Determinants of functional tricuspid regurgitation in incomplete tricuspid valve closure: Doppler color flow study of 109 patients

Sagie, Alex; Schwammenthal, Ehud; Padial, Luis Rodrı́guez; Prada, José Antonio Vázquez de; Weyman, Arthur E.; Levine, Robert A.

doi:10.1016/0735-1097(94)90302-6

Cited by 166 publications

(102 citation statements)

References 33 publications

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“…Sagie et al reported that apical displacement of the tricuspid leaflets rather than tricuspid annular dilatation is the major determinants of functional TR. 21 In the present study, no patients showed significant apical displacement of the tricuspid leaflets. We investigated patients with lone AF without right ventricular dysfunction/dilatation whereas they examined patients with functional TR including severe TR (73%) secondary to myocardial dysfunction, left sided valve disease, pulmonary hypertension, and congenital disease, potentially leading to right ventricular dysfunction/dilatation.…”

Section: Relation To Previous Studiesmentioning

confidence: 68%

Impact of Atrial Fibrillation on Tricuspid and Mitral Annular Dilatation and Valvular Regurgitation.

Zhou

Otsuji

Shiro

et al. 2002

Circ J

122

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Section: Relation To Previous Studiesmentioning

confidence: 68%

Impact of Atrial Fibrillation on Tricuspid and Mitral Annular Dilatation and Valvular Regurgitation.

Zhou

Otsuji

Shiro

et al. 2002

Circ J

122

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“…Third, the etiology of functional TR is thought to be annular dilatation and tethering of the leaflets due to ventricular dilatation and dysfunction. 7,29 We previously showed that annuloplasty, performed to reduce the annulus size, might not be enough to eliminate TR in patients with severe tethering of the leaflets. 7 In fact, residual TR after TV annuloplasty, varying from 10% to 20%, has been reported.…”

Section: Study Limitationsmentioning

confidence: 99%

Three-Dimensional Geometry of the Tricuspid Annulus in Healthy Subjects and in Patients With Functional Tricuspid Regurgitation

et al. 2006

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Background-Most rings currently used for tricuspid valve annuloplasty are formed in a single plane, whereas the actual tricuspid annulus (TA) may have a nonplanar or 3-dimensional (3D) structure. The purpose of this study was therefore to investigate the 3D geometry of the TA in healthy subjects and in patients with functional tricuspid regurgitation (TR). Methods and Results-This study consisted of 15 healthy subjects and 16 patients with functional TR who had real-time 3D echocardiography. With our customized software, 8 points along the TA were determined with the rotated plane around the axis at 45°intervals. The TA was traced during a cardiac cycle. The distance between diagonals connecting 2 points was measured. The height was defined as the distance from the plane determined by least-squares regression analysis at all 8 points. Both the maximum (7.5Ϯ2.1 versus 5.6Ϯ1.0 cm 2 /m 2 ) and minimum (5.7Ϯ1.3 versus 3.9Ϯ0.8 cm 2 /m 2 ) TA areas in patients with TR were larger than those in healthy subjects (both PϽ0.01). Healthy subjects had a nonplanar-shaped TA with homogeneous contraction. The posteroseptal portion was the lowest toward the apex from the right atrium, and the anteroseptal portion was the highest. In patients with functional TR, the TA was dilated in the septal to lateral direction, resulting in a more circular shape than in healthy subjects. A similar 3D pattern was observed in patients with TR, but it was more planar than that in healthy subjects. Conclusions-Real-time 3D echocardiography showed a complicated 3D structure of the TA, which appeared to be different from the "saddle-shaped" mitral annulus, suggesting an annuloplasty for TR different from that for mitral regurgitation.

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“…[7][8][9] Annulus dilatation compromised leaflet closure or coaptation by limiting the amount of leaflet overlap. Changes in RV geometry presumably caused displacement of the papillary muscles, resulting in tethering of the TV leaflet.…”

Section: Relationship Between Preoperative Tricuspid Valve Deformatiomentioning

confidence: 99%

“…[7][8][9] TR severity also is related to both dilated TV annulus and leaflet tethering, which decrease the degree of leaflet overlap or coaptation at their tips. 9 However, annuloplasty, performed to reduce the TV annulus, might not be sufficient to correct functional TR. Therefore, this study was designed to investigate the degree of association between preoperative TV deformations (TV annular dilatation and tethering) and residual TR after TV annuloplasty.…”

mentioning

confidence: 99%

Tricuspid Valve Tethering Predicts Residual Tricuspid Regurgitation After Tricuspid Annuloplasty

et al. 2005

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Background-Tricuspid valve (TV) annuloplasty is recommended for functional tricuspid regurgitation (TR), which is caused by TV annulus dilatation and tethering of the leaflets. However, the impact of TV deformations on the outcome of TV annuloplasty remains unknown. The goal of this study was to investigate the relationship between preoperative TV deformation and residual TR after TV annuloplasty. Methods and Results-Two hundred sixteen patients with functional TR had 2D echocardiography before and after TV annuloplasty. Right ventricular fractional area change and left ventricular ejection fraction were determined with the apical views. Minimal TV annulus diameter was determined by frame-by-frame analysis. The distance of TV tethering was measured from the annulus plane to the coaptation point and tethering area by tracing the leaflets from the annulus plane. TR severity was determined by the ratio of the maximal jet area to the corresponding right atrial area. The severity of residual TR was associated with age, right and left ventricular dysfunction, tethering distance and area, and severity of preoperative TR (all PϽ0.05). TV annular dimension was not associated with outcome of TV annuloplasty. Multivariate analysis revealed that age, tethering distance, and severity of preoperative TR (all PϽ0.001) were independent parameters predicting residual TR. The sensitivity and specificity in predicting residual TR after surgery were 86% and 80% for tethering distances Ͼ0.76 cm and 82% and 84% for tethering areas Ͼ1.63 cm 2 , respectively. Conclusions-Severe TV tethering predicted residual TR after TV annuloplasty, whereas preoperative TV annular dimension was not associated with outcome of TV annuloplasty.

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Determinants of functional tricuspid regurgitation in incomplete tricuspid valve closure: Doppler color flow study of 109 patients

Cited by 166 publications

References 33 publications

Impact of Atrial Fibrillation on Tricuspid and Mitral Annular Dilatation and Valvular Regurgitation.

Impact of Atrial Fibrillation on Tricuspid and Mitral Annular Dilatation and Valvular Regurgitation.

Three-Dimensional Geometry of the Tricuspid Annulus in Healthy Subjects and in Patients With Functional Tricuspid Regurgitation

Tricuspid Valve Tethering Predicts Residual Tricuspid Regurgitation After Tricuspid Annuloplasty

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