scholarly journals 145 Prognostic value of three-dimensional echocardiographic assessment of tricuspid valve geometry in atrial and ventricular functional tricuspid regurgitation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesca Heilbron ◽  
Mara Gavazzoni ◽  
Diana Florescu ◽  
Roberto Ochoa ◽  
Michele Tomaselli ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Major Axis ◽  
Right Atrial ◽  
Vena Contracta ◽  
Functional Tricuspid Regurgitation ◽  
Significant Difference ◽  
History Of ◽  
The Difference

Abstract Aims Atrial and ventricular functional tricuspid regurgitation (A-FTR and V-FTR) have recently emerged as different phenotypes of FTR. Given the difference in mechanisms that are postulated to be underlying these two entities, a different remodelling of tricuspid valve (TV) apparatus can occur and therefore also a specific quantitative approach could be deemed. Moreover, considered the known limitation of the two-dimensional flow convergence method (2D-PISA) for quantifying FTR in advanced valve apparatus remodelling with irregular effective valve orifice (ERO) morphology, it would be expected that also the parameters of severity of FTR can be different in these two types of FTR. The aim of this study was to investigate the TV apparatus remodelling in the two different phenotypes of FTR: ventricular (V-FTR) and atrial (A-FTR) and the role of echocardiographic parameters of TV remodelling and TR severity to predict clinical outcomes. Methods and results The present retrospective study included consecutive patients with moderate to severe functional tricuspid regurgitation (FTR) referred for echocardiography in two Italian centres. The composite endpoint of death for any cause and heart failure (HF) hospitalization was used as primary outcome of this analysis. According to more recent guidelines, patients were considered having A-FTR if having history of long-standing atrial fibrillation, without history of pulmonary hypertension and left side heart disease. A total of 180 patients were included. Despite the right atrial volume (RAV) was not different in the two groups, in A-FTR tethering height was significantly lower (11.7 ± 4.8 mm vs. 15.0 ± 5.5 in V-FTR. P < 0.01) and the 3D-derived tricuspid annulus (TA) diameters were larger both in end-diastolic and mid-systolic phase (3D-TA-End diastolic-major axis: 45.2 ± 6.2 mm in A-FTR vs. 42.8 ± 5.4 in V-FTR. P = 0.04; 3D-TA mid systolic major axis: 41.7 ± 6.4 mm in A-FTR vs. 37.9 ± 5.1 in V-FTR, P < 0.01). 3D-TA-End diastolic-minor axis: 39.7 ± 6.8 vs. 37.1 ± 5.2. P = 0.03. Regarding the parameters of severity of FTR, patients with V-FTR had larger vena contracta (VC), either when 2D estimated or 3D (2D-VC-average: 5.3 ± 2.8 mm in A-FTR vs. 6.6 ± 3.7 in V-FTR. P = 0.02; 3D-VCA: 0.9 ± 0.4 cm2 vs. 1.3 ± 1.1 cm2, P = 0.02); conversely the value of 2D-ERO and regurgitant volume estimated with 2D-PISA method did not show significant difference between the two groups. After a median follow-up of 24 months (IQR: 2–48) 72 patients (40%) reached the primary endpoint and 64 (36%) hospitalized for HF. Different predictors of combined endpoint were found in the two groups: tenting height. 2D-VC. 3D-VCA and regurgitant fraction were prognostic correlates in V-FTR; TA dimensions as well as all the parameters of severe TR, including EROA with PISA method were related to the prognosis in A-FTR. Conclusions Different TV remodelling occurs in patients with A- and V-FTR, having the second more pronounce tethering of TV leaflets; the prognostic role of quantitative parameters of FTR in these two groups is different, thus reaffirming: (1) the limitation of PISA method without correction in case of more pronounced tenting of leaflets; (2) the difference in underlying pathogenic mechanisms; and (3) the needing for a more specific diagnostic approach and prognostic stratification in these two FTR phenotypes.

scholarly journals Functional tricuspid regurgitation, related right heart remodeling, and available treatment options: good news for patients with heart failure?

