Tricuspid annular abnormalities following different surgical strategies in adults with corrected tetralogy of Fallot (Results from the CSONGRAD Registry and MAGYAR-Path Study)

Abstract

Background: Although there is an increasing number of patients with corrected tetralogy of Fallot (cTOF), who reach adulthood due to recent successful surgical procedures, some of them suffers from late complications, including functional tricuspid regurgitation (FTR). The purpose of the present study was to examine tricuspid annular (TA) abnormalities in adult cTOF patients and their relationship right atrial (RA) volumes respecting the cardiac cycle assessed by three-dimensional speckle-tracking echocardiography (3DSTE). Moreover, the effect of different surgical procedures on TA morphologic and functional parameters was examined as well.Methods: The study comprised 24 cTOF patients (32.8±13.5 years, 9 males) in which early palliative surgery and late total correction were performed in 12 cases (pcTOF), while early total reconstruction was performed in 12 subjects (etrTOF). Their results were compared to those of 33 matched healthy adults (36.7±7.2 years, 15 males).Results: Dilated end-systolic and end-diastolic TA morphologic parameters and their body surface areaindexed counterpart could be detected in cTOF patients as compared to that of controls. TA fractional area change and TA fractional shortening proved to be reduced in cTOF patients as well as in etrTOF and pcTOF patients compared to controls. None of the TA morphologic and functional parameters showed any differences between etrTOF and pcTOF patients. Increased maximum, preatrial contraction and minimum RA volumes could be detected in cTOF patients compared to controls, which correlated with TA dimensions.Conclusions: TA is dilated with reduced function in adult patients with cTOF. TA dilation is related to RA volumes. etrTOF and pcTOF patients have similar TA dimensions and TA functional properties.

The tricuspid annulus in amyloidosis with cardiac involvement: Detailed analysis from the three-dimensional speckle tracking echocardiographic MAGYAR-Path Study

“…3DSTE is capable not only for volumetric and functional assessment of ventricles and atria [6] , [7] , but for non-invasive evaluation of annular dimensions of atrio-ventricular valves as well [14] , [15] . Although mitral and tricuspid valves have a special 3D shape, 3DSTE-derived measurements allow only their 2D-projected ‘en-face’ assessment in one plane.…”

“…This type of evaluation is relatively simple, only planes could be optimized on valvular edges as demonstrated above. Due to the limited nature of 2D echocardiography in assessing the tricuspid valve and its annulus, 3D echocardiography offers new insight into the valvular dynamics during the cardiac cycle via a simple non-invasive way [5] , [12] , [13] , [14] . Moreover, disease-specific alterations could be theorized due to specific volumetric and functional properties of certain disorders.…”

“…End-diastolic (just before mitral valve closure) and end-systolic (just before mitral valve opening) measurements were performed to calculate the following morphological and functional TA parameters ( Fig. 1 ) [12] , [13] , [14] :

Fig. 1 Extract from a three-dimensional full-volume dataset demonstrating the tricuspid annulus (TA) in a patient with cardiac amyloidosis: apical four-chamber view (A); apical two-chamber view (B); and a cross-sectional view at the level of the tricuspid annulus optimized in apical four- and two-chamber views (C7).

…”

Normal reference values of tricuspid annular dimensions and functional properties in healthy adults using three-dimensional speckle-tracking echocardiography (insights from the MAGYAR-Healthy Study)

“…First, a full volume 3D 'echocloud' was acquired from the apical window, then a special software (3D Wall Motion Tracking, version 2.7, Toshiba Medical Systems, Tokyo, Japan) was used for offline analysis. Lateral and septal TA endpoints in AP2CH and AP4CH views were optimized, then TA dimensions were determined in the C7 short-axis view (Figure 2) (6,18,19):…”

“…Three-dimensional (3D) speckle-tracking echocardiography (STE) is a relatively new non-invasive imaging modality with the ability to determine valvular dimensions and functional properties in addition to simultaneous chamber quantifications (1)(2)(3)(4)(5)(6). 3DSTE is using a block-matching algorithm and merges advantages of 3D echocardiography (visualizing the heart as a 3D organ) and speckletracking echocardiography (quantitative featuring of wall contractility by strain and rotational parameters), and became clinically available in the early 2000s (1)(2)(3)(4).…”