Tricuspid Valve Geometrical Changes in Patients with Functional Tricuspid Regurgitation: Insights from a CT Scan Analysis Focusing on Commissures

Abstract

Background: Cardiac computed tomography (CT) provides important insights into the geometrical configuration of the tricuspid valve (TV). The purpose of the present study was to assess the geometrical changes of TV in patients with functional tricuspid regurgitation (TR) using novel CT scan parameters and to correlate these findings with echocardiography. Methods: This single-center study enrolled 86 patients undergoing cardiac CT and divided them into two groups according to the presence or not of severe TR (43 patients with TR ≥ 3+ and 43 controls). The measurements collected were as follows: TV annulus area and perimeter, septal-lateral and antero-posterior annulus diameters, eccentricity, distance between commissures, segment between the geometrical centroid and commissures, and the angles of commissures. Results: We found a significant correlation between all annulus measurements and the grade of TR, except in regard to angles. TR ≥ 3+ patients had significantly larger TV annulus area and perimeter, larger septal-lateral, and antero-posterior annulus dimensions, as well as larger commissural distance and centroid-commissural distance. In patients with TR ≥ 3+ and controls, the eccentricity index predicted a circular shape and an oval shape of the annulus, respectively. Conclusions: These novel CT variables focusing on commissures increase the anatomical understanding of the TV apparatus and the TV geometrical changes in patients with severe functional TR.

Perioperative Right Ventricular Dysfunction and Abnormalities of the Tricuspid Valve Apparatus in Patients Undergoing Cardiac Surgery

“…However, the incidence of RV failure after elective cardiac surgery is relatively low, occurring in approximately 0.1% of patients. On the other hand, in the context of heart transplant and left ventricular assist device (LVAD) implantation, the incidence significantly rises, reaching peak rates of 30-40% [2][3][4][5][6]. RV dysfunction has important clinical consequences; a study conducted by Bootsma et al involving 1109 cardiac patients demonstrated an independent association between RV dysfunction and 2-year all-cause mortality after heart surgery [7].…”

“…The normal range for TAPSE is 20.7 mm ± 11.1 (SD) for males and 20.3 mm ± 8.6 (SD) for females, with values under 17 mm usually indicating some degree of dysfunction [52]. TAPSE has gained popularity thanks to its easy measurement and reproducibility [6,53,54]; however, it has some disadvantage, mainly because it does not detect regional dysfunction. Moreover, it is angle-dependent, load-dependent, and may be increased in the case of tricuspid regurgitation.…”