2021 ◽  
Author(s):  
Marijana Tadic ◽  
Cesare Cuspidi ◽  
Daniel Armando Morris ◽  
Wolfang Rottbauer
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Right Atrial ◽  
Functional Mitral Regurgitation ◽  
Tricuspid Valve Repair ◽  
Right Heart ◽  
Heart Remodeling ◽  
Functional Tricuspid Regurgitation ◽  
Patients With Heart Failure

AbstractSignificant functional tricuspid regurgitation (FTR) represents a poor prognostic factor independent of right ventricular (RV) function. It is usually the consequence of left-sided cardiac diseases that induce RV dilatation and dysfunction, but it can also resulted from right atrial (RA) enlargement and consequent tricuspid annular dilatation. FTR is very frequent among patients with heart failure, particularly in those with reduced LVEF and concomitant functional mitral regurgitation. The development of three-dimensional echocardiography enabled detailed assessment of tricuspid valve anatomy, subvavlular apparatus, and RA and RV changes, as well as accurate evaluation of FTR etiology. Due to high in-hospital mortality risk in patients who were operatively treated for isolated FTR, it has been treated only medically for a long time. Percutaneous approach considers mainly transcatheter tricuspid valve repair (edge-to-edge and annuloplasty) and represents a very attractive option for the high-risk patients. Studies that investigated the effects of different devices showed excellent feasibility and safety, followed by significant reduction in FTR grade, improvement in functional capacity and NYHA class, quality of life, and reduction in hospitalization due to heart failure. Some investigations also reported a decreased mortality in FTR patients. Nevertheless, the results of these investigations should be interpreted with cautious due to the small number of participants and relatively short follow-up. The aim of this review was to summarize the existing data about the clinical importance of FTR and FTR-induced right heart remodeling and currently existing therapeutic approaches for treatment of FTR.

scholarly journals Ring, Band or Suture in Tricuspid Annuloplasty for Functional Tricuspid Regurgitation; Which is Better and More Durable?

2019 ◽  
Vol 22 (5) ◽  
pp. E411-E415 ◽  
Author(s):  
Ahmed Adas ◽  
Ahmed Elnaggar ◽  
Yehia Balbaa ◽  
Ahmed Elashkar ◽  
Hesham Mostafa Alkady
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Late Results ◽  
Tricuspid Valve Repair ◽  
Recurrence Rates ◽  
Vena Contracta ◽  
Functional Tricuspid Regurgitation ◽  
Tricuspid Incompetence ◽  
Group B

Background: In this study, we evaluate different annuloplasty modalities to repair functional tricuspid regurgitation. Patients and methods: Between January 2011 and January 2017, 200 patients with moderate or greater functional tricuspid regurgitation received tricuspid valve repair as part of primary surgeries on the left side of their cardiac valves. Of these, 39 patients received rings (Group A), 84 patients received bands (Group B), and 77 patients received suture annuloplasty (Group C). Results: Two patients from Group C were operated on again, during the primary hospital stay due to severe symptomatic tricuspid regurgitation. The degrees of early postoperative tricuspid regurgitation – mean vena contracta and mean jet area – significantly were higher in Group C. During a mean follow-up period of 26 ± 12.6 months, 5 patients within Group C (6.85%) and one patient in Group B (1.3%) were operated on again with tricuspid valve replacement due to severe symptomatic tricuspid incompetence. Also during follow up, mean degrees of tricuspid regurgitation, mean vena contracta, and mean jet areas significantly were higher in Group C. Conclusion: Patients who received rings followed by band annuloplasty had better early and late results with lower recurrence rates than those who received suture annuloplasty

Tricuspid valve geometry and right heart remodelling: insights into the mechanism of atrial functional tricuspid regurgitation

2020 ◽  
Vol 21 (10) ◽  
pp. 1068-1078 ◽  
Author(s):  
Hiroto Utsunomiya ◽  
Yu Harada ◽  
Hitoshi Susawa ◽  
Yusuke Ueda ◽  
Kanako Izumi ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
Volume Ratio ◽  
Right Atrial ◽  
Right Heart ◽  
Systolic Volume ◽  
Functional Tricuspid Regurgitation ◽  
End Systolic Volume ◽  
Tip Position

Abstract Aims  We sought to investigate tricuspid valve (TV) geometry and right heart remodelling in atrial functional tricuspid regurgitation (AF-TR) as compared with ventricular functional TR with sinus rhythm (VF-TR). Methods and results  Transoesophageal 3D echocardiography datasets of the TV and right ventricle were acquired in 51 symptomatic patients with severe TR (AF-TR, n = 23; VF-TR, n = 28). Three-dimensional right ventricular (RV) endocardial surfaces were reconstructed throughout the cardiac cycle and then postprocessed using semiautomated integration and segmentation software to calculate position of papillary muscle (PM) tips. Compared with VF-TR, AF-TR had more dilated and posteriorly displaced annulus and less leaflet tethering angles with more prominent right atrium and smaller RV end-systolic volume. On the XY (annular) plane, the centre of annulus was getting closer towards the anterior and posterior PM tips and was going away from the medial PM tip caused by prominent annular dilatation in AF-TR. On the Z-axis, the position of each PM tip in AF-TR was not so much displaced apically as that in VF-TR. Multiple linear regression analyses revealed that right atrial volume and right atrial/RV end-systolic volume ratio were determinants of annular area and orientation in AF-TR, respectively (both P < 0.001). Additionally, the posteromedial-directed component of posterior PM tip position and the apically directed component of the position of all three PM tips were independently associated with TV tethering angles of each leaflet in AF-TR (all P < 0.02). Conclusion  Right heart remodelling and its association with 3D TV geometry differ entirely between AF-TR and VF-TR, which may offer distinctive therapeutic implication.

