Surgical Reconstruction of Mitral-Tricuspid Insufficiency Combined with Biatriomegaly in Marfan Syndrome
The aim. To analyze the results of introduction of complex reconstruction of the left and right parts of the heart in Marfan syndrome combined with mitral-tricuspid insufficiency, biatriomegaly and left ventriculomegaly.
Materials and methods. As an example of this pathology, we present our observation. Female patient T., 24 years old, was examined and treated from 7/27/2022 to 8/17/2022 at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with a diagnosis: Marfan syndrome. Stage IV mitral-tricuspid insufficiency. Biatriomegaly. High pulmonary hypertension. Permanent form of atrial fibrillation (for 10 years, since 2011). IIB heart failure with left ventriculomegaly with reduced left ventricular ejection fraction. NYHA functional class IV+. The patient underwent surgery in the following volume: mitral valve replacement with full preservation of the valve apparatus + tricuspid valve plasty with the imposition of a support ring + triangular plasty of the left atrium with its partial resection + resection of the right atrium.
Results. Within 4 months after surgery, echocardiographic parameters showed significant decrease in the volume of the left ventricle, the diameters of both atria. In addition, there was a significant decrease in the level of N-terminal pro-brain natriuretic peptide and manifestations of heart failure.
Conclusion. Taking into account the initial serious condition of the patient with Marfan syndrome and advanced mitral-tricuspid heart disease, left ventriculomegaly with a reduced left ventricular ejection fraction, biatriomegaly (left atrium 7.2 cm, right atrium 6.5 cm), permanent form of atrial fibrillation, complex reconstruction of the left and right parts of the heart leads to an improvement in the functional state of the myocardium.
- Kurfirst V, Mokráček A, Krupauerová M, Canádyová J, Bulava A, Pešl L, et al. Health-related quality of life after cardiac surgery--the effects of age, preoperative conditions and postoperative complications. J Cardiothorac Surg. 2014 Mar 11;9:46. https://doi.org/10.1186/1749-8090-9-46
- Prabhu S, McLellan AJ, Walters TE, Sharma M, Voskoboinik A, Kistler PM. Atrial Structure and Function and its Implications for Current and Emerging Treatments for Atrial Fibrillation. Prog Cardiovasc Dis. 2015;58(2):152-167. https://doi.org/10.1016/j.pcad.2015.08.004
- Abd Elaziz ME, Ibrahim IM. Reversal of Left Ventricular Functions in Chronic Mitral Regurgitation after Mitral Valve Replacement. Heart Surg Forum. 2016;19(4):E160-E164. https://doi.org/10.1532/hsf.1440
- Chen L, Chen B, Hao J, Wang X, Ma R, Cheng W, et al. Complete Preservation of the Mitral Valve Apparatus during Mitral Valve Replacement for Rheumatic Mitral Regurgitation in Patients with an Enlarged Left Ventricular Chamber. Heart Surg Forum. 2013;16(3):E137-E143. https://doi.org/10.1532/HSF98.20121128
- Guo Y, He S, Wang T, Chen Z, Shu Y. Comparison of modified total leaflet preservation, posterior leaflet preservation, and no leaflet preservation techniques in mitral valve replacement - a retrospective study. J Cardiothorac Surg. 2019 Jun 7;14(1):102. https://doi.org/10.1186/s13019-019-0918-7
- Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al.; ESC Scientific Document Group. 2017 ESC/ EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2017;52(4):616-664. https://doi.org/10.1093/ejcts/ezx324. Erratum in: Eur J Cardiothorac Surg. 2017 Oct 1;52(4):832.
- Stassen J, Butcher SC, Namazi F, Ajmone Marsan N, Bax JJ, Delgado V. Left Atrial Deformation Imaging and Atrial Fibrillation in Patients with Rheumatic Mitral Stenosis. J Am Soc Echocardiogr. 2022;35(5):486-494.e2. https://doi.org/10.1016/j.echo.2021.12.010
- Vohra S, Pradhan A, Jaiswal V, Sharma P, Pokhrel NB, Song D. Silent giant left atrium: A case report. Clin Case Rep. 2022;10(2):e05363. https://doi.org/10.1002/ccr3.5363
- Liu QQ, Du Y, Zhang R, Shen WQ, Du GQ. Evaluation of longitudinal trajectory of functional tricuspid regurgitation on the risk of right ventricular dysfunction after mitral valve replacement. J Card Surg. 2022;37(11):3995-4001. https://doi.org/10.1111/jocs.16891
- Suwanto D, Dewi IP, Budiarto M. Managing tricuspid valve pathology in multiple valvular heart disease. Ann Med Surg (Lond). 2022;82:104719. https://doi.org/10.1016/j.amsu.2022.104719
- Collins N, Sugito S, Davies A, Boyle A, Sverdlov A, Attia J, et al. Prevalence and survival associated with pulmonary hypertension after mitral valve replacement: National echocardiography database of Australia study. Pulm Circ. 2022;12(4):e12140. https://doi.org/10.1002/pul2.12140
- Yokoyama Y, Tsukagoshi J, Takagi H, Takayama H, Kuno T. Concomitant tricuspid annuloplasty in patients with mild to moderate tricuspid valve regurgitation undergoing mitral valve surgery: meta-analysis. J Cardiovasc Surg (Torino). 2022;63(5):624-631. https://doi.org/10.23736/S0021-9509.22.12354-2
- Hasan IS, Qrareya M, Crestanello JA, Daly RC, Dearani JA, Lahr BD, et al. Impact of tricuspid valve regurgitation on intermediate outcomes of degenerative mitral valve surgery. J Thorac Cardiovasc Surg. 2022 Sep 26:S0022-5223(22)01025-X. Forthcoming 2022. https://doi.org/10.1016/j.jtcvs.2022.09.035