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Le Ventricule Droit Et L'insuffisance Tricuspide Right Ventricle & Tricuspid

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Le Ventricule Droit Et L'insuffisance Tricuspide Right Ventricle & Tricuspid MEETING REPORT 2017 JOURNÉE INTERNATIONALE DU CENTRE CARDIO-THORACIQUE DE MONACO Organisée par Organized by Le Conseil Scientifique du Centre Cardio-Thoracique de Monaco Président Chairwoman Professeur Jane Somerville Le ventricule droit et l’insuffisance tricuspide Right ventricle & tricuspid insufficiency Vendredi, 3 novembre 2017 Friday, November 3rd 2017 Lieu Location Salle Eiffel - Hôtel Hermitage, Monaco Organization Dear Friends, Dear Colleagues, For almost 30 years now, the Cardio-Thoracic Centre perpetrates the tradition of our yearly Scientific Meeting. It is a forum where cardiologists, surgeons and prestigious speakers can meet and discuss thoracic and cardiovascular topics whether medical or surgical. This year is dedicated to “Right ventricle and Tricuspid Valve”. Many French and foreign speakers are invited and will share their expertise and we expect your active interaction to make this meeting lively. The Cardio-Thoracic Centre is happy and proud to host this meeting and we hope we will be, once more, reaching your expectations. The Scientific Committee of the CCM. The 29th International Meeting of the Centre Cardio-Thoracique de Monaco is organised by the Scientific Council of the Centre Cardio-Thoracique We warmly thank the following company for his precious help: Société des Bains de Mer Partner: Siemens Healthineers, specialist in medical imaging, in vitro diagnosis and health information systems, for the greatest benefit to both patients and care providers. p. 2 Welcome, introduction Jean-Joseph PASTOR Jane SOMERVILLE Vincent DOR Cardiologist | Monaco. Cardiologist | United Kingdom. Surgeon | Monaco. Speakers (in order of appearance) Y. Topilsky J-N. Trochu D. Muraru G. Dreyfus Cardiologist Cardiologist Cardiologist Surgeon Tel Aviv, ISRAEL Paris, FRANCE Padova, ITALY MONACO Elena Surkova C. Bucciarelli-Ducci Mathias Claeys Guillaume Geri Marco Guazzi Cardiologist Cardiologist Cardiologist M.C.U. Cardiologist London, UK. Bristol, UK. Leuven, BELGIUM. Paris, FRANCE. Milano, ITALY. Luc Pierard Luigi Paolo Badano. F. Levy S. Kuwata Cardiologist Cardiologist Cardiologist Cardiologist Liege, BELGIUM. Padova, ITALY. Monaco. Zurich, SWITZERLAND. p. 3 Morning FUNCTIONNAL TR Epidemiology, Pathogenesis and Natural History of TR – are all types of TR equal? Yan Topilsky, Tel Aviv - Israel p 7 Is there any room for medical treatment in functional tricuspid regurgitation ? Jean-Noël Trochu, Paris - France p 9 Anatomy and functional dysfunction: the imaging cardiologist point of view (echo-MRI) Denisa Muraru, Padova - Italy Tricuspid in the real world: surgeons point of view Filip Dulguerov / Gilles Dreyfus, C.C.Monaco THE RIGHT VENTRICLE Echocardiographic assessment (2D vs 3D) Elena Surkova, London - UK p 12 Cardiac magnetic resonance Chiara Bucciarelli-Ducci, Bristol - UK p 13 Right ventricular function at rest and during exercise Mathias Claeys, Leuven - Belgium p 15 Adaptation of the right ventricle to different loading conditions (volume vs pressure overload) Guillaume Geri, Paris - France p 17 Right Ventricle and Heart Failure Marco Guazzi, Milano - Italy p 18 THE TRICUSPID VALVE Should moderate TR be addressed ? : debate pro/con Gilles Dreyfus, C.C.Monaco / Luc Pierard, Liège - Belgium Outcome of patients with FTR following guidelines Gilles Dreyfus, C.C.Monaco Assessment of functional tricuspid regurgitation. Need to think outside the box Luigi Paolo Badano, Padova - Italy p. 4 Afternoon RAPID FIRE SESSION : VARIOUS CLINICAL SETTINGS Primary FTR, poor RV, when to treat, when to neglect Secondary FTR, poor RV - TFR, when late is too late Luigi Paolo Badano, Padova - Italy Aortic stenosis AF and FTR Franck Levy, C.C.Monaco Pace Maker induced TR Franck Levy, C.C.Monaco Severe recurent T.R. in Ebstein: to neglect or not ? François Bourlon / Franck Levy C.C.Monaco FUNCTIONAL T.R.: TREATMENT OF THE EXTREMS Tricuspid valve: the tethering concept Yan Topilsky, Tel Aviv - Israel p 21 The tethering: should it be repaired or replaced ? Gilles Dreyfus, C.C.Monaco Percutaneous treatment: Myth or Reality? Shingo Kuwata, Zurich - Switzerland p 23 The following collection of abstracts is not complete, it includes summaries submitted after the congress by the speakers who so wished. To go further, you have the possibility to consult most of the presentations on the event’s webpage: http://www.ccm.mc/actualites/03-11-2017.html Good reading ! p. 5 L’INSUFFISANCE TRICUSPIDIENNE FONCTIONNELLE FUNCTIONNAL TR Epidemiology and Natural History of