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Right Ventricular Remodeling Determines Tricuspid Valve Geometry and the Severity of Functional Tricuspid Regurgitation: A Real-Time 3-Dimensional Echocardiography Study

  • Song, Jong-Min (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jang, Min-Kyoung (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Yun-Jeong (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Dae-Hee (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kang, Duk-Hyun (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Jae-Kwan (Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2009.12.30
  • Accepted : 2010.03.09
  • Published : 2010.09.30

Abstract

Background and Objectives: Right ventricle (RV) remodeling can determine tricuspid valve (TV) geometry and the severity of functional tricuspid regurgitation (TR). Subjects and Methods: In 53 patients with various degrees of functional TR and in sinus rhythm, RV and TV geometries were analyzed using real-time 3-dimensional echocardiography, including tenting angles of 3 leaflets, septal-lateral and antero-posterior tricuspid annulus diameters and inlet RV dimensions, mid-RV septal-lateral dimension, and the distance between annulus and apex. A mid-systole frame when the TV tenting is smallest was selected for the analysis. RV end-diastolic and end-systolic volumes were measured. The severity of functional TR was determined by distal jet area. Results: TR distal jet area was mainly determined by septal-lateral annulus diameter (p<0.001) RV inlet dimension (p=0.015), RV end-systolic volume (p=0.010), septal (p=0.019), and anterior leaflet tenting angles (p=0.045) by multiple stepwise linear regression analysis. Leaflet tenting angles were mainly determined by septal-lateral RV inlet dimension. Septal-lateral annulus diameter was determined by septal-lateral RV inlet dimension (p<0.001) and mid RV dimension (p=0.033), whereas antero-posterior annulus diameter was determined by antero-posterior RV inlet dimension (p<0.001). Conclusion: Functional TR severity is determined by septal-lateral annulus and RV dilation, and tenting of septal and anterior leaflets. TV leaflet tenting is mainly determined by septal-lateral RV inlet dilation, and tricuspid annulus dilation is closely linked with inlet RV dilation.

Keywords

References

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