Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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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
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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

  1. Sagie A, Schwammenthal E, Padial LR, Vazquez de Prada JA, Weyman AE, Levine RA. Determinants of functional tricuspid regurgitation in incomplete tricuspid valve closure: Doppler color flow study of 109 patients. J Am Coll Cardiol 1994;24:446-53. https://doi.org/10.1016/0735-1097(94)90302-6
  2. Ton-Nu TT, Levine RA, Handschumacher MD, et al. Geometric determinants of functional tricuspid regurgitation: insights from 3-dimensional echocardiography. Circulation 2006;114:143-9. https://doi.org/10.1161/CIRCULATIONAHA.106.611889
  3. Park YH, Song JM, Lee EY, Kim YJ, Kang DH, Song JK. Geometric and hemodynamic determinants of functional tricuspid regurgitation: a real-time three-dimensional echocardiography study. Int J Cardiol 2008;124:160-5. https://doi.org/10.1016/j.ijcard.2006.12.036
  4. Fukuda S, Saracino G, Matsumura Y, et al. Three-dimensional geometry of the tricuspid annulus in healthy subjects and in patients with functional tricuspid regurgitation: a real-time, 3-dimensional echocardiographic study. Circulation 2006;114(1 Suppl):I492-8. https://doi.org/10.1161/CIRCULATIONAHA.106.630764
  5. Sukmawan R, Watanabe N, Ogasawara Y, et al. Geometric changes of tricuspid valve tenting in tricuspid regurgitation secondary to pulmonary hypertension quantified by novel system with transthoracic realtime 3-dimensional echocardiography. J Am Soc Echocardiogr 2007; 20:470-6. https://doi.org/10.1016/j.echo.2006.10.001
  6. Kanter KR, Doelling NR, Fyfe DA, Sharma S, Tam VK. De Vega tricuspid annuloplasty for tricuspid regurgitation in children. Ann Thorac Surg 2001;72:1344-8. https://doi.org/10.1016/S0003-4975(01)02976-9
  7. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008;118:e523-e661. https://doi.org/10.1161/CIRCULATIONAHA.108.190748
  8. Kwon DA, Shin DH, Jung JW, et al. Echocardiographic parameters for predicting the outcome of patients undergoing surgery for severe tricuspid regurgitation. Korean Circ J 2005;35:916-20. https://doi.org/10.4070/kcj.2005.35.12.916
  9. Fukuda S, Song JM, Gillinov AM, et al. Tricuspid valve tethering predicts residual tricuspid regurgitation after tricuspid annuloplasty. Circulation 2005;111:975-9. https://doi.org/10.1161/01.CIR.0000156449.49998.51
  10. Fukuda S, Gillinov AM, McCarthy PM, et al. Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty. Circulation 2006;114(1 Suppl):I582-7.
  11. Tamborini G, Brusoni D, Torres Molina JE, et al. Feasibility of a new generation three-dimensional echocardiography for right ventricular volumetric and functional measurements. Am J Cardiol 2008;102:499-505. https://doi.org/10.1016/j.amjcard.2008.03.084
  12. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16:777-802. https://doi.org/10.1016/S0894-7317(03)00335-3
  13. Koelling TM, Aaronson KD, Cody RJ, Bach DS, Armstrong WF. Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction. Am Heart J 2002;144:524-9. https://doi.org/10.1067/mhj.2002.123575
  14. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 2004;43:405-9. https://doi.org/10.1016/j.jacc.2003.09.036
  15. Louie EK, Bieniarz T, Moore AM, Levitsky S. Reduced atrial contribution to left ventricular filling in patients with severe tricuspid regurgitation after tricuspid valvulectomy: a Doppler echocardiographic study. J Am Coll Cardiol 1990;16:1617-24. https://doi.org/10.1016/0735-1097(90)90311-C
  16. Reynertson SI, Kundur R, Mullen GM, Costanzo MR, McKiernan TL, Louie EK. Asymmetry of right ventricular enlargement in response to tricuspid regurgitation. Circulation 1999;100:465-7. https://doi.org/10.1161/01.CIR.100.5.465
  17. Mukherjee D, Nader S, Olano A, Garcia MJ, Griffin BP. Improvement in right ventricular systolic function after surgical correction of isolated tricuspid regurgitation. J Am Soc Echocardiogr 2000;13:650-4. https://doi.org/10.1067/mje.2000.103958
  18. Liel-Cohen N, Guerrero JL, Otsuji Y, et al. Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation: insights from 3-dimensional echocardiography. Circulation 2000;101:2756-63. https://doi.org/10.1161/01.CIR.101.23.2756
  19. Hung J, Guerrero JL, Handschumacher MD, Supple G, Sullivan S, Levine RA. Reverse ventricular remodeling reduces ischemic mitral regurgitation: echo-guided device application in the beating heart. Circulation 2002;106:2594-600. https://doi.org/10.1161/01.CIR.0000038363.83133.6D
  20. Inoue M, McCarthy PM, Popovic ZB, et al. The Coapsys device to treat functional mitral regurgitation: in vivo long-term canine study. J Thorac Cardiovasc Surg 2004;127:1068-76; discussion 1076-7. https://doi.org/10.1016/j.jtcvs.2003.12.005

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