Prognostic Value of Tricuspid Valve Geometry and Leaflet Coaptation Status in Patients Undergoing Tricuspid Annuloplasty: A Three-Dimensional Echocardiography Study

Chen, Yan; Liu, Yingxian; Yu, Yu-Juan; Wu, Mei‐Zhen; Lam, Yui‐Ming; Sit, Ko‐Yung; Chan, Daniel; Ho, Cally Ka-Lai; Ho, Lok Sang; Fang, Ligang; Zhang, Shuyang; Lau, Chu‐Pak; Au, Wing‐Kuk; Tse, Hung‐Fat; Yiu, Kai‐Hang

doi:10.1016/j.echo.2019.07.002

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…The details of image acquisition of the TV using 3DE were described in our previous work. 18 In brief, real-time three-dimensional echocardiographic data of the TV were acquired from the apical four-chamber view using a 4V probe (BT 11; GE Vingmed Ultrasound) with electrocardiographic gating over four consecutive cardiac cycles during a single breath hold to maximize temporal resolution. Full-volume imaging was performed in the RV-focused view, and the horizontal line was aligned at the level of the TV cusp in apical four-chamber views, and the central axis of the pyramidal screen was aligned with the RV long axis.…”

Section: Three-dimensional Transthoracic Echocardiographymentioning

confidence: 99%

Nonapical Right Ventricular Pacing Is Associated with Less Tricuspid Valve Interference and Long-Term Progress of Tricuspid Regurgitation

Chen

Lau

et al. 2020

Journal of the American Society of Echocardiography

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Background: Tricuspid regurgitation (TR) is a well-known complication after permanent pacemaker implantation. The aim of this study was to compare the degree of TR and the relationship of lead position across the tricuspid valve (TV) between patients with right ventricular apical (RVA) and non-RVA pacing determined by three-dimensional echocardiography.Methods: Conventional and three-dimensional echocardiography was performed in 284 patients to determine the change in TR severity following permanent pacemaker implantation. Transvenous lead locations were based on fluoroscopic images. This was a retrospective study, and the selected pacing mode was not randomized.Results: RVA pacing had more frequent severe TR (37.9% vs 25.7%, P = .03) compared with non-RVA pacing. Severe TR occurred in 9.7%, 12.6%, and 58.8% of patients when the lead passed through the middle, between the commissures, and impinging the TV leaflets, respectively. Non-RVA leads were more likely to be positioned in the middle of the TV (30.3% vs 12.1%, P < .01) and had the lowest chance of leaflet impingement (33.6% vs 51.5%, P < .01) compared with RVA leads. RVA pacing was associated with worsening of grade $2 TR severity compared with non-RVA pacing (42.4% vs 27.6%, P < .01). A TV lead passage angle of À15 to 15 minimized TR.Conclusions: Pacing-induced TR is more prevalent with RVA than non-RVA pacing. Preferential lead impingement on the TV leaflet, as determined by TV lead passage angle, can explain the development and progression of pacing-induced TR.

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Section: Three-dimensional Transthoracic Echocardiographymentioning

confidence: 99%

Nonapical Right Ventricular Pacing Is Associated with Less Tricuspid Valve Interference and Long-Term Progress of Tricuspid Regurgitation

Chen

Lau

et al. 2020

Journal of the American Society of Echocardiography

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“…25, 26 Recent studies demonstrate the usefulness of 3-D echocardiographic parameters of the TV to predict residual TR and adverse outcome following tricuspid annuloplasty. 15, 16 Utsunomiya et al found that short total leaflet length (<53.5 mm), large tenting volume (>3.5 mL), and high TV morphological score (>18) are associated with residual TR after surgery. 15 It is worthy of note that in some cases diagnosed as "functional" TR, it is difficult to differentiate completely functional vs. organic TR.…”

Section: Prognostic Value Of 3-d Echocardiography Parametersmentioning

confidence: 99%

“…Most recently, a retrospective cohort study with a propensitymatched sample found that in patients with isolated severe TR, there is no difference in long-term survival for patients who undergo surgical intervention compared with medical can be assessed using the ratio of total leaflet length in mid-diastole (a+b+c in Figure 5) to total closure length in mid-systole (d+e+f in Figure 5) obtained on 3-D analysis. 13, 16 Not only annular dilatation and leaflet tethering but also leaflet coaptation status have been proven to be associated with mechanisms of both functional mitral regurgitation and functional TR. 13,17,18…”

