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A Case of Traumatic Tricuspid Regurgitation Caused by Multiple Papillary Muscle Rupture
진한영,장재식,서정숙,양태현,김대경,김동기,김웅,설상훈,김두일,김동수 한국심초음파학회 2011 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.19 No.1
Traumatic tricuspid regurgitation is a rare complication of blunt chest trauma. With the increase in the number of automobile accidents, traumatic tricuspid regurgitation has become an important problem after blunt chest trauma. It has been reported more frequently because of better diagnostic procedures and a better understanding of the pathology. The early diagnosis of traumatic tricuspid regurgitation is important because traumatic tricuspid injury could be effectively corrected with reparative techniques, early operation is considered to relieve symptoms and to prevent right ventricular dysfunction. Echocardiography can reveal the cause and severity of regurgitation. We experienced a case of tricuspid regurgitation after blunt chest trauma early diagnosis and valve repair were performed. This case reminds the physicians in the emergency department should be aware of this potential complication following non-penetrating chest trauma and echocardiography is useful and should play an early role.
삼첨판 성형술 [De Vega 술식]의 원격 성적에 대한 고찰
김병열 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery (J Chest Surg) Vol.26 No.11
From Jan 1982 through Dec.1991, thirty-three DeVega`s tricuspid annuloplasties were performed in association with mitral and combined mitral and aortic valve disease. Preoperatively,all of the patients were in NYHA functional class III or IV.There were one early death and 4 patients died during follow up period of 18 to 138 months [ mean follow up : 67.3 months ]. Nine patients required reoperation because of biological mitral valve failure at 4.7 to 11 years after tricuspid annuloplasty[TAP]. Among these patients,2 cases needed for reoperation of TAP due to loosening of suture material. Twenty four [86%] of the survivors were in NYHA functional class I or II after TAP.The actuarial survival rate for the TAP was 74% at 138 months. Rt atrial pressure of 9 reoperation cases were significantly decreased [P<0.05] compared with initial Rt.atrial pressure [ Mean period; 93.6 months].Doppler echocardiographic studies for tricuspid regurgitation were performed in 15 cases after TAP [Mean period: 42.3 months].These results showed significantly reduced [P<0.01] tricuspid annulus diameter and tricuspid regurgitation distance [ P<0.05 ].Our surgical experience that the DeVega`s TAP is a simple,safe,effective procedure and resulted in good hemodynamic improvement with moderate to severe functional tricuspid regurgitation.
증례 : 갑상샘항진증에서 우심부전을 동반한 중증 삼첨판 폐쇄부전증 1예
장원일 ( Won Il Jang ),김은미 ( Eun Mi Kim ),안계택 ( Kye Taek Ahn ),박재형 ( Jae Hyeong Park ),최시완 ( Si Wan Choi ) 대한내과학회 2007 대한내과학회지 Vol.73 No.2
결론적으로 갑상샘항진증과 연관된 좌심부전의 소견이 없이 우심부전을 동반한 삼첨판 폐쇄 부전증을 보였던 예에서 항갑상샘제제 및 소량의 이뇨제 치료로 호전되었다. 폐동맥 고혈압을 동반한 우심부전과 삼첨판 폐쇄부전이 있을 경우 갑상샘항진증은 이의 가능한 원인으로서 고려되어야 한다. Left-sided heart failure can be complicated in the patient suffering with thyrotoxicosis; however, predominantly right heart failure in thyrotoxic patients is a rare condition. We present here a case of reversible right-heart failure with severe tricuspid regurgitation associated with thyrotoxicosis. A 71-year-old woman was admitted to the hospital because of a 10-day history of shortness of breath and indigestion. On echocardiography, there was a normal-sized left ventricle with preserved systolic and diastolic function. However, the right atrium and ventricle were dilated, and there was incomplete systolic coaptation of the tricuspid leaflets, resulted in severe tricuspid regurgitation. The maximal velocity of tricuspid regurgitation was 3.7 m/sec and the estimated pressure gradient between the right two chambers was 55 mmHg. After treatment that included diuretics and antithyroid drug (methimazole), the symptoms of right heart failure resolved. Four weeks later, a second echocardiogram was obtained revealing a normalized right atrium and ventricle, trivial tricuspid regurgitation and the resting pulmonary hypertension had disappeared.(Korean J Med 73:206-209, 2007)
송종민,장민경,김윤정,김대희,강덕현,송재관 대한심장학회 2010 Korean Circulation Journal Vol.40 No.9
Background and Objectives: Right ventricle (RV) remodeling can determine tricuspid valve (TV) geometry and the severity of functional tricuspid regurgitation (TR). Subjects and Methods: In 53 patients with various degrees of functional TR and in sinus rhythm, RV and TV geometries were analyzed using real-time 3-dimensional echocardiography, including tenting angles of 3 leaflets, septal-lateral and antero-posterior tricuspid annulus diameters and inlet RV dimensions, mid-RV septal-lateral dimension, and the distance between annulus and apex. A mid-systole frame when the TV tenting is smallest was selected for the analysis. RV end-diastolic and end-systolic volumes were measured. The severity of functional TR was determined by distal jet area. Results: TR distal jet area was mainly determined by septal-lateral annulus diameter (p<0.001)RV inlet dimension (p=0.015), RV end-systolic volume (p=0.010), septal (p=0.019), and anterior leaflet tenting angles (p=0.045) by multiple stepwise linear regression analysis. Leaflet tenting angles were mainly determined by septal-lateral RV inlet dimension. Septal-lateral annulus diameter was determined by septal-lateral RV inlet dimension (p<0.001) and mid RV dimension (p=0.033), whereas antero-posterior annulus diameter was determined by antero-posterior RV inlet dimension (p<0.001). Conclusion: Functional TR severity is determined by septal-lateral annulus and RV dilation, and tenting of septal and anterior leaflets. TV leaflet tenting is mainly determined by septal-lateral RV inlet dilation, and tricuspid annulus dilation is closely linked with inlet RV dilation.
