PMC5494552_01
Twelve-lead electrocardiogram (ECG) demonstrating AF rhythm on admission (a) but demonstrating normal sinus rhythm two months after annuloplasty (d). Doppler echocardiography showing severe TR due to insufficient leaflet coaptation on admission (b) but showing the improvement of TR after annuloplasty (e) in the apical view tract at systole. Three-dimensional transesophageal echocardiography showing coaptation defect (arrows) (c). RV: right ventricular; LV: left ventricular; RA: right atrium; LA: left atrium.
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Electrocardiogram showed AF rhythm (Figure 1(a)). TR was detected without left-sided heart disease by Doppler echocardiography (Figure 1(b)). Three-dimensional transesophageal echocardiography revealed tricuspid annular dilation (40.6 mm) and cusp separation without apparent leaflet tethering (Figure 1(c)). TTE showed trivial TR (Figure 1(e)) and increased cardiac output, 2.8 L/min (cardiac index, 1.88 L/min/m2). The plasma BNP was significantly decreased to 41.0 pg/mL at 9 months after surgery.
Cardiac magnetic resonance imaging and cardiac pool scintigraphy demonstrating reduced right ventricular ejection fraction (39% and 57%, resp.). RV: right ventricular; LV: left ventricular; RA: right atrium; LA: left atrium; ESV: end-systolic volume; EDV: end-diastolic volume; RVEF: right ventricular ejection fraction.
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In addition, right ventricular EF was established by cardiac magnetic resonance imaging and cardiac pool scintigraphy (39% and 57%, resp.) (Figure 2).