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Aortic valve replacement because of aortic valve stenosis, repair of tricuspid valve because of regurgitation

Author: Tomáš Toporcer

Published on: 22.11.2017, last modified on: 26.3.2021

Discipline: Cardiology, Angiology, Surgery, Traumatology and Orthopaedics | Departments: Department of Heart Surgery

Aortic valve replacement because of aortic valve stenosis, repair of tricuspid valve because of regurgitation

The case study describes the hospitalization of women with aortic valve stenosis and secondary regurgitation of the tricuspid valve. The patient underwent aortic valve replacement by bioprosthesis and repair surgery of the tricuspid valve. The postoperative course was complicated by pneumohorax on the right side. Drainage was performed. The patient was placed in outpatient care on the eighth postoperative day.

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Figure 1 - ECHO picture of aortic valve stenosis.
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Figure 2 - ECHO picture of tricuspid valve regurgitation.
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Figure 3 - ECHO measurement of tricuspid valve annulus diameter.
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Figure 4 - Cutting out of native calcified stenotic aortic valve.
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Figure 5 - Measurement of aortic valve annulus diameter for aortic valve prosthesis size determination.
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Figure 6 -Simple sutures implantation to the biological prosthesis of aortic valve.
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Figure 7 - Selective application of cardioplegic solution into the coronary arteries orifices.
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Figure 8 - Stitching of individual stitches during aortic valve prosthesis implantation.
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Figure 9 - Simple sutures implantation to the annulus of tricuspid valve.
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Figure 10 - Simple sutures implantation to the anuloplasty ring of tricuspid valve.
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Figure 11 - Stitching of individual stitches during aortic tricuspid valve anuloplasty ring implantation.
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Figure 12 - Pneumothorax on the right side (first day after surgery).
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Figure 13 - Drained right pleural cavity (drain implanted through 2nd intercostal space in medioclavicular line).

Anamnesis:

76-years-old women
PA: arterial hypertension, diabetes mellitus, no other diseases
FA: no hereditary diseases in relatives
PA: Nitresan 20mg 0,5-0-0,5 Rawel 1-0-0, Atorvastatin l0mg 0-0-1, Siofor 500mg 1-0-0, ANP l00mg 0-1-0,
Milurit 300mg 0,5-0-0
AA: no
DA: no
SA: retiree
AD: Patient with aortic valve stenosis documented by echocardiography accepted to the cardiology department because of evaluation of aortic stenosis severity. The patient actually does not describe pain, dyspnoea or other difficulties.

Laboratoty results:

ECG: sinus rhythm, fr.55/min., intermed. el. axis, R/S v V3-4, PQ 240ms, QRS 90m, QT 360ms,
ST: no elevations/depressions., T flatter in VL, I
Lab. results: physiological

Imaging methods:

Echocardiograph: aortic bulbus 29mm, ao. Asc. 32mm, ring of aortic valve 20 mm, Vmax 0,5m/s, LVD 45, IVS 11, RV 40 mm, RAA 14,4 cm2, LAA 17,1 cm2, aortic valve: Vmax 4,0m/s, PPG 64, MPG 35 mmHg, AVA 0,78 cm2, aortic regurgitation mild, PAP 30 mmHg,
Conclusion: left ventricle of normal diameter with concentric hypertrophy, LVEF 55%, without local kinetic dysfunctions, diastolic dysfunction – disease of relaxation, LA physiologic diameter, MR 1+, calcification of posterior leaflet, degenerative aortic valve disease: aortic valve stenosis: serious, aortic valve regurgitation: mild, right ventricle: easily dilated with good function, tricuspid regurgitation 2nd.-3rd. degree – central jet, without signs of pulmonary hypertension, inter-atrial septum without defect.

Coronarography: left common coronary artery – without stenosis, LAD- without stenosis, circumflex artery- without stenosis, right coronary artery: without stenosis, Conclusion: physiological finding.

Diagnosis:

Aortic valve stenosis (AVA 0.78cm2)
Tricuspid valve regurgitation 2nd.-3rd. degree
Arterial hypertension
Diabetes mellitus

Therapy and conclusion:

Treatment strategy:
Surgery (reparation/replacement) of aortic valve and surgery of tricuspid valve (reparation) indicated (AVR+TVr).

Surgery procedure:
Substitutio valvulae aortalis cum bioprosthesis, Trifecta GT, No. 19; TVr cum anuloplasty ring N28– CPB time: 72min, aortic clamp time: 63min.

Postoperative course:
Postoperative course complicated by pneumothorax. Drainage of right pleural cavity performed on the first day after surgery. Drain explanted on the 3rd day after surgery. On the 8th postoperative day released to outpatient care.

 

Abbreviations:
AVA – aortic valve area; CPB – cardiopulmonary bypass; IVS – diameter of interventricular septum; LA – left atrium; LAA – left atrium area; LAD – left anterior descending coronary artery; LVD – left ventricle diameter; LVEF – left ventricle ejection fraction; MPG – median pressure gradient; MR – mitral regurgitation; PPG – peak pressure gradient; RAA – right atrium area; RV – right ventricle; TVr – tricuspid valve repair


Authors declare the case report will not be published in any national or international publications.

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citation: Tomáš Toporcer: Aortic valve replacement because of aortic valve stenosis, repair of tricuspid valve because of regurgitation. Multimedia support in the education of clinical and health care disciplines :: Portal of Pavol Jozef Šafárik University in Košice Faculty of Medicine [online] , [cit. 21. 11. 2024]. Available from WWW: https://portal.lf.upjs.sk/articles.php?aid=298. ISSN 1337-7000.