scholarly journals P1522 Long term follow-up after early mitral valve surgery. Role of 3D echocardiographic right chambers evaluation in predicting tricuspid regurgitation development

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Volpato ◽  
V Mantegazza ◽  
L Manfredonia ◽  
L Fusini ◽  
P Gripari ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Tricuspid Regurgitation ◽  
Major Axis ◽  
Right Atrial ◽  
3D Analysis ◽  
Long Term Follow Up ◽  
And Function

Abstract Background Combined mitral and tricuspid surgery is recommended in patients diagnosed with significant tricuspid regurgitation (TR) or dilatation of tricuspid annulus (TA) undergoing mitral valve (MV) surgery. Despite the prognostic value of significant TR is well known, the role of TA is still debated, due to inaccuracy of 2D measurements. Data about the role of 3D echocardiographic evaluation of TA and right chambers in predicting TR development after early MV surgery are lacking. Purpose To test whether a comprehensive 3D evaluation of right chambers and TA may predict TR development after early surgery in patients with MV prolapse, at a long term follow-up. Methods Between 2012 and 2015, 100 patients diagnosed with MV prolapse and severe mitral regurgitation, who underwent early MV repair were retrospectively studied. All patients underwent 3D transthoracic examination before surgery; for each patient right atrial (RA) volume and right ventricular (RV) volumes, function and strain were derived. 3D dimensions and function of TA were also measured using commercial software. The median follow-up was 48 months. Results 9 patients underwent TVR for moderate TR and were excluded. At baseline, our patients showed more than moderate TR, normal 3D RV volumes and function (EDV 67 ±16ml/m2, EF 56 ± 6%, GLS free wall 28 ± 5 %) and RA volume (54 ± 15 ml/m2). Pulmonary artery pressure was 36 ±9 mmHg. Based on 2D evaluation, dilatation of TA (more than 21 mm/m2) was measured in 21 patients over 91. 3D analysis of TA showed a function of 38 ± 12% and a major axis of 46 ± 6 mm no significant differences in 3D values were noted between patients with normal and dilated annuli. Based on 2D. Over the follow-up, none of our patients developed clinically significant TR (more than moderate) Conclusion Patients who underwent early MV repair with normal 3D values of right chambers have a low risk of developing TR, regardless of 2D dimensions of TA.

Abstract 15424: Tricuspid Valve Geometry and Right Heart Remodeling: Insights Into the Mechanism of Atrial Functional Tricuspid Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hiroto Utsunomiya ◽  
Yu Harada ◽  
hitoshi susawa ◽  
Yusuke Ueda ◽  
Kanako Izumi ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Right Atrium ◽  
Right Atrial ◽  
Right Heart ◽  
Systolic Volume ◽  
Therapeutic Implications ◽  
Heart Remodeling ◽  
Functional Tricuspid Regurgitation ◽  
End Systolic Volume

Introduction: Functional tricuspid regurgitation (TR) caused by chronic atrial fibrillation with structurally normal tricuspid valve (TV) leaflets, normal right ventricular (RV) function, and dilated right atrium (RA), is considered as a new clinical entity, atrial functional TR (AF-TR). We sought to investigate TV geometry and right heart remodeling in AF-TR compared with ventricular functional TR with sinus rhythm (VF-TR). Methods: Transesophageal 3D echocardiography datasets of the TV and the RV were acquired in 51 symptomatic severe TR. 3D RV endocardial surfaces were reconstructed throughout the cardiac cycle and then postprocessed using semiautomated integration and segmentation software to calculate position of papillary muscle (PM) tips (Figure). Results: Compared with VF-TR, AF-TR had more dilated and posteriorly displaced annulus and less leaflet tethering angles with more prominent right atrium and smaller RV end-systolic volume. On the XY (annular) plane, the center of annulus was getting closer towards the anterior and posterior PM tips and was going away from the medial PM tip caused by prominent annular dilatation in AF-TR. On the Z axis, the position of each PM tip in AF-TR was not so much displaced apically as that in VF-TR. Multiple linear regression analyses revealed that right atrial volume and right atrial/RV end-systolic volume ratio were determinants of annular area and orientation in AF-TR, respectively (both P <0.001). Additionally, the posteromedial directed component of posterior PM tip position and the apically directed component of the position of all 3 PM tips were independently associated with TV tethering angles of each leaflet in AF-TR (all P <0.02). In subgroup analysis, massive to torrential AF-TR had a larger RV volume with more apically displaced PM tips than severe AF-TR. Conclusion: Right heart remodeling and its association with TV geometry differ between AF-TR and VF-TR, which offers distinctive therapeutic implications.

