Three-dimensional Tricuspid Annular Function Provides Insight into the Mechanisms of Tricuspid Valve Regurgitation in Classic Hypoplastic Left Heart Syndrome

Nii, Masaki; Guerra, Vitor; Roman, Kevin S.; Macgowan, Christopher K.; Smallhorn, Jeffrey F.

doi:10.1016/j.echo.2005.10.025

Cited by 57 publications

(71 citation statements)

References 25 publications

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“…[15][16][17] Similar findings were noted in patients with HLHS in whom the annulus changed from a normal elliptical 10 to a more circular shape. 11 It is unlikely that the observed changes in this study are related only to alterations in global function and shape change. It also appears that LV size in HLHS did not appear to affect the degree of TR or to be related to significant tethering or prolapse.…”

Section: Rv Geometry and Functionmentioning

confidence: 74%

“…10,11 This enhances temporal resolution during analysis of the RT3D data sets, particularly in children with higher heart rates. The validity of the software used to analyze the RT3D data sets had previously been tested by our group in a phantom model.…”

Section: Three-dimensional Analysis Methodsmentioning

confidence: 99%

“…6 -9 Using real-time 3-dimensional echocardiography (RT3D), we previously demonstrated the importance of mitral-tricuspid annular interaction 10 and the role of tricuspid annular function and papillary muscle (PM) displacement as a cause of TR in HLHS. 11 Our hypothesis was that abnormalities of tricuspid annular function and PM location are directly related to the severity of TR in HLHS through disturbances of leaflet function.…”

Section: Clinical Perspective On P 1098mentioning

confidence: 98%

“…TR was characterized on a 0 to 4ϩ grading scale and defined as follows: 0ϭnone, 1ϭmild (narrow regurgitant jet, Ͻ2 mm, single jet), 2ϭmild to moderate (jet Ͻ4 mm, multiple jets, or both; mild atrial enlargement), 3ϭmoderate to severe (wide jet Ͼ4 mm that reaches the back wall of the atrium; moderate atrial enlargement), and 4ϭsevere (wide jet Ͼ4 mm that reaches the back wall of the atrium; reversal of flow in the hepatic veins; severe atrial enlargement). 2,11 Studies with TR in the range of 0 to 2 were characterized as mild, whereas those with grade 3 to 4 were characterized as moderate. RV function was assessed by fractional area change in the apical 4-chamber view.…”

Section: Two-dimensional Echocardiographymentioning

confidence: 99%

“…The normal tricuspid annulus has 2 high and low points 6,8,11 and, when viewed from a 3-dimensional perspective, has some intrinsic tethering and prolapse. The RV is poorly suited to contract against high afterload 15 and, when faced with a high afterload, assumes a more cylindrical shape, with leftward septal shift resulting in annular dilatation and leaflet tethering.…”

Section: Rv Geometry and Functionmentioning

confidence: 99%

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Real-Time 3-Dimensional Echocardiography Provides New Insight Into Mechanisms of Tricuspid Valve Regurgitation in Patients With Hypoplastic Left Heart Syndrome

et al. 2009

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Background-Tricuspid regurgitation in hypoplastic left heart syndrome has an impact on outcome, but its mechanisms remain unclear. Methods and Results-Real-time 3-dimensional echocardiography was performed in 35 patients with hypoplastic left heart syndrome (age, 1 month to 10 years; 10 after first-stage Norwood, 12 after superior cavopulmonary shunt, 13 after Fontan). From the 3-dimensional data set, we marked the annulus in systole and diastole. At mid systole, we marked the location of the papillary muscle tip and point of chordal attachment to the leaflet. We traced the surfaces of the tricuspid valve leaflets and measured the volume of leaflet prolapse, tethering, annular and septal leaflet areas, and papillary muscle position. Seventeen patients had moderate tricuspid regurgitation (prolapse, 7; tethered leaflets, 7) and 18 mild (prolapse, 0; tethered leaflets, 7). Multiple linear regression analysis revealed that moderate tricuspid regurgitation is associated with leaflet tethering and prolapse; that in hypoplastic left heart syndrome with tethered leaflets, the papillary muscle is displaced laterally and the tricuspid annulus is more planar; and that enlargement of the annulus at mid systole, small septal leaflet area, and age affect the degree of prolapse. Conclusion-In hypoplastic left heart syndrome, moderate tricuspid regurgitation may be associated with increasing age, geometrical changes of the annulus, leaflet prolapse, lateral papillary muscle displacement, and subsequent leaflet tethering, as well as a smaller septal leaflet.

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