Management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplantCentral MessagePerspective
Objective: Even though severe tricuspid regurgitation is not uncommon after cardiac transplantation, primary severe tricuspid regurgitation is rare. We present such a case with additional complexities. Methods: The patient was 44-year-old man with a HeartWare durable left ventricular assist device (...
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| Language: | English |
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Elsevier
2023-10-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250723002626 |
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| author | Erin M. Schumer, MD, MPH Kunal D. Kotkar, MD M. Faraz Masood, MD Tsuyoshi Kaneko, MD Ralph J. Damiano, MD Amit Pawale, MD |
| author_facet | Erin M. Schumer, MD, MPH Kunal D. Kotkar, MD M. Faraz Masood, MD Tsuyoshi Kaneko, MD Ralph J. Damiano, MD Amit Pawale, MD |
| author_sort | Erin M. Schumer, MD, MPH |
| collection | DOAJ |
| description | Objective: Even though severe tricuspid regurgitation is not uncommon after cardiac transplantation, primary severe tricuspid regurgitation is rare. We present such a case with additional complexities. Methods: The patient was 44-year-old man with a HeartWare durable left ventricular assist device (Heartware Inc) who received a temporary right ventricular assist device (RVAD) with a ProtekDuo cannula (LivaNova Inc USA) for refractory ventricular fibrillation and underwent a heart transplant as United Network for Organ Sharing Status 1, in the presence of partially compensated cardiogenic shock, renal failure. Given complex re-operative surgery in a volume-overloaded patient with unknown pulmonary vascular resistance, an RVAD cannula was preserved and re- inserted during cardiac transplant. Postoperatively he required hemodialysis, had severe primary tricuspid regurgitation discovered after RVAD removal and developed Enterobacter mediastinitis. He underwent complex tricuspid valve repair for flail tricuspid leaflet due to ruptured papillary muscle likely due to RVAD cannula injury, after multiple mediastinal washouts and was followed by delayed chest reconstruction. Results: The patient is doing well, 6 months after discharge to home, asymptomatic, without re-admissions, on renal recovery path, with no tricuspid regurgitation and good biventricular function. Conclusions: Replacing the tricuspid valve in presence of hemodialysis catheter, immunosuppression and mediastinitis could be high risk for endocarditis. Even though we have short-term follow-up, tricuspid valve repair can be an effective way of managing primary severe regurgitation especially when there is a desire or need to avoid valve replacement. |
| format | Article |
| id | doaj-art-056a22d41aad4204b20e07cdab345f77 |
| institution | DOAJ |
| issn | 2666-2507 |
| language | English |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-056a22d41aad4204b20e07cdab345f772025-08-20T03:04:59ZengElsevierJTCVS Techniques2666-25072023-10-012110610810.1016/j.xjtc.2023.07.014Management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplantCentral MessagePerspectiveErin M. Schumer, MD, MPH0Kunal D. Kotkar, MD1M. Faraz Masood, MD2Tsuyoshi Kaneko, MD3Ralph J. Damiano, MD4Amit Pawale, MD5Division of Cardiothoracic Surgery, Washington University, St Louis, MoDivision of Cardiothoracic Surgery, Washington University, St Louis, MoDivision of Cardiothoracic Surgery, Washington University, St Louis, MoDivision of Cardiothoracic Surgery, Washington University, St Louis, MoDivision of Cardiothoracic Surgery, Washington University, St Louis, MoAddress for reprints: Amit Pawale, MD, Division of Cardiothoracic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110.; Division of Cardiothoracic Surgery, Washington University, St Louis, MoObjective: Even though severe tricuspid regurgitation is not uncommon after cardiac transplantation, primary severe tricuspid regurgitation is rare. We present such a case with additional complexities. Methods: The patient was 44-year-old man with a HeartWare durable left ventricular assist device (Heartware Inc) who received a temporary right ventricular assist device (RVAD) with a ProtekDuo cannula (LivaNova Inc USA) for refractory ventricular fibrillation and underwent a heart transplant as United Network for Organ Sharing Status 1, in the presence of partially compensated cardiogenic shock, renal failure. Given complex re-operative surgery in a volume-overloaded patient with unknown pulmonary vascular resistance, an RVAD cannula was preserved and re- inserted during cardiac transplant. Postoperatively he required hemodialysis, had severe primary tricuspid regurgitation discovered after RVAD removal and developed Enterobacter mediastinitis. He underwent complex tricuspid valve repair for flail tricuspid leaflet due to ruptured papillary muscle likely due to RVAD cannula injury, after multiple mediastinal washouts and was followed by delayed chest reconstruction. Results: The patient is doing well, 6 months after discharge to home, asymptomatic, without re-admissions, on renal recovery path, with no tricuspid regurgitation and good biventricular function. Conclusions: Replacing the tricuspid valve in presence of hemodialysis catheter, immunosuppression and mediastinitis could be high risk for endocarditis. Even though we have short-term follow-up, tricuspid valve repair can be an effective way of managing primary severe regurgitation especially when there is a desire or need to avoid valve replacement.http://www.sciencedirect.com/science/article/pii/S2666250723002626tricuspid regurgitationtricuspid repairheart failureheart transplantright ventricular assist device |
| spellingShingle | Erin M. Schumer, MD, MPH Kunal D. Kotkar, MD M. Faraz Masood, MD Tsuyoshi Kaneko, MD Ralph J. Damiano, MD Amit Pawale, MD Management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplantCentral MessagePerspective JTCVS Techniques tricuspid regurgitation tricuspid repair heart failure heart transplant right ventricular assist device |
| title | Management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplantCentral MessagePerspective |
| title_full | Management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplantCentral MessagePerspective |
| title_fullStr | Management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplantCentral MessagePerspective |
| title_full_unstemmed | Management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplantCentral MessagePerspective |
| title_short | Management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplantCentral MessagePerspective |
| title_sort | management of severe tricuspid valve regurgitation due to ruptured papillary muscle in a patient with mediastinitis early after heart transplantcentral messageperspective |
| topic | tricuspid regurgitation tricuspid repair heart failure heart transplant right ventricular assist device |
| url | http://www.sciencedirect.com/science/article/pii/S2666250723002626 |
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