Section: Trans-catheter Procedures For Trmentioning

confidence: 99%

“…The pathophysiology of functional TR has been investigated, and critical TV deformations in its development have been proven to be annular dilatation, 13,37 leaflet tethering, 38 and poor coaptation status with insufficient leaflet adaptation. 13,16,17 In most of these previous studies, however, the study population was limited to functional TR because of the pulmonary hypertension. Recent real-time 3D-TEE elucidated different pathoanatomy and mechanisms of functional TR according to TR subgroup.…”

Section: Mechanismmentioning

confidence: 99%

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Role of 3-Dimensional Echocardiography in the Comprehensive Evaluation of the Tricuspid Valve in Patients With Tricuspid Regurgitation

Utsunomiya

Kihara

2020

Circ Rep

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Three-dimensional echocardiography is one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an essential clinical tool owing to the continued development of real-time transesophageal echocardiography (TEE) technology. And now an era of renewed interest and enthusiasm surrounding the diagnosis and treatment of valvular heart disease has come, which is driven by emerging trans-catheter procedures. Nonetheless, little or no attention has been given to the treatment of tricuspid regurgitation (TR). The application of 3D-TEE is useful for simultaneous visualization of all 3 leaflets in order to grasp the whole picture of the tricuspid valve (TV; "en face" view). The implications of 3-D assessment of TV annulus, leaflets, and morphology involve an improved understanding of both the mechanics and treatment of TR. This method has been useful for surgical management, including accurate measurement of tricuspid annular diameter and prediction of the post-surgical outcome. Moreover, this method may be indispensable for detailed and comprehensive evaluation of the TV in patients with TR who are candidates for trans-catheter tricuspid procedures. In addition, color Doppler 3D-TEE has been valuable to identify the location of the regurgitant orifice and the severity of the TR. It is now clear that this method will enhance the diagnosis and management of TR patients.

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“…Third, 3D TTE provides a more reliable means to identify the TV leaflets and commissures compared to 2D TTE, which is important in evaluating the effect of damage secondary to pacemaker leads or other implanted devices in patients with primary, catheter-related TR [26] . Lastly, in addition to TA diameter, decreased TV leaflet coaptation and degree of leaflet tethering are important prognostic factors predicting outcomes in patients undergoing tricuspid repair [55] . Both of these anatomic pathologies are better visualized using 3D (rather than 2D) TTE.…”

Section: Imaging Of the Tvmentioning

confidence: 99%

Imaging and computational modeling of tricuspid regurgitation and repair

Morgan¹,

Howell²,

Chen³

et al. 2020

Vessel Plus

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The tricuspid valve (TV) and right ventricle (RV) are a complex mechanical system. Tricuspid regurgitation impacts a growing and heterogeneous population, leading to right-sided volume overload and right heart failure if left untreated. In part because isolated surgical tricuspid valve repair (TVR) is performed infrequently and has a high mortality, several percutaneous TVR options are being developed. However, the mechanical effects of different types of percutaneous or surgical TVR are unclear. Both the quality of RV imaging and the power of cardiac computational modeling have increased, and accurate computational models of the TV + RV with simulated TVR are now possible. Computational models of TV + RV may aid in patient selection and procedural planning prior to surgical and percutaneous TVR.

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Prognostic Value of Tricuspid Valve Geometry and Leaflet Coaptation Status in Patients Undergoing Tricuspid Annuloplasty: A Three-Dimensional Echocardiography Study

Cited by 7 publications

References 33 publications

Nonapical Right Ventricular Pacing Is Associated with Less Tricuspid Valve Interference and Long-Term Progress of Tricuspid Regurgitation

Nonapical Right Ventricular Pacing Is Associated with Less Tricuspid Valve Interference and Long-Term Progress of Tricuspid Regurgitation

Role of 3-Dimensional Echocardiography in the Comprehensive Evaluation of the Tricuspid Valve in Patients With Tricuspid Regurgitation

Imaging and computational modeling of tricuspid regurgitation and repair

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