Geometric Changes of Tricuspid Valve Tenting in Tricuspid Regurgitation Secondary to Pulmonary Hypertension Quantified by Novel System with Transthoracic Real-time 3-Dimensional Echocardiography

Sukmawan, Renan; Watanabe, Nozomi; Ogasawara, Yasuo; Yamaura, Yasuko; Yamamoto, Katsunori; Wada, Nozomi; Kume, Teruyoshi; Okura, Hiroyuki; Yoshida, Kiyoshi

doi:10.1016/j.echo.2006.10.001

Cited by 78 publications

(46 citation statements)

References 18 publications

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“…The RV is poorly suited to contract against high afterload 15 and, when faced with a high afterload, assumes a more cylindrical shape, with leftward septal shift resulting in annular dilatation and leaflet tethering. [15][16][17] Similar findings were noted in patients with HLHS in whom the annulus changed from a normal elliptical 10 to a more circular shape. 11 It is unlikely that the observed changes in this study are related only to alterations in global function and shape change.…”

Section: Rv Geometry and Functionsupporting

confidence: 76%

Real-Time 3-Dimensional Echocardiography Provides New Insight Into Mechanisms of Tricuspid Valve Regurgitation in Patients With Hypoplastic Left Heart Syndrome

et al. 2009

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Background-Tricuspid regurgitation in hypoplastic left heart syndrome has an impact on outcome, but its mechanisms remain unclear. Methods and Results-Real-time 3-dimensional echocardiography was performed in 35 patients with hypoplastic left heart syndrome (age, 1 month to 10 years; 10 after first-stage Norwood, 12 after superior cavopulmonary shunt, 13 after Fontan). From the 3-dimensional data set, we marked the annulus in systole and diastole. At mid systole, we marked the location of the papillary muscle tip and point of chordal attachment to the leaflet. We traced the surfaces of the tricuspid valve leaflets and measured the volume of leaflet prolapse, tethering, annular and septal leaflet areas, and papillary muscle position. Seventeen patients had moderate tricuspid regurgitation (prolapse, 7; tethered leaflets, 7) and 18 mild (prolapse, 0; tethered leaflets, 7). Multiple linear regression analysis revealed that moderate tricuspid regurgitation is associated with leaflet tethering and prolapse; that in hypoplastic left heart syndrome with tethered leaflets, the papillary muscle is displaced laterally and the tricuspid annulus is more planar; and that enlargement of the annulus at mid systole, small septal leaflet area, and age affect the degree of prolapse. Conclusion-In hypoplastic left heart syndrome, moderate tricuspid regurgitation may be associated with increasing age, geometrical changes of the annulus, leaflet prolapse, lateral papillary muscle displacement, and subsequent leaflet tethering, as well as a smaller septal leaflet.

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Section: Rv Geometry and Functionsupporting

confidence: 76%

Real-Time 3-Dimensional Echocardiography Provides New Insight Into Mechanisms of Tricuspid Valve Regurgitation in Patients With Hypoplastic Left Heart Syndrome

et al. 2009

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“…The size of the annulus area was adjusted from normal (6 cm 2 ) to 100% dilatation (12 cm 2 ) with septal/lateral (2.27Ϯ0.05 to 3.53Ϯ0.04 cm) and anterior/posterior (3.13Ϯ0.04 to 4.10Ϯ0.07 cm) diameters, which replicated previously reported human measurements (area, 19,20 circumference, 20,21 septal/lateral diameter, 19,22 anterior/ posterior diameter 8,19 ) at normal and all levels of dilatation. The annulus was constructed from a flexible spring (anterior/posterior section) that was attached to a hollow acrylic tube (septal section) on both ends and surrounded by silicone-lined Dacron cloth.…”