Tricuspid Regurgitation Yan Topilsky, MD We have divided the presentation to address the For organic TR, regurgitation caused by flail topics of epidemiology and natural history of TR. leaflets was associated with excess morbidity Epidemiology: Compared with the vast literature and mortality 6. The group in the Leiden concerning the prevalence of left valvular disease, University showed that significant lead-induced the data concerning the prevalence of tricuspid TR is associated with poor long-term prognosis regurgitation (TR) in the community is limited. The even when adjusted for multiple clinical and most important papers are the Framingham Heart echo parameters 7. Sagie A et al.8 showed that Study that found a prevalence of moderate or functional TR post balloon mitral valvuloplasty for severe TR of 0.8% for the entire cohort, increasing rheumatic mitral stenosis is associated with excess with age 1. Recently, the OxVALVE investigators morbidity and mortality, even when adjusted for 2 found that the prevalence of moderate/severe systemic co-morbidities. For functional TR, the TR in patients older than 65 years is 2.7%, similar Mayo group showed that in patients with idiopathic to the prevalence in the older individuals in the functional TR, ERO≥0.4cm2 (quantified by the Framingham Heart Study. PISA method) is associated with excess mortality Natural History: The historic view of tricuspid and clinical events, irrespective of RV dysfunction, regurgitation (TR) has been one of benign or symptomatic status 9. Surprisingly, the neglect, supported by the two old reports. The first pendulum has turned over again in recent years. was the Braunwald report suggesting, based on Kammerlander A. et al have shown that in patients hemodynamic data that correction of TR at the time post left valvar surgery (mitral, aortic, or combined) of mitral valve surgery was unnecessary because RV dysfunction, but not TR, was independently TR would always improve 3. This neglect was associated with survival10. Similarly, researchers reinforced based on a case series of intravenous in Vienna prospectively followed patients with young drug users who underwent tricuspid valve congestive heart failure and showed that TR was removal, leaving torrential tricuspid regurgitation independently associated with outcome only in (TR) and reporting reasonable long term survival patients with mild or moderately impaired LV and rare need for tricuspid replacement 4. Later, systolic function but had no impact in patients with a large retrospective study on >5000 patients 5 severely impaired LV function11. demonstrated the deleterious effects of untreated Conclusions: The prevalence of significant severe TR in a heterogeneous cohort of patients. (moderate-severe) TR is ≈0.8% in the community, However, the report was based on echo data, increasing with age (reaching≈3.0% in patients with no knowledge of systemic associated co- older than 65), and expected to increase with the morbidities, limited assessment of RV function ageing population. TR is heterogeneous and its and hemodynamics, precluding comprehensive outcome depends on associated co-morbidities adjustment. Because the etiology of TR is and specific etiology. Thus there is need for heterogeneous, recent studies have tried to isolate more outcome studies, preferably prospective for TR from potential confounders, and to assess individual etiologies. outcome for individual etiologies separately. p. 6 L’INSUFFISANCE TRICUSPIDIENNE FONCTIONNELLE FUNCTIONNAL TR 1. Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the framingham heart study). Am J Cardiol. 1999;83:897-902 2. d’Arcy JL, Coffey S, Loudon MA, Kennedy A, Pearson-Stuttard J, Birks J, Frangou E, Farmer AJ, Mant D, Wilson J, Myerson SG, Prendergast BD. Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: The oxvalve population cohort study. Eur Heart J.37:3515- 3522 3. Braunwald NS, Ross J, Jr., Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation. 1967;35:I63-69 4. Arbulu A, Holmes RJ, Asfaw I. Tricuspid valvulectomy without replacement. Twenty years’ experience. J Thorac Cardiovasc Surg. 1991;102:917-922 5. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004;43:405-409 6. Messika-Zeitoun D, Thomson H, Bellamy M, Scott C, Tribouilloy C, Dearani J, Tajik AJ, Schaff H, Enriquez- Sarano M. Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. J Thorac Cardiovasc Surg. 2004;128:296-302 7. Hoke U, Auger D, Thijssen J, Wolterbeek R, van der Velde ET, Holman ER, Schalij MJ, Bax JJ, Delgado V, Marsan NA. Significant lead-induced tricuspid regurgitation is associated with poor prognosis at long-term follow-up. Heart.100:960-968 8. Sagie A, Schwammenthal E, Newell JB, Harrell
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