Determinants of the Severity of Functional Tricuspid Regurgitation

Kim, Yong Jin; Kim, Yong-Jin; Park, Jin-Shik; Kim, Kyung Hwan; Kim, Ki-Bong; Ahn, Hyuk; Sohn, Dae‐Won; Oh, Byung‐Hee; Park, Young-Bae; Choi, Yun‐Shik

doi:10.1016/j.amjcard.2006.01.082

Cited by 161 publications

(104 citation statements)

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“…Similar to mitral regurgitation, 18 an altered RV geometry displaces TV papillary muscle and position for chordae insertion, leading to inadequate leaflet coaptation, which closely correlates with the severity of TR. 19,20 The position of the papillary muscle is usually at the RV midcavity; thus, RV midcavity diameter measured in the present study may reflect the position of the anterior and septal papillary muscles of the RV. The larger diameter at the RV midcavity would thus suggest a greater displacement of the papillary muscle of the TV.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Preoperative Right Ventricular Geometry and Tricuspid Valve Tethering Area in Patients Undergoing Tricuspid Annuloplasty

et al. 2014

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Background-Patients who undergo tricuspid annuloplasty during left-side heart valve surgery have a poor postoperative clinical outcome. However, preoperative right ventricular (RV) echocardiography parameters that predict adverse events in these patients are poorly understood. Methods and Results-We studied 74 patients (age, 58±10 years; men, 27%) with significant tricuspid regurgitation who consequently underwent tricuspid annuloplasty during left-side heart valve surgery.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Preoperative Right Ventricular Geometry and Tricuspid Valve Tethering Area in Patients Undergoing Tricuspid Annuloplasty

et al. 2014

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“…In a previous study, we demonstrated that right ventricular geometry and tricuspid annular dilation are closely associated with functional TR development and severity. 10,17,18 This issue requires further investigation.…”

Section: Mechanism Of Late Trmentioning

confidence: 99%

Development of tricuspid regurgitation late after left-sided valve surgery: A single-center experience with long-term echocardiographic examinations

Kwak

Kim

et al. 2008

American Heart Journal

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168

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Objectives This study sought to investigate the incidence and identify the predictors of significant tricuspid regurgitation (TR) development long after left-sided valve surgery.Methods Of 615 patients who underwent surgery for left-sided valve disease between 1992 and 1995, 335 patients without significant TR who completed at least 5 years of clinical and echocardiographic follow-up were enrolled. Late significant TR development was assessed by echocardiography with a mean follow-up duration of 11.6 ± 2.1 years.Results Significant late TR was found in 90 patients (26.9%). Patients with late TR showed an advanced age (47.6 ± 13.4 vs 44.3 ± 13.2 years, P = .04), a higher prevalence of preoperative atrial fibrillation (83.3 vs 46.5%, P b .001), a greater left atrial dimension (56.9 ± 13.2 vs 52.4 ± 11.5mm, P = .006), and a higher prevalence of prior valve surgery (40.0 vs 25.3%, P = .01). In addition, late TR occurred more frequently in patients who had undergone mitral valve surgery than in those who did not (93.3 vs 72.2%, P b .001). However, multivariate analysis showed that the presence of preoperative atrial fibrillation (odds ratio 5.37; 95% CI 2.71-10.65; P b .001) was the only independent factor of late TR development. Patients who developed late TR had a lower event-free survival rate than those who did not (P = .03).Conclusions The development of significant TR long after left-sided valve surgery is not uncommon with an estimated incidence of 27% and is closely associated with a poor prognosis. The presence of preoperative atrial fibrillation was identified as the only independent predictor of the development of late TR. (Am Heart J 2008;155:732-7.) Tricuspid regurgitation (TR) is a common finding in patients undergoing mitral or combined mitral/aortic valve surgery. 1,2 Although TR may decrease gradually after left-sided valve surgery owing to reduced right ventricular pressure or volume overload, 3 TR does not always regress after adequate correction of the underlying lesions 4,5 and often progresses some time after surgery without leftsided valvular dysfunction, even after tricuspid annuloplasty. Furthermore, TR can appear de novo during postoperative follow-up. Because it is well known that TR progression badly affects long-term mortality and morbidity, and that surgical correction of TR after left-sided valve surgery is associated with disappointingly high mortality and morbidity, 6-9 the prevention of late TR is clinically important. In this regard, information regarding the incidence and predictors of progression or development of late TR is of substantial value for determining optimal operative timing and the surgical strategy to prevent late TR development, at the time of surgery for underlying left-sided valve disease. Several previous reports on this topic have been limited by a relatively small study population, 5,10 a short-term follow-up, 11 or the lack of reliable echocardiographic data. 12 Therefore, the present study was performed to investigate the incidence of late de novo TR develo...

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“…The LV diastolic eccentricity index (EI) was calculated as D2/D1. 12 The greater the EI, the more compressed the left ventricle is.…”

Section: - and 3-dimensional Echocardiographymentioning

confidence: 99%

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Cheung

Wong

Liang

et al. 2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp hile right ventricular (RV) dysfunction has been the main concern in patients after repair of tetralogy of Fallot (TOF), 1-3 the importance of left ventricular (LV) dysfunction as a risk factor of long-term adverse outcomes is increasingly acknowledged. 1,4,5 Dysfunction of the left ventricle is characterized by reduced ejection fraction, 1,4 altered systolic myocardial deformation, 6,7 and systolic mechanical dyssynchrony. 1,7,8 These LV functional abnormalities have been attributed to suboptimal ventricular-ventricular interaction, 1,4 although the nature of this interaction remains to be defined.Assessment of cardiac mechanics has extended from evaluation of linear to torsional deformation, which might provide new mechanistic insights. Twisting motion of the left ventricle during the ejection phase is important in the Frank-Starling mechanism, 9 while untwisting contributes to LV diastolic relaxation and early diastolic filling. 10 Interaction between LV subendocardial and subepicardial helical myocardial fibres has been proposed to explain the phenomenon of torsional deformation. 11 Alteration of septal geometry and changes in LV shape due to volume overloading of the right ventricle might potentially distort this interaction and impair torsional deformation. In the present study, we tested the hypothesis that alteration of LV torsional mechanics occurs in postoperative TOF patients and is associated with RV volume overload and changes in LV configuration. Methods SubjectsFifty-five patients who had undergone surgical repair of TOF with transannular patch enlargement of the RV outflow were recruited consecutively from the cardiac clinic of Queen Mary Hospital. From the case records, the following data were retrieved: age at operation, types of surgical procedure, and duration of follow up since total repair. Twenty-seven healthy subjects, including those followed up for non-specific chest pain and palpitation but without documented cardiac arrhythmias and healthy siblings, were recruited as controls. The weight and height of all subjects were measured and the body surface area was calculated accordingly. The Institutional Review Board approved the study and all of the subjects gave

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Determinants of the Severity of Functional Tricuspid Regurgitation

Cited by 161 publications

References 24 publications

Prognostic Value of Preoperative Right Ventricular Geometry and Tricuspid Valve Tethering Area in Patients Undergoing Tricuspid Annuloplasty

Prognostic Value of Preoperative Right Ventricular Geometry and Tricuspid Valve Tethering Area in Patients Undergoing Tricuspid Annuloplasty

Development of tricuspid regurgitation late after left-sided valve surgery: A single-center experience with long-term echocardiographic examinations

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

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