Section: Adjustable Annulus Platesupporting

confidence: 68%

In Vitro Characterization of the Mechanisms Responsible for Functional Tricuspid Regurgitation

et al. 2011

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Background-Functional tricuspid regurgitation (TR) is increasingly recognized as a source of morbidity. Current repair strategies focus on annular remodeling because annular dilatation is common in patients with TR. Although papillary muscle (PM) displacement is recognized in functional mitral regurgitation, its role in TR is less well characterized. The objective of this in vitro study was to further clarify the mechanisms by which TR occurs as an effect of annular dilatation and PM displacement. Methods and Results-Porcine tricuspid valves (nϭ16) were studied in an in vitro right heart simulator. The valve dynamics were quantified with isolated annular dilatation starting with a normal annular size (6 cm 2 ) and incrementally dilated up to 100%, isolated PM displacement, and a combination of the 2. All valves lost competence at 40% dilatation, resulting in a TR of 7.9Ϯ3.4 mL (PՅ0.05) compared with baseline and central residual leaflet length of 0.5Ϯ0.2 cm. Multidirectional displacement of the anterior and posterior/septal PMs and all PMs significantly (PՅ0.05) increased TR, with normal annular area. Malcoaptation was observed where the 3 leaflets joined with all significant levels of TR. The anterior leaflet had the greatest percent change in residual leaflet length, whereas PM displacement caused a reduction in residual leaflet length for the septal leaflet for all conditions. Conclusions-This study shows that although annular dilatation alone leads to TR, isolated PM displacement can also cause TR; annular remodeling strategies should be tailored in the setting of severe PM displacement. (Circulation. 2011;124:920-929.)

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“…The association between female sex and PAH is also supported by a literature that highlights hormonal differences and pregnancy effects. 2,9,18 Because PAH may cause right ventricular and tricuspid annular dilation, 21 the association between at least moderate tricuspid regurgitation and PAH seems intuitively plausible.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Arterial Hypertension in Patients With Transcatheter Closure of Secundum Atrial Septal Defects

Yong

Khairy

Guise

et al. 2009

Circ: Cardiovascular Interventions

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Background— Pulmonary arterial hypertension (PAH) may develop in patients with atrial septal defects (ASD); however, little is known about associated risk factors and its evolution after transcatheter ASD closure. Methods and Results— We conducted a cohort study on 215 adults with attempted transcatheter ASD closure from 1999 to 2006. Patients were classified according to baseline systolic pulmonary artery pressures as having no (I, <40 mm Hg), mild (II, 40 to 49 mm Hg), moderate (III, 50 to 59 mm Hg), or severe (IV, ≥60 mm Hg) PAH. Independent predictors of moderate or severe PAH were older age (odds ratio [OR], 1.10 per year; P <0.0001), larger ASD (OR, 1.13 per millimeter; P =0.0052), female sex (OR, 3.9; P =0.0313), and at least moderate tricuspid regurgitation (OR, 3.6; P =0.0043). At 15 (interquartile range, 8 to 43) months post–ASD closure, patients with higher baseline pressures were more likely to experience a ≥5-mm Hg decrease (33.7%, 73.9%, 79.2%, and 100.0% in groups I to IV, P <0.0001), with a larger magnitude of reduction (0, 8, 17, and 22 mm Hg; P <0.0001). However, normalization of pressures (<40 mm Hg) occurred less frequently in patients with more advanced PAH (90.2%, 71.7%, 66.7%, and 23.5%, P <0.0001). Among patients with moderate or severe PAH, independent predictors of normalization were lower baseline pressures (OR, 0.91 per mm Hg; P =0.0418) and no more than mild tricuspid regurgitation (OR, 0.14; P =0.0420). Conclusion— In adults with ASDs, severity of PAH is modulated by age, sex, defect size, and degree of tricuspid regurgitation. Patients with moderate or severe PAH may benefit from substantial reductions in pulmonary artery pressures after transcatheter ASD closure, although the PAH values remain elevated in a sizeable proportion.

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Geometric Changes of Tricuspid Valve Tenting in Tricuspid Regurgitation Secondary to Pulmonary Hypertension Quantified by Novel System with Transthoracic Real-time 3-Dimensional Echocardiography

Cited by 78 publications

References 18 publications

Real-Time 3-Dimensional Echocardiography Provides New Insight Into Mechanisms of Tricuspid Valve Regurgitation in Patients With Hypoplastic Left Heart Syndrome

Real-Time 3-Dimensional Echocardiography Provides New Insight Into Mechanisms of Tricuspid Valve Regurgitation in Patients With Hypoplastic Left Heart Syndrome

In Vitro Characterization of the Mechanisms Responsible for Functional Tricuspid Regurgitation

Pulmonary Arterial Hypertension in Patients With Transcatheter Closure of Secundum Atrial Septal Defects

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