Successful Repair of Critical Tricuspid Regurgitation Secondary to a Ruptured Papillary Muscle in a Neonate

Min, Jooncheol; Kim, Eung Re; Yang, Chan Kyu; Jang, Woo Sung; Cho, Sungkyu

doi:10.5090/kjtcs.2014.47.4.398

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…With scarce published in the pediatric population, TVP tends to be a forgotten mechanism of cyanosis in children. To the best of our knowledge, TVP-induced cyanosis has merely been observed in neonatal patients with or without congenital heart anomalies (26 reported cases), whose pulmonary vascular resistances have not yet fallen to adult levels, thus facilitating severe TR and the right to left shunting through PFO (13,(22)(23)(24)(25). However, our case emphasized this phenomenon could also be found even in previously healthy infants after environmental exposure predisposing to TVP.…”

Section: Before Surgery After Surgerymentioning

confidence: 64%

Case Report: unexpected cause of cyanosis in an infant after acute exposure to high altitude—severe tricuspid regurgitation secondary to tricuspid valve prolapse

Cui,

Yang,

et al. 2024

Front. Cardiovasc. Med.

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BackgroundSevere tricuspid regurgitation (TR) causing cyanosis with patent foramen ovale (PFO) and right-to-left atrial shunting requires a precise diagnosis for optimal therapy. Tricuspid valve prolapse (TVP) can lead to TR and is sometimes overlooked, especially in complex cases with factors like pulmonary hypertension (PH). We present an infant with cyanosis and profound TR after high-altitude exposure, initially misattributed to PH but found to be primarily due to spontaneous chordae tendineae rupture and TVP. This case underscores the challenges in diagnosing TR-induced cyanosis.Case presentationThe 3-month-old infant rapidly developed cyanosis, hypoxemia, right atrial enlargement, severe tricuspid regurgitation (TR), and patent foramen ovale (PFO) shunting after high-altitude exposure. Although echocardiography revealed tricuspid valve prolapse (TVP), initial consideration linked TR and right-to-left shunting to pulmonary hypertension (PH) due to the temporal correlation with rapid altitude exposure. Despite hemodynamic stability and the absence of respiratory distress after respiratory support and combined PH medication therapy, the persistent hypoxemia did not reverse as expected. This treatment outcome and repeated echocardiograms reminded us that TR was primarily caused by TVP rather than PH alone. Intraoperative exploration confirmed that TVP was caused by a rupture of TV chordae tendineae and anterior papillary muscle head, and the chordae tendineae/papillary muscle connection was reconstructed. After surgery, this patient was noncyanotic with an excellent long-term prognosis, a trivial TR with normal TV function being observed echocardiographically.ConclusionsTR-induced cyanosis can be not only a consequence of PH and right-sided heart dilation but also a primary condition. Repetitive reassessment should be undertaken with caution, particularly when patients are not improving on therapy in the setting of conditions known to predisposition to secondary TR. Since TVP caused by rupture of the chordae or papillary muscles is rare but fatal in children, early diagnosis is clinically substantial to proper management and satisfactory long-term outcomes.

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Section: Before Surgery After Surgerymentioning

confidence: 64%

Case Report: unexpected cause of cyanosis in an infant after acute exposure to high altitude—severe tricuspid regurgitation secondary to tricuspid valve prolapse

Cui,

Yang,

et al. 2024

Front. Cardiovasc. Med.

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“…Rupture therefore occurred during the third trimester or the intrapartum period. Echogenic chordae and papillary muscles have been observed in case reports of papillary muscle rupture; 2 , 3 , 9 however, the clinical significance of isolated echogenicity, observed in an otherwise structurally normal heart, is not completely understood.…”

Section: Discussionmentioning

confidence: 99%

Flail anterior tricuspid valve leaflet in a neonate: association with maternal antiphospholipid syndrome

2017

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This brief report describes a case of flail anterior tricuspid valve leaflet in a neonate associated with maternal antiphospholipid syndrome. Fetal echocardiography at 27 weeks of gestation showed competent atrioventricular valves with biventricular echogenic chordae. Fetal distress was noted at delivery, and echocardiography showed a flail anterior leaflet of the tricuspid valve with severe regurgitation. Possible causation and implications of maternal antiphospholipid syndrome are discussed.

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Children’s heart and prematurity: a current view of the problem

Pavlyukova,

Kolosova,

Neklyudova

et al. 2024

Kazan Med J

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Improved survival of children born with low, extremely low and very low body weight in modern conditions due to increased nursing capabilities, optimization of treatment and increased efficiency of resuscitation measures has led to the need for greater understanding of the importance of assessing the cardiovascular system’s state beyond the neonatal period. With approximately 10% of infants worldwide being born preterm, there is an increasing need for further research into optimal regimens, lifestyle and clinical interventions that can benefit and modify cardiovascular morphology and function in this growing population. Modern theoretical postulates on the physiology and pathophysiology of the child’s heart include ideas about the key process of cardiac biomechanics — diastole, during which the earliest disturbances, that precede the formation of systolic dysfunction, occur. Assessment of the pumping properties of the left ventricle in systole and diastole is a fundamental methodological technique for an in-depth understanding of the pathophysiological mechanisms of cardiovascular system’s emerging diseases, their early diagnosis and assessment of the complex therapy’s effectiveness. However, despite the widespread use of standard echocardiography to assess systolic and diastolic function, its traditional parameters have limitations in terms of diagnostic accuracy and effectiveness in practice. Expanding knowledge about new pathogenetic mechanisms of the cardiac dysfunction formation in conditions of prematurity at the current stage of cardiology development using the “trace spot” technology (two-dimensional speckle tracking echocardiography) will be very useful for scientists studying the mechanics formation of the child’s heart after premature birth, and for doctors of various specialties in early diagnosis of heart diseases.

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Successful Repair of Critical Tricuspid Regurgitation Secondary to a Ruptured Papillary Muscle in a Neonate

Cited by 3 publications

References 7 publications

Case Report: unexpected cause of cyanosis in an infant after acute exposure to high altitude—severe tricuspid regurgitation secondary to tricuspid valve prolapse

Case Report: unexpected cause of cyanosis in an infant after acute exposure to high altitude—severe tricuspid regurgitation secondary to tricuspid valve prolapse

Flail anterior tricuspid valve leaflet in a neonate: association with maternal antiphospholipid syndrome

Children’s heart and prematurity: a current view of the problem

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