Abstract 17094: A New Grading of Tricuspid Regurgitation Beyond Severe and Its Clinical Importance

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Omori Taku ◽  
Goki Uno ◽  
Shunsuke Shimada ◽  
Florian Rader ◽  
Robert J Siegel ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Cardiac Death ◽  
Clinical Importance ◽  
Right Atrial ◽  
Grading System ◽  
Cardiac Events ◽  
Vena Contracta ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Dimensional Echocardiography

Introduction: Recently a new grading system for tricuspid regurgitation (TR) beyond severe has been proposed. However, few studies assessing the validity of the new grade of TR has been conducted. We evaluated the new grading system of TR by comparing it with patient hemodynamics and outcome. Methods: We retrospectively reviewed patients who underwent 2 dimensional echocardiography and had severe TR in 2014. According to the vena contracta width (VC) of TR jet, the patients were classified into 3 groups: VC&lt;11mm, 11&lt;=VC&lt;14 and VC &gt;=14mm (160,113 and 86 patients respectively). Stroke volume (SV), cardiac index (CI) and right atrial pressure (RAP) were estimated by echocardiography. Cardiac events were defined as cardiac death or admission for heart failure (HF). Results: 376 patients were diagnosed as severe TR. We excluded 15 patients on mechanical respiratory support and 2 with missing clinical data. Remaining 359 severe TR patients (75 ± 16 years, 204 (57%) female) were investigated. TR patients with VC &gt;=14mm had significantly lower SV and CI compared to the other groups, though there was no difference in SV and CI between those with VC&lt;11 and those with 11&lt;=VC&lt;14 (Figure). Compared to TR patients with VC&lt;11, those with VC &gt;=14 had a significantly higher frequency of RAP &gt;=15mmHg (Odds ratio (OR) 1.30; 95% Confidence Interval (CI), 1.01 to 3.08; p=0.047 ), though those with 11&lt;=VC&lt;14 had no significant difference (OR 1.30; 95% CI 0.79 to 1.37; p=0.31 ) (Figure). During a follow-up period (median, 205 days; range, 36 to 1032 days), 124 (35%) patients experienced cardiac events (30 cardiac death and 94 HF admission). The Kaplan-Meier curves showed that TR patients with VC&gt;=14 was at higher risk for cardiac events (Figure). Conclusion: TR patients with VC &gt;=14mm showed significantly worse hemodynamics and outcome than those with VC&lt;14mm. TR with VC &gt;=14mm should be considered to clinical grade of TR that is beyond severe.

scholarly journals Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Nishiwaki ◽  
S Watanabe ◽  
F Yoneda ◽  
M Tanaka ◽  
A Komasa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Tricuspid Regurgitation ◽  
Right Atrial ◽  
Main Role ◽  
Funding Sources ◽  
Functional Tricuspid Regurgitation ◽  
Significant Difference ◽  
One Year ◽  
The Impact

