New insight into tricuspid valve anatomy from 100 hearts to reappraise annuloplasty methodology

Sakon, Yoshito; Murakami, Takashi; Fujii, Hiromichi; Morisaki, Akimasa; Yamane, Kokoro; Ohsawa, Masahiko; Shintani, Ayumi; Seki, Toshiko; Shibata, Toshihiko

doi:10.1007/s11748-019-01092-9

Cited by 15 publications

(12 citation statements)

References 10 publications

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“…Furthermore, when we selected the ring size during tricuspid annuloplasty based on the length of the septal annulus, we observed that Carpentier's technique of measurement was not applicable in some cases because the septal annulus could be larger than the largest size of the obturator ( Supplementary Figures 1A–D ). Several Japanese studies also confirmed our findings that the septal annulus could dilate in FTR to as large as 60 mm ( 9 , 10 ), and markers on the annuloplasty ring do not always conform to the commissures due to a varied number of scallops in the posterior leaflet ( 11 , 12 ). Moreover, Pfannmuller et al observed that ring dehiscence after tricuspid annuloplasty only occurred at the septal annulus ( 13 ).…”

Section: Introductionsupporting

confidence: 85%

“…Isomura et al proposed a technique of septal plication in patients with FTR and significantly improved the intraoperative repair success rate from 62 to 93% ( 9 ). Two studies specified that the markers on tricuspid rings vary among manufacturers and suggested new techniques for tricuspid ring annuloplasty ( 11 , 12 ). The underlying explanation remains unknown and requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

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Tricuspid Annulus Dilation in Patients With Combined Functional Tricuspid Regurgitation and Left-Heart Valvular Disease: Does Septal Annulus Not Dilate?

Teng

Dai

Zou

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThis study aimed to investigate the course of tricuspid annulus dilation in functional tricuspid regurgitation with varied severities by direct intraoperative assessment.MethodsA total of 317 patients who underwent left heart surgery and concomitant tricuspid repair were divided into three groups according to the severity of the functional tricuspid regurgitation (mild, moderate and severe). Demographic and echocardiographic data were collected. The length of each tricuspid annulus segment was measured intraoperatively. The risk factors for preoperative severe functional tricuspid regurgitation and its postoperative recurrence were identified, and the impact of each tricuspid annulus segment on postoperative recurrence was compared.ResultsIn the course of tricuspid annulus dilation, the posterior annulus dilated 17% (group 1: 33.31 ± 6.94 mm vs. group 2: 35.56 ± 7.63 vs. group 3: 38.98 ± 8.70, p < 0.01), the anterior annulus dilated 13.4% (group 1: 36.71 ± 6.30 mm vs. group 2: 38.21 ± 8.35 vs. group 3: 41.63 ± 9.20, p < 0.01), and the septal annulus dilated 11.4% (group 1: 38.11 ± 5.28 mm vs. group 2: 39.76 ± 6.90 vs. group 3: 42.46 ± 7.50, p < 0.01). Tricuspid annulus circumference index (p < 0.01) independently correlated with preoperative severe tricuspid regurgitation and postoperative recurrence. When patients were grouped based on the length of each segment, the septal annulus demonstrated significantly higher sensitivity (p < 0.001) to postoperative recurrence than the anterior (p = 0.085) or posterior annulus (p = 0.262).ConclusionsThis study revealed that each segment of tricuspid annulus could dilate in functional tricuspid regurgitation and highlighted the potential benefits of septal annulus plication in tricuspid annuloplasty, which may aid in the development of a methodology for prosthetic ring annuloplasty.

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Section: Introductionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Tricuspid Annulus Dilation in Patients With Combined Functional Tricuspid Regurgitation and Left-Heart Valvular Disease: Does Septal Annulus Not Dilate?

Teng

Dai

Zou

et al. 2022

Front. Cardiovasc. Med.

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“…The height of the septal leaflet is reported to be 14.5 to 20.6 mm by Sakon and colleagues. 5 Thus, the coaptation length between the anterior and septal leaflets would be more than 7 mm, which is almost equal to one half of the septal leaflet height. The smaller-sized ring was not selected because Min and colleagues 6 reported that leaflet tethering became aggravated after TAP and annulus size reduction could be achieved at the expense of aggravation of leaflet tethering.…”

Section: Discussionmentioning

confidence: 99%

Papillary muscle relocation and annular repositioning for functional tricuspid regurgitation

et al. 2020

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“…In the present study, a TV with two posterior leaflets was an independent predictor of additional procedures. The TV consists of multiple posterior leaflets in about half of patients, and the morphological diversity of these leaflets has attracted attention among researchers (10,17,18).…”

Section: Discussionmentioning

confidence: 99%

Morphological diversity of the tricuspid posterior leaflet affects surgical complexity for control of tricuspid regurgitation

Kawase

Nishiya

Kishimoto

et al. 2021

Preprint

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Objective: We investigated the effect of morphological diversity of the tricuspid valve with multiple posterior leaflets on the technical outcomes of tricuspid valve repair. Methods: From April 2016 to November 2020, 141 patients were diagnosed with secondary tricuspid regurgitation associated with left heart disease and underwent tricuspid valve repair. We retrospectively analyzed the clinical and echocardiographic data of patients who underwent both preoperative and postoperative transthoracic echocardiography. We divided the patients into two groups according to the surgical technique used to treat tricuspid regurgitation: ring annuloplasty alone (Group 1, n=109) or additional approximation of leaflet edges (edge-to-edge repair) with ring annuloplasty (Group 2, n=32). We measured the morphological diversity of the tricuspid valve during the operation in all patients. Results: The preoperative tricuspid regurgitation score was higher in Group 2 than in Group 1 (2.1±0.78 vs. 1.6±0.7, respectively; p=0.0046), and Group 2 contained more patients with two posterior leaflets than Group 1 [20 (63%) vs. 36 (33%), respectively; p=0.003]. The univariate and multivariate logistic regression analyses showed that the presence of two posterior leaflets was an independent risk factor for additional procedures during tricuspid valve repair (odds ratio, 2.6; 95% confidence interval, 1.1–6.1; p=0.033). Conclusions: Additional procedures to reduce tricuspid regurgitation were required more frequently in patients with two posterior leaflets of the tricuspid valve. The morphological diversity of two posterior leaflets is a potential risk factor for a more complicated tricuspid repair.

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New insight into tricuspid valve anatomy from 100 hearts to reappraise annuloplasty methodology

Cited by 15 publications

References 10 publications

Tricuspid Annulus Dilation in Patients With Combined Functional Tricuspid Regurgitation and Left-Heart Valvular Disease: Does Septal Annulus Not Dilate?

Tricuspid Annulus Dilation in Patients With Combined Functional Tricuspid Regurgitation and Left-Heart Valvular Disease: Does Septal Annulus Not Dilate?

Papillary muscle relocation and annular repositioning for functional tricuspid regurgitation

Morphological diversity of the tricuspid posterior leaflet affects surgical complexity for control of tricuspid regurgitation

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