Tricuspid Valve Flashcards
What should you inquire about before tricuspid intervention for endocarditis?
- stopped drug use?
- is patient jaundiced/is Tbili high? If so, get liver biopsy to ensure no cirrhosis
Where should you position posts for TVR?
at 11 and 7 o’clock to keep posts out of outflow tract
RV dysfunction after TVR. What do you do?
- Try to reperfuse for 20 more mintues and try to wean off CPB again
- If fails, inotropy with milrinone and unload RV with iNO or flolan
Heart block when weaning off after TVR. What do you do ?
Place and A and V wires. Also place epicardial pacing wires bc difficulty to percutaneously place wires later in RV across the valve
How can pre-op RHC hemodynamics help evaluate for TVR?
If no RA to PAdiastolic gradient, then RV likely has severe dysfunctoin and will not improve or tolerate TVR
PA pressures > 60mmHg suggest TR is secondary and consequent to L sided pathology or severe pulmonary disease
How does RA react to tricuspid stenosis?
Low diastolic gradients (2-5) signify significant pathology. Pressure overload causes RA thickening (early) and RA dilatation (late)
How to place stitches for TVR to avoid conduction system?
Place interrupted pledgeted U-stitches along annulus, incorporating the leaflets
Avoid AV node damage with septal sutures close to anteroseptal commissary by passing U-stitches at base of leaflet avoiding myocardial tissue
How do you base size for TV ring?
Based on intertrigonal distance
Preserve AV node - close to anteroseptal commissure and apex of triangle of Koch