Abstract Background Since atrial functional tricuspid regurgitation (AF-TR) is associated with increased heart failure and mortality, the management of AF-TR is clinically important. Atrial fibrillation (AF) plays the main role in AF-TR. However, the effectiveness of catheter ablation (CA) and mechanism of improvement of AF-TR haven't been fully evaluated. Purpose We sought to investigate the impact of CA for AF on AF-TR in patients with moderate or more TR. Methods We retrospectively investigated consecutive 2685 patients with AF who received CA from February 2004 to December 2019 in Japan. The current study population consisted of 102 patients with moderate or greater TR who underwent CA for AF. The echocardiographic parameters were compared between pre-ablation and post-ablation transthoracic echocardiography (TTE), and the recurrence rate of AF/ atrial tachycardia (AT) was measured. Results The mean age was 73.2 years, 53% were women. TR severity and TR jet area significantly improved after CA for AF (TR jet area: 5.8 [3.9–7.6] cm2 to 2.0 [1.1–3.0] cm2, p&lt;0.001). In addition, mitral regurgitation (MR) jet area, left atrial (LA) area, mitral valve diameter, right ventricular (RV) end-diastolic area, right atrial (RA) area, tricuspid valve (TV) diameter decreased after CA (p&lt;0.001, &lt;0.001, &lt;0.001, = 0.02, &lt;0.001, and &lt;0.001, respectively). There was no significant difference between one-year recurrence of AF/AT and TR severity at pre-ablation TTE (moderate 28.6%, moderate to severe 37.2%, and severe 31.6%, p=0.72). Conclusions TR severity and jet area improved after CA in patients with AF and moderate or more TR. RV size, RA size, TV diameter also decreased after CA, which may be associated with TR improvement. There was no significant difference between one-year recurrence of AF/AT and TR severity at pre-ablation TTE. FUNDunding Acknowledgement Type of funding sources: None.

Changes of tricuspid valve geometry after interventional implantation of an anuloplasty band

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Landendinger ◽  
S Smolka ◽  
J Haug ◽  
M Troebs ◽  
F Ammon ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Clinical Results ◽  
Vena Contracta ◽  
Functional Tricuspid Regurgitation ◽  
Area Reduction ◽  
Before And After ◽  
Grade Scale ◽  
New Treatment ◽  
Lateral Diameter

Abstract Background Implantation of an anuloplasty band (Cardioband, Edwards Lifesciences) is a new treatment option for patients with functional tricuspid regurgitation (TR). The initial clinical results are promising. Nevertheless very few details about the mechanism of reducing TR beyond the basic principle of reducing the annular perimeter are known. Therefore we sought to study the changes of the tricuspid valve geometry after Cardioband implantation. Methods In all patients, that were treated by Cardioband implantation for tricuspid valve implantation at our institution, fluoroscopic images of the implant were optained at an angle, which would correspond to an echocardiographic “enface” view of the tricuspid valve. In these images the area enclosed by the implant, the perimeter of this area, the septal to lateral diameter, the anterior to posterior diameter and the length of the implant before and after contracting the band was measured. In all patients an echocardiographic evaluation of the tricuspid regurgitation before and after cardioband implantation was performed. These clinical finding were correlated to changes of the above mentioned dimension in the fluoroscopic images. Results Between October 2018 und January 2019 17 patients with severe tricuspid regurgitation were treated by Cardioband implantation. In one patient the procedure had to be aborted due to extensive movement of the tricuspid annulus. In the remaining 16 patients (mean age 78±8 years, 7 males) the procedure could be completed successfully and the required measurements were done. The mean severity grade (5 grade scale) of the TR was 3.5±0.6 before and 2±0.7 (p&lt;0.0001) after the implantation, the corresponding mean vena contracta changed from 12±4 mm to 6±3 mm (p&lt;0.000, 51% reduction). The area decreased after band contraction from 10.6±1.4 cm2 to 4.7±1.4 cm2 (p&lt;0.0001; 56% reduction), the perimeter from 13.4±1.8 cm to 9.6±1.6 cm (p&lt;0.0001; 28% reduction) the septal to lateral diameter from 2.8±0.5 cm to 1.6±0.2 cm (p&lt;0.0001; 40% reduction), the anterior to posterior diameter from 4.8±0.9 cm to 3.8±1.0 cm (p&lt;0.005; 19% reduction) and the measured device length from 8.6 cm±1.0 to 5.8±0.8 cm (p&lt;0.0001; 32% reduction). The strongest correlation was seen between area reduction and reduction of the vena contracta (r=0.5), reduction of the septal to lateral dimension as well as the reduction of the device length had a weaker correlation (r=0.3 and r=0.2). The reduction of the anterior posterior diameter and perimeter reduction showed no relevant correlation with regard to TR reduction. Conclusion In our patient population Cardioband implantation lead to effective TR reduction. Area reduction and reduction of the septal to lateral diameter of the tricuspid valve seem to have the strongest impact. These findings may be considered when implantations techniques are being optimized or when new devices for TR treatment are developed. Funding Acknowledgement Type of funding source: None

Tricuspid Valve Anterior Leaflet Strains in Ovine Functional Tricuspid Regurgitation

2020 ◽  
Author(s):  
Tomasz Jazwiec ◽  
Marcin J. Malinowski ◽  
Haley Ferguson ◽  
Jessica Parker ◽  
Mrudang Mathur ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Anterior Leaflet ◽  
Functional Tricuspid Regurgitation
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