Texas Heart Institute Journal Volume 46: Issue 2

Various techniques for treating tricuspid regurgitation have been described; however, because of scarce data about the long-term outcomes of different repairs, the optimal technique has not been established. We evaluated the effectiveness and durability of artificial neochordae implantation in the treatment of tricuspid regurgitation.

From 2009 through 2014, 507 patients underwent tricuspid valve repair at our institution. Of those, 48 patients implanted with artificial neochordae were included in our study. The median age of the participants was 62 years (range, 4–77 yr) and 50% were women. Thirty patients (63%) were in New York Heart Association functional class III, and 11 (23%) were in class II. The cause of tricuspid regurgitation was functional in 33 patients (69%) and rheumatic in 15 (31%). In 46 patients, neochordae implantation was performed in addition to Kay annuloplasty (n=13) or ring annuloplasty (n=33).

Forty-two patients were discharged from the hospital with absent or mild tricuspid regurgitation. The mean follow-up period was 44.3 ± 20.2 months. Follow-up echocardiograms revealed that tricuspid regurgitation was absent, minimal, or mild in 38 patients (80.8%), moderate in 7, and severe in 2.

Our results indicate that the use of artificial neochordae implantation as an adjunct procedure to annuloplasty leads to effective and durable repair in comparison with conventional techniques for treating tricuspid regurgitation.

We explored the potential clinical value of material separation enabled by dual-energy spectral computed tomography in detecting left atrial appendage thrombi.

The study enrolled 24 patients who were scheduled to undergo atrial fibrillation ablation (12 with and 12 without left atrial appendage thrombi). Computed tomograms were acquired in gemstone spectral imaging mode; the densities in the regions of the left atrial appendage cavities, pectinate muscles, and left atrial appendage thrombi were analyzed on monochromatic 70-keV images. Iodine and blood were chosen as the material basis pair; the iodine and blood densities were observed and quantitatively determined from the iodine- and blood-specific material decomposition images.

On the 70-keV monochromatic and iodine-specific images, the left atrial appendage pectinate muscles and thrombi appeared as areas of hypodense attenuation. On the blood-specific images, similar areas of high attenuation were observed in the thrombi and cavities, whereas lower attenuation was noticed in the pectinate muscles. The quantitative iodine and blood densities in the pectinate muscles were lower than those in the cavities (P <0.001). The iodine densities in the thrombi were lower than those in the cavities (P <0.001); however, blood densities did not differ significantly between the thrombi and cavities (P=0.192). Compared with the pectinate muscles, the thrombi showed lower blood-density differences (P=0.003) and higher iodine-density differences (P=0.006) in relation to the cavities.

Spectral computed tomography-enabled material separation is a novel method for differentiating left atrial appendage thrombi from pectinate muscles. The potential applications of this technology warrant further studies.

Venous thromboembolism is a leading cause of cardiovascular death. Historically, surgical intervention has been associated with high morbidity rates. Pharmacologic therapy alone can be inadequate for patients with substantial hemodynamic compromise, so minimally invasive procedures are being developed to reduce clot burden. We describe our initial experience with using the AngioVac system to remove thromboemboli percutaneously.

We reviewed all suction thromboembolectomy procedures performed at our institution from March 2013 through August 2015. The main indications for the procedure were failed catheter-directed therapy, contraindication to thrombolysis, bleeding-related complications, and clot-in-transit phenomena. We collected details on patient characteristics, procedural indications, thrombus location, hemodynamic values, cardiac function, pharmacologic support, and survival to discharge from the hospital. The Wilcoxon signed-rank test was used for statistical analysis.

Thirteen patients (mean age, 56 ± 15 yr; 10 men) underwent suction thromboembolectomy; 10 (77%) survived to hospital discharge. The median follow-up time was 74 days (interquartile range [IQR], 23–221 d). Preprocedurally, 8 patients (62%) had severe right ventricular dysfunction; afterwards, 11 (85%) had normal function or mild-to-moderate dysfunction, and only 2 (17%) had severe dysfunction (P=0.031).

Percutaneous suction thromboembolectomy, a promising therapeutic option for patients, appears to be safe, and we found it to be associated with improved right ventricular function.

