Author + information
- Received December 13, 2012
- Accepted December 19, 2012
- Published online July 23, 2013.
- José-Luis Moya Mur, MD, PhD∗,
- Derly-Carlos Becker Filho, MD∗,
- Daniel Rodríguez Muñoz, MD∗,
- Marcelo Haertel Miglioranza, MD∗,
- Antonio Epeldegui Torres, MD†,
- Covadonga Fernández Golfín, MD∗ and
- José-Luis Zamorano Gómez, MD, PhD∗
Two patients referred for echocardiography years after valvular surgery showed a normal mitral prosthesis and an abnormal “spot” (arrow) behind the tricuspid valve as seen in transthoracic echocardiography (TTE, A) and transesophageal echocardiography (TEE, B). Three-dimensional (3-D) TTE (patient A; C, D, Online Videos 1 and 3) and 3-D TEE (patient B; E, F, Online Videos 2 and 4) showed a “cord” crossing the tricuspid annulus from the anterior (Ant.) to posterior (Post.) segments, conforming a double-orifice annulus and causing mild (patient A; G, Online Video 5) and severe (patient B) tricuspid regurgitation, respectively.
Both patients had previously undergone de Vega annuloplasty to correct tricuspid regurgitation. These images, known as the “guitar string” sign, occur as a specific complication of continuous suture annuloplasty when several points are torn and the suture is free on the valve orifice (H). RA = right atrium; RV = right ventricle; Sept. = septal; TV = tricuspid valve.
- Received December 13, 2012.
- Accepted December 19, 2012.
- American College of Cardiology Foundation