Background: The incidence of prosthetic tricuspid valve (TV) thrombosis is the highest among heart valves. It can lead to high morbidity and mortality without proper treatment. In this study, we sought to report the management and clinical outcomes of patients with mechanical TV thrombosis.Methods: The current study was conducted in Rajaei Heart Center on 42 patients with mechanical TV thrombosis from 2006 to 2017. The baseline characteristics and the rates of adverse events during the follow-up period were assessed.Results: A total of 67 episodes of mechanical TV thrombosis in 42 patients were observed. The mean age of patients was 45.5 ± 14.3 years (19-77), and overall two-thirds were female. Thrombolytic therapy was used in 41 (61.1%), anticoagulant intensification in 16 (23.9%), and surgery as the first approach in 10 (14.9%) episodes; subsequently, surgery as the final approach was implemented in 20 (29.8%) episodes. In-hospital mortality occurred in two (2.98%) patients. The rates of freedom from recurrent thrombosis were 84%, 61%, and 21% at the end of 1, 4, and 10 years, respectively. Survival rates and freedom from chronic valve dysfunction were 93%, 82%, and 75% after 1, 4, and 10 years. Conclusions:The results of the present study showed that recurrent thrombosis requiring intervention is a major complication of mechanical TV, which underscores individual-approached therapy and close follow-up.

Background Constrictive physiology is a transitory condition that could lead to constrictive pericarditis, which is a rare complication after open‐heart surgery. Anti‐inflammatory drugs like colchicine are recommended for prevention of constrictive pericarditis; however, there is no evidence about the effect of colchicine on constrictive pericarditis. Thus, the aim of this study is to evaluate the preventive effect of colchicine on the incidence of echocardiographic constrictive physiology after open‐heart surgery. Methods This was a parallel randomized, double‐blind trial. Patients were randomly assigned to receive 1 mg colchicine once‐daily from 48 hours before and 0.5 mg twice daily for 5 days after surgery. Primary outcome was the incidence of the constrictive physiology after primary endpoint (1 week after the surgery). The secondary outcome was the primary outcome after secondary endpoint (4 weeks after surgery) plus the new cases of constrictive physiology between the primary and secondary endpoints. Results Out of 160 participating patients, the primary outcome occurred in 19 patients (23%) in placebo and 11 (13%) in intervention groups. There was no significant difference between two groups (P = .106). After 4 weeks of follow‐up, 19 patients (23%) in placebo and 9 (11%) in intervention groups had constrictive physiology whereas 2 out of 11 patients (18.2%) were recovered. The difference was significant (P = .038). No new case of constrictive physiology occurred between primary and secondary endpoints. Conclusion Short‐term use of colchicine has a preventive effect on reducing constrictive physiology after 1 month of open‐heart surgery but not a week after that.

Background: The incidence of prosthetic tricuspid valve (TV) thrombosis is the highest among heart valves. It can lead to high morbidity and mortality without proper treatment. In this study we sought to report the management and clinical outcomes of patients with mechanical TV thrombosis. Methods: In in a retrospective single-center study, all patients with mechanical TV thrombosis were evaluated from 2006 to 2017. The data on baseline characteristics, management of mechanical TV thrombosis, and the rates of adverse events during follow-up period were assessed. Results: A total of 67 episodes of mechanical TV thrombosis in 42 patients were observed. The mean age of patients was 45.5±14.3 years (19 to 77), and overall two-thirds were female. Thrombolytic therapy (TT) was used in 41 (61.1%), anticoagulant intensification in 15 (22.3%), and surgery as first approach in 11 (16.4%) episodes; subsequently, surgery as the final approach was implemented in 20 (29.8%) episodes. There were a total of 2 (2.98%) in-hospital deaths. Moreover, 2 (4.87%) episodes of retroperitoneal hematoma and 1(2.43%) episode of non-hemorrhagic thalamic infarct in TT group, and 1 (5%) episode of non-hemorrhagic stroke following surgery were developed. The rates of freedom from recurrent thrombosis were 84%, 61%, and 21% at the end of 2, 4, and 10 years, respectively. Survival rates and freedom from chronic valve dysfunction was 93%, 82%, and 75% after 1, 4, and 10 years. Conclusions: The recurrent thrombosis requiring intervention is a major complication of mechanical TV, which underscores individual-approached therapy and close follow-up to improve outcome.

Background Percutaneous mitral commissurotomy (PMC) is currently the treatment of choice for patients with symptomatic mitral stenosis (MS) that have favorable valvular characteristics. We aimed to evaluate the effect of PMC on the longitudinal strain of the right ventricular (RV) free wall in patients with severe MS. Methods This prospective study recruited patients who underwent PMC. Transesophageal and transthoracic echocardiographic examinations were performed. The mitral valve area (MVA) was measured by three‐dimensional evaluation. The RV longitudinal strain was measured via the speckle‐tracking method. Results A total of 42 patients with a maximum MVA of 1.5 cm2 underwent PMC in our study. The MVA increased significantly after the procedure (pre‐PMC MVA = 0.94 ± 0.20 cm2 vs post‐PMC MVA = 1.45 ± 0.18 cm2; P < .01). Systolic pulmonary artery pressure decreased from 46.05 ± 14.08 mm Hg preprocedurally to 35.86 ± 7.53 mm Hg postprocedurally (P < .01). The mean RV free wall longitudinal strain was −19.00 ± 5.14%, which rose significantly after PMC to −20.97 ± 3.81 (P < .05). There were postprocedural increases, albeit nonsignificant, in the tricuspid annular peak systolic excursion, the peak systolic Doppler velocity of the RV free wall, and fractional area change. The improvement in the RV longitudinal strain was more prominent in the patients with an MVA of less than 1.0 cm2. Conclusions There was a significant post‐PMC rise in the RV free wall longitudinal strain measures in our study population, demonstrating an immediate improvement in the RV systolic function of the patients.

Background Echocardiographic measurement of mitral valve area (MVA) is critical prior to percutaneous transmitral commissurotomy (PTMC). This study aimed to compare the agreement between transthoracic (TTE) and transesophageal echocardiography (TEE) in three‐dimensional (3D) planimetric measurement of the MVA among patients with severe mitral stenosis. Methods MVA was measured with planimetry in 105 patients before undergoing PTMC. 3D reconstruction was applied to both TTE and TEE examinations. The MVA values from four different methods of 3D reconstruction were compared to the average values of 3D methods in TEE as the gold standard measurement method for the MVA in this study. The agreement levels between the two examinations were evaluated and analyzed for various reconstruction methods. Results The mean age was 49 ± 12 years for 28 men and 77 women who were enrolled. The image quality was graded as “excellent” in 57% of 3D images obtained by TTE, while it was graded as “excellent” in 81% of 3D images obtained by TEE. The ventricular zooming method in TTE with a bias of −0.006 ± 0.065 cm2 (P < 0.0001) had the highest agreement with the 3D‐MVA in TEE. While 2D‐TTE and 3D‐TEE measurements of the MVA (R = 0.91; P < 0.0001) were significantly correlated, 2D‐TTE overestimated the MVA by 0.19 cm2. Conclusion Although the quality of 3D images was significantly better in TEE than those in TTE, a good agreement existed between the measured 3D‐TTE and 3D‐TEE studies. We also demonstrated that 2D‐TTE overestimated the MVA compare to 3D‐TEE.