NC, Ahmed S, Huang WY, Pacifico AD. Transesophageal three-dimensional echocardiographic demonstration of clefts in the anterior tricuspid valve leaflet. THE AMERICAN JOURNAL OF GERIATRIC CARDIOLOGY 2002; 11:329-30. [PMID: 12214173 DOI: 10.1111/j.1076-7460.2002.00886.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rajasekhar Nekkanti
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 35249, USA
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Okutan H, Yavuz T, Bilgin S, Düver H, Kutsal A. Congenital cleft of anterior tricuspid leaflet in adolescent. Asian Cardiovasc Thorac Ann 2002; 10:262-3. [PMID: 12213755 DOI: 10.1177/021849230201000318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diagnostic findings and treatment of an isolated congenital cleft of the anterior leaflet of the tricuspid valve in a 14-year-old boy are described. An atrial septal defect was closed by primary suturing, and the tricuspid valve was successfully reconstructed by De Vega annuloplasty.
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Affiliation(s)
- Hüseyin Okutan
- Department of Thoracic and Cardiovascular Surgery Sevket Demirel Heart Center Süleyman Demirel University Medical School Isparta, Turkey.
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Hagler DJ, Squarcia U, Cabalka AK, Connolly HM, O'Leary PW. Mechanism of tricuspid regurgitation in paramembranous ventricular septal defect. J Am Soc Echocardiogr 2002; 15:364-8. [PMID: 11944015 DOI: 10.1067/mje.2002.116335] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Literature has been limited in regard to the mechanisms of tricuspid regurgitation (TR) in patients with paramembranous (perimembranous) ventricular septal defect (VSD). Most observations have noted tricuspid valve clefts or dysplasia. We describe another mechanism for production of TR in association with paramembranous VSD. In 8 patients, we found significant TR produced by the VSD jet pushing the tricuspid anterior leaflet forward to open the tricuspid valve orifice. In these patients, a moderate paramembranous VSD extended slightly below the septal tricuspid leaflet with only partial obstruction of the VSD jet. All patients had restrictive VSD with low right ventricular pressure. This mechanism to produce TR was best defined by intraoperative transesophageal echocardiography, but current higher resolution imaging should allow correct diagnosis. We believe that when this mechanism for TR is found in association with a moderate VSD, surgical VSD closure is warranted.
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Affiliation(s)
- Donald J Hagler
- Division of Pediatric Cardiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
We report a case of isolated congenital tricuspid regurgitation caused by a cleft in the anterior tricuspid leaflet associated with a patent foramen ovale. Preoperative echocardiography revealed severe tricuspid regurgitation resulting from anterior tricuspid leaflet prolapse. The patient underwent successful tricuspid valve repair with simple cleft suture and annuloplasty and direct closure of the patent foramen ovale.
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Affiliation(s)
- N Motoyoshi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan.
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McElhinney DB, Silverman NH, Brook MM, Hanley FL, Stanger P. Asymmetrically short tendinous cords causing congenital tricuspid regurgitation: improved understanding of tricuspid valvar dysplasia in the era of color flow echocardiography. Cardiol Young 1999; 9:300-4. [PMID: 10386700 DOI: 10.1017/s1047951100004972] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Tricuspid regurgitation as a manifestation of an isolated congenital anomaly of the tricuspid valve is rare. Cross-sectional and color Doppler echocardiography allow improved evaluation of tricuspid valvar function. As a result, the heterogeneous category of congenital tricuspid valvar dysplasia may be better understood from a functional point of view. We are reporting a distinct entity in which tricuspid valvar regurgitation results from failure of coaptation due to short tendinous cords tethering the septal leaflet. PATIENTS AND RESULTS Three children with significant primary tricuspid regurgitation were evaluated, treated, and followed. On echocardiographic evaluation, a central regurgitant jet of moderate or severe degree was directed toward the atrial septum through poorly coapting tricuspid valvar leaflets, which did not approximate due to tethering of the septal leaflet by abnormally short cords. In one patient, the tricuspid valve was otherwise normal; in the other two the leaflets and cords were also thickened. Two patients underwent surgery at 9 and 11 years of age. The cords tethering the septal leaflet were augmented by interposing appropriate lengths of expanded polytetrafluoroethylene suture and performing commissural annuloplasty. Both patients are asymptomatic 33 and 42 months postoperatively, with mild residual tricuspid regurgitation that has not changed since surgery. The other patient, an 8 month-old infant, has not yet undergone surgery. CONCLUSIONS Asymmetric tendinous cords of the tricuspid valve causing tethering of the septal leaflet is a distinct cause of tricuspid regurgitation that can be recognized with echocardiography. Although rare, the importance of recognizing this lesion lies in its being readily amenable to surgical repair.
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Affiliation(s)
- D B McElhinney
- Division of Pediatric Cardiology, University of California, San Francisco, USA
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Abstract
The tricuspid and mitral valves are homologous whose function depends on coordination among components. Isolated tricuspid valve abnormalities are relatively uncommon. Rheumatic disease, chemicals, immunologic and degenerative disorders alter leaflet anatomy and may result in either stenosis, insufficiency or a combination. More often, tricuspid disorders present as a component of congenital syndromes or secondary to pulmonary vascular or let heart disease which alter geometry and function of nonleaflet components.
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Affiliation(s)
- A S Blaustein
- Cardiac Non-Invasive Laboratory, VA Medical Center, Houston, Texas, USA
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Abstract
This brief report presents a patient with isolated right heart failure and two rare underlying causes, hyperthyroidism and dysplastic tricuspid valve. Repair of the tricuspid valve and treatment of the hyperthyroidism were both essential for successful treatment of the right heart failure. Most important, recrudescence of hyperthyroidism in this patient was associated with reappearance of florid right heart failure. This report provides further information about a potential linkage of hyperthyroidism and severe right heart failure.
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Affiliation(s)
- N P Xenopoulos
- Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1045, USA
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