Premium
Intermediate term hemodynamic effects of single inferior vena cava valve implant for the treatment of severe tricuspid regurgitation
Author(s) -
Rakita Val,
Lakhter Vladimir,
Patil Pravin,
O'Neill Brian P.
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26931
Subject(s) - medicine , inferior vena cava , cardiology , hemodynamics , regurgitation (circulation) , tricuspid valve , heart failure , implant , central venous pressure , tricuspid valve insufficiency , surgery , blood pressure , heart rate
Severe tricuspid regurgitation (TR) remains a vastly undertreated disease, with sustained elevation of right atrial (RA) pressure directly resulting in chronic end‐organ damage. Recently, bi‐caval valve implantation has been shown to improve symptoms in patients with symptomatic TR who are at high risk for surgery. We present the first report of intermediate term hemodynamic effects of single inferior vena cava (IVC) valve implantation (CAVI) for treatment of severe TR. We performed CAVI on a 66‐year‐old female with severe TR, who suffered from repeat hospitalizations for treatment refractory NYHA class III–IV heart failure symptoms and had prohibitive operative risk. Pre‐implantation right heart catheterization (RHC) revealed a mean RA pressure of 12 mm Hg, an IVC mean pressure of 13 mm Hg, with V‐waves to 16 and 18 mm Hg in the RA and IVC respectively, and a cardiac output (CO) of 3.5 liters per minute (LPM). Postprocedure, mean IVC and RA pressures decreased to 11 and 10 mm Hg, respectively, with CO increasing to 5.1 LPM. At one month, symptoms improved to NYHA class II. At 9 months, mean RA pressure was 5 mm Hg with V‐waves to 7 mm Hg and an improvement in CO to 6.3 LPM. CAVI appears to result in similar decreases in RA pressure at intermediate follow‐up as compared to bi‐caval valve implantation. The favorable hemodynamic effects were likely mediated by redirection of regurgitant blood flow away from the IVC thereby resulting in sustained reduction in right‐sided pressures as well as an increase in CO. © 2017 Wiley Periodicals, Inc.