Afana and colleagues¹ have presented a case that illustrates the complex interaction between transient takotsubo cardiomyopathy (TC) and pheochromocytoma, which merits discussion.

Some authors have accepted the idea that catecholamine surges are the biochemical cause of TC.² However, others view this explanation as simplistic and have suggested additional considerations, as follows.

1)
Frequently, patients presenting with TC complicated by hypotension have been empirically treated with those hormones, usually effectively. In addition, among the many patients who have no tachycardia or hypertension but have TC, very few typically undergo studies of catecholamine blood levels, meaning that this

Lyme Carditis and Inflammation-Driven Plaque Erosion Presenting as Sudden Cardiac Arrest

Marco KaldasMD,

Moneal ShahMD,

Diana PashaievaBDS,

Georgios LygourisMD, and

Anita RadhakrishnanMD

More on Waiting for Test Results: When a Doctor is the Patient

Professional Advantages

My Wife's Back

From Rags to Riches: My Association with Maxwell Myer Wintrobe

The SASH Phenomenon: Calling Attention to the Natural History of Diseases

English Can Be Tricky: Homophones, Homographs, and Other Linguistic Oddities

The Last Word

In Memoriam: Herbert L. Fred, MD (1929–2018)

Texas Heart Institute Medal and the Ray C. Fish Award for Scientific Achievement in Cardiovascular Diseases

Effectiveness of Artificial Neochordae Implantation in Tricuspid Valve Repair

Dual-Energy Computed Tomography-Enabled Material Separation in Diagnosing Left Atrial Appendage Thrombus

Effect of Percutaneous Suction Thromboembolectomy on Improved Right Ventricular Function

Minimally Invasive Endovascular Repair of Ascending Thoracic Aortic Aneurysm with Use of Local Anesthesia and Conscious Sedation

Pheochromocytoma-Induced Takotsubo Cardiomyopathy

Adjunctive Ischemic Lower-Limb Perfusion during Aortic Repair with Cardiopulmonary Bypass Prevents Fatal Reperfusion Injury

Surgical Repair of a Giant Aorto–Left Ventricular Fistula

Unconventional 2:1 Ventricular Pacing in a Neonate with Congenital Heart Block and Biventricular Noncompaction

Reversible Cerebral Vasoconstriction Syndrome Associated with Coronary Artery Vasospasm

Use of a Covered CP Stent to Exclude an Aortic–Brachiocephalic Conduit Pseudoaneurysm

Surgical Repair of Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm in a High-Risk Patient 13 Years after Aortic Root Replacement

Acute Isolated Right Ventricular Infarction: Unusual Presentation of Anterior ST-Segment-Elevation Myocardial Infarction

An Unusual Case of Takotsubo Cardiomyopathy in Pheochromocytoma

ST-Segment Elevation Soon after Coronary Artery Bypass Grafting

Transapical Implantation of Edwards Sapien XT Valve to Close a Left Ventricular Outflow Tract Pseudoaneurysm

Lyme Carditis and Inflammation-Driven Plaque Erosion Presenting as Sudden Cardiac Arrest

Risk Factors for Development of Stroke in Patients With Continuous-Flow Left Ventricular Assist Device Support as Destination Therapy

Midterm Outcomes of Pediatric Mitral Valvuloplasty for Moderate to Severe Mitral Valve Regurgitation and Associated Risk Factors for Postoperative Deterioration

Navigating the Complexities of Mitral Valve Clipping: Early Severe Mitral Valve Stenosis After Mitral Valve Clipping

The Department of Cardiovascular Anesthesia of The Texas Heart Institute: An Informal History

Iliac Artery Aneurysm Repair with Preservation of a Single Ectopic Pelvic Kidney

Restoration of Renal Allograft Function via Reduced-Contrast Percutaneous Revascularization of Transplant Renal Artery Stenosis

More on Pulmonary Artery Sarcoma

Ectopic Right Renal Artery Originating from Anomalous Common Celio-Mesenteric Trunk: Multifaceted Imaging Approach

Good Doctors and the State of Missouri: A Connection Worth Remembering