Geometric Determinants of Functional Tricuspid Regurgitation

Abstract

Background-Tricuspid regurgitation (TR) is an important predictor of morbidity and mortality in heart failure. We aimed to examine the 3D geometry of the tricuspid valve annulus (TVA) in patients with functional TR, comparing them with patients with normal tricuspid valve function and relating annular geometric changes to functional TR. Methods and Results-TVA shape was examined by real-time 3D echocardiography in 75 patients: 35 with functional TR and 40 with normal tricuspid valve function (referent group). The 3D shape of the TVA was reconstructed from rotated 2D planes, and the annular plane was computed by least-squares fitting. Annular area and mediolateral, anteroposterior, and high (superior)-low (inferior) distances were calculated. TR was assessed by vena contracta width. The normal TVA has a bimodal pattern (high-low distanceϭ7.23Ϯ1.05 mm). High points were located anteroposteriorly, and low points were located mediolaterally. With moderate or greater TR (vena contracta width 5.80Ϯ2.62 mm), the TVA became dilated (17.24Ϯ4.75 versus 9.83Ϯ2.18 cm 2 , PϽ0.0001, TR versus referent), more planar with decreased high-low distance (4.14Ϯ1.05 mm), and more circular with decreased ratio of mediolateral/anteroposterior (1.11Ϯ0.09 versus 1.32Ϯ0.09, PϽ0.0001, TR versus referent). Conclusions-The normal TVA has a bimodal shape with distinct high points located anteroposteriorly and low points located mediolaterally. With functional TR, the annulus becomes larger, more planar, and circular. These changes in annular shape with TR have potentially important mechanistic and therapeutic implications for tricuspid valve repair.

Progression of Isolated Tricuspid Regurgitation Late After Left-Sided Valve Surgery - Clinical Features and Mechanisms -

“…15 Normal tricuspid annulus has a bimodal shape but the annulus becomes larger, more planar, and circular in patients with functional TR. Previous studies using 3-D echocardiography showed that tricuspid tethering was an important mechanism for functional TR.…”

Clinical Utility of 3-Dimensional Echocardiography in the Evaluation of Tricuspid Regurgitation Caused by Pacemaker Leads

“…6,7 However, in the clinical setting, the diagnosis of lead-induced TR can be challenging because conventional 2-dimensional echocardiography (2-DE) has limitations in identifying the anatomical relationship between the lead and the tricuspid leaflets. 7 The 3-dimensional echocardiography (3-DE) has been recently developed for assessing tricuspid valve morphology and pathology, including TR, [8][9][10][11] and case reports on its utility in the diagnosis of PPM-and ICD-lead-related TR have been published. 12,13 However, the ability of 3-DE to identify both the anatomical lead route through the tricuspid valve and lead-induced valve malfunction has not been studied systematically.…”

Prevalence, Predictors, and Prognostic Value of Residual Tricuspid Regurgitation in Patients With Left Ventricular Assist Device

“…Moreover, RV size and geometry are technically difficult to determine accurately with 2‐dimensional echocardiography because of its anatomic complexity. Although the 3‐dimensional echocardiography now offers an accurate and real‐time assessment of the size and shape of RV and the TV deformation,30, 36 high feasibility, and reproducibility of TV annulus diameter using 2‐dimensional echocardiography in apical 4‐chamber view has been reported when compared with 3‐dimensional echocardiography 26…”