심장 자상 후에 발생된 삼첨판막 폐쇄부전의 삼첨판막 성형술 -1예 보고-
이석열,김동현,이승진,이철세,이길노 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.5
51세 환자가 3개월 전에 심장 자상으로 본원에 입원하여 심장봉합수술을 받았다. 이후 별다른 소견 없이 지내다가 약 2개월 전부터 발생된 호흡곤란을 주소로 내원하였다. 심장초음파상 심한 삼첨판막 폐쇄부전이 관찰되었으며 삼첨판막의 건삭치환술과 판윤 성형술을 실시하였다. 이에 저자들은 심장 자상 후에 발생된 삼첨판막 폐쇄부전을 판막성형술로 치료하였기에 증례보고를 하는 바이다.
이광희,조용욱,원종호,신승호,김순길,김선주 순천향대학교 1990 논문집 Vol.13 No.3
A 46 year old male patient was admitted to Soochunhyang University Chunan Hospital on Oct. 1989 due to exertional dyspnea and generalized edema. He was diagnosed as severe tricuspid regurgitation and later discovered to be thyrotoxic. Appropriate antithyroid treatment resulted in improvement of right side heart failure and tricuspid regurgitation. The possible mechanisms of various cardiac manifestations of hyperthyroidism and tricuspid regurgitation associated with right side heart failure are discussed.
( Ryan Bylsma ),( Mustafa Baldawi ),( Bruce Toporoff ),( Matthew Shin ),( Meghan Cochran-yu ),( Davinder Ramsingh ),( Purvi Parwani ),( David G. Rabkin ) 대한외상학회 2021 大韓外傷學會誌 Vol.34 No.2
We present a case of delayed diagnosis of traumatic tricuspid valve rupture in a patient who was emergently brought to the operating room for repair of lacerations to the heart and liver without intraoperative transesophageal echocardiography (TEE). Initial post-operative transthoracic echocardiography (TTE) did not show structural pathology. One week later, TTE with better image quality showed severe tricuspid regurgitation. Subsequently, TEE clearly demonstrated rupture of the anterior papillary muscle and flail anterior tricuspid leaflet. The case description is followed by a brief discussion of the utility of TEE in the setting of blunt thoracic trauma.
삼첨판 폐쇄부전 환자에서 도플러 심에코도를 이용한 우심실 수축기압 및 폐동맥평균압의 추정
김유호(You Ho Kim),전은석(Eun Seok Jeon),손대원(Dae Won Sohn),오병희(Byung Hee Oh),박영배(Young Bae Park),최윤식(Yun Shik Choi),서정돈(Jung Don Seo),이영우(Young Woo Lee) 대한내과학회 1987 대한내과학회지 Vol.32 No.5
N/A The comparison between the results of right ventricular systolic pressure and mean pulmonary artery pressure using catheterization and that of right ventricular systolic pressure and right ventricular systolic time intervals using Doppler echocardiography in patients with tricuspid regurgitation as follows: 1) Adding the tranatricuspid gradient (△P) to the JVP gave prediction of right ventricular systolic pressure (RVSP) that correlated well with catheterization values. 2) There was also significant correlation between the transtricuspid gradient predicted by Doppler echocardiography and RVSP by catheterization. 3) As the mean pulmonary artery pressure (MPAP) increased, the PEP/AT also increased, while AT/ET decreased. When MPAP was less than 20 mmHg, PEP/AT, AT/ET were 1.06±0.12, 0.40±0.05 respectively, while when MPAP was between 20 and 39 mmHg, PEP/AT, AT/ET were 1.37±0.25, 0.33±0.05, and when MPAP was over 40 mmHg, PEP/AT, AT/ET were 1.65±0.21, 0.26±0.03. 4) There was significant correlation hetween the results of PEP/AT obtained by Doppler echocardiography and MPAP obtained by catheterization and negative correlation between the results of AT/ET by Doppler echocardiography and MPAP by catheterization.
Tricuspid Regurgitation: Clinical Importance and Its Optimal Surgical Timing
김형관,이승표,김용진,손대원 한국심초음파학회 2013 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.21 No.1
Tricuspid regurgitation (TR) has long been neglected based on the false belief that it is substantially rare in prevalence and is not so important in determining prognosis. Recent consecutive publications refuted this concept surrounding TR, and now we are contemplating this entity from different point of view. In this review, we mainly focus on isolated form of severe TR. In our daily clinical practice, however, patients with problems in more than one valve are more frequently encountered. Hence, we briefly touch on the results of severe TR surgery with or without left side valve operations here and there, as well.