Alimi Hedieh, Fazlinezhad Afsoon
Assistant Professor, Cardiovascular Research Center AND Department of Cardiology, School of Medicine, Quaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Professor, Cardiovascular Research Center AND Department of Cardiology, School of Medicine, Quaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
ARYA Atheroscler. 2017 Mar;13(2):88-90.
Parachute tricuspid valve is a rare congenital malformations explained in the literature. In most cases, this malformation coexists with other congenital defects. The importance of this condition depends on its functional consequences.
First case was a 52-year-old female patient presented with palpitation. She had a history of paroxysmal supraventricular tachycardia. Transthoracic echocardiography revealed large secundum type atrial septal defect and all the tricuspid valve leaflets appeared to be connected to a single calcified papillary muscle in right ventricle suggestive of parachute tricuspid valve. Echocardiography showed severe right ventricle and right atrial enlargement, and moderate to severe tricuspid regurgitation without significant tricuspid stenosis. Another case was a 30-year-old female patient referred for echocardiography prior to her breast cancer chemotherapy. Transthoracic echocardiography revealed a right ventricle with an unusual fusion of papillary muscles resulting in a single calcified head for the attachment of all tricuspid leaflets. These findings were suggestive of a parachute-like tricuspid valve. Other data were mild to moderate tricuspid regurgitation without any stenosis, and normal right ventricle size and function. In both cases, parachute tricuspid valve was confirmed by three dimensional echocardiograph.
In our first case, parachute tricuspid valve was associated with atrial septal defect, although in the second case, no associated anomaly was detected, a condition not previously reported in the literature. In both cases, parachute tricuspid valve was not associated with tricuspid stenosis. Based on other published cases, parachute involvement of the tricuspid valve is less often reported than cases involving the mitral valve. Additionally, the associated consequences in tricuspid valve position such as tricuspid stenosis seem to be less significant than cases involving mitral valve. It is recommended that in patients with tricuspid valve involvement, parachute anomaly should be considered as a possible rare cause.
降落伞样三尖瓣是文献中解释的一种罕见先天性畸形。在大多数情况下，这种畸形与其他先天性缺陷并存。该病症的重要性取决于其功能后果。
首例为一名52岁女性患者，表现为心悸。她有阵发性室上性心动过速病史。经胸超声心动图显示巨大的继发孔型房间隔缺损，所有三尖瓣叶似乎都与右心室中的单个钙化乳头肌相连，提示降落伞样三尖瓣。超声心动图显示右心室和右心房严重扩大，中度至重度三尖瓣反流，无明显三尖瓣狭窄。另一例为一名30岁女性患者，在乳腺癌化疗前接受超声心动图检查。经胸超声心动图显示右心室乳头肌异常融合，导致所有三尖瓣叶附着的单一钙化头部。这些发现提示为降落伞样三尖瓣。其他数据为轻度至中度三尖瓣反流，无任何狭窄，右心室大小和功能正常。在这两例中，三维超声心动图均证实为降落伞样三尖瓣。
在我们的首例病例中，降落伞样三尖瓣与房间隔缺损相关，尽管在第二例中未检测到相关异常，这是文献中先前未报道的情况。在这两例中，降落伞样三尖瓣均与三尖瓣狭窄无关。根据其他已发表的病例，三尖瓣受累的降落伞样畸形比二尖瓣受累的病例报道较少。此外，三尖瓣位置的相关后果如三尖瓣狭窄似乎比二尖瓣受累的病例不太显著。建议在三尖瓣受累的患者中，应将降落伞样异常视为一种可能的罕见病因。
