Tricuspid valvuloplasty

Tricuspid valvuloplasty has a good therapeutic effect on diseases of the tricuspid valve area, but the operation is very risky. We should fully communicate with the doctor about our physical condition so that we can determine the most suitable treatment plan for ourselves, but we should have some understanding of our own disease. There are many things to be aware of after a tricuspid valvuloplasty. So, what is tricuspid valvuloplasty?

1. Methods and key steps

(1) The operating procedure, anesthesia and disinfection are the same as those for right cardiac catheterization.

(2) Percutaneously puncture the femoral veins on both sides and insert a 7F puncture sheath. Two balloon-floating catheters were inserted through sheaths to synchronously measure right atrial and right ventricular pressures, and cardiac output was measured according to the Fick method as necessary preoperative data. Then two balloon floating catheters are sent into the right ventricle and pulmonary artery, and then two J-shaped long guide wires are sent through the balloon floating catheters to the right ventricle and pulmonary artery. Then, withdraw the balloon floating catheter, and insert a balloon dilatation catheter with a diameter of 15 to 20 mm along the guide wire, and place the two balloons under the tricuspid valve orifice under X-ray fluoroscopy. The diluted contrast agent is rapidly injected into the two balloons at the same time. When the balloons are filled to 303.98-405.30 kPa (3-4 atm), the "waist" disappears and lasts for 10 or 15 seconds, and then the contrast agent is quickly withdrawn. Repeat this 2 to 3 times. The balloon dilatation catheter was withdrawn and the balloon flotation catheter was delivered, and the hemodynamic data were repeatedly measured.

2. Postoperative treatment is the same as right heart catheterization.

3. The therapeutic efficacy should be evaluated based on the tricuspid valve transvalvular pressure gradient and valve orifice area.

(1) Alikhan group reported that after dilation, the tricuspid valve transvalvular pressure gradient decreased from 0.8±0.13 kPa (61 mmHg) to 0.24±0.08 kPa (1.8±0.6 mmHg), P less than 0.01.

The tricuspid valve area increased from 0.75±1cm2 to 1.8±0.6cm2 (P less than 0.05), and cardiac output increased by 1L/min. The above is the therapeutic effect of tricuspid stenosis in rheumatic heart disease.

(2) Efficacy of congenital tricuspid stenosis: Lokhandwaia et al. and Chen Chuanrong et al. reported that simple tricuspid stenosis combined with pulmonary valve stenosis and balloon dilatation had a good therapeutic effect.

(3) Efficacy of percutaneous balloon bioprosthesis: Feit reported a case of tricuspid valve bioprosthesis stenosis, which was successfully treated with balloon dilatation. Rao, Waldman and others used balloon angioplasty to treat 12 patients with pulmonary valve bioprosthesis, with a success rate of 75% and no major complications.

Balloon valvuloplasty for the treatment of bioprosthetic valve stenosis is risky. Even in patients without thrombus or vegetation detected by echocardiography before surgery, serious embolic complications may still occur after surgery. If the bioprosthetic valve has a small perforation or paravalvular leakage, the balloon catheter may enter the small perforation or small perivalvular hole after being inserted, which may lead to severe or even fatal insufficiency after the operation.