Abstract 16289: Deformation of Tricuspid Annulus After Tricuspid Ring Annuloplasty: A Three-dimensional Transesophageal Echocardiography Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Atsushi Hayashi ◽  
Jun Akashi ◽  
Yosuke Nabeshima ◽  
Mai Iwataki ◽  
Yutaka Otsuji
Keyword(s):  
Transesophageal Echocardiography ◽  
Tricuspid Valve ◽  
Heart Surgery ◽  
Three Dimensional ◽  
Tricuspid Annulus ◽  
Annuloplasty Ring ◽  
Functional Tricuspid Regurgitation ◽  
Ring Annuloplasty ◽  
Percent Area ◽  
The Impact

Background: Tricuspid ring annuloplasty (TAP) is usually performed for patients with mild or greater functional tricuspid regurgitation (TR) at the time of left-sided valve surgery. However, there were limited data regarding the shape of tricuspid annulus after TAP. The aim of this study was using three-dimensional (3D) transesophageal echocardiography to investigate the impact of the ring annuloplasty on the tricuspid annulus after TAP. Methods: 3D tricuspid valve was retrospectively analyzed in 20 patients who underwent concomitant left-sided heart surgery and TAP for functional TR. 3D data of tricuspid valve were acquired before TAP, immediate after surgery (intraoperative), and before discharge (15±5 days after TAP). TAP was performed by one surgeon using a Carpentier-Edwards Physio Tricuspid annuloplasty ring. The ring size was determined by measuring the distance from anteroseptal to posteroseptal commissures. 3D tricuspid annular area was measured. The area protruded outside the annuloplasty ring was obtained by subtracting the ring area from the annular area (Figure). Results: All 20 patients underwent successfully TAP with less than mild residual TR. Annuloplasty rings size 28mm, 30mm, 32mm, and 34mm were used in 6 (30%), 4 (20%), 5 (25%), and 5 (25%) patients, respectively. Median annular area decreased from 1074 (interquartile rage 893-1276) mm 2 before TAP to 591 (519-706) mm 2 immediate after TAP, but showed significant increase to 645 (501-766) mm 2 at the time of discharge (P<0.001). Percent area protruded outside the annuloplasty ring was 14% immediate after TAP and increased to 24% before discharge (P<0.001). Before discharge, there were 9 patients with more than mild residual TR (2 had moderate TR). Percent area protruded outside the annuloplasty ring was associated with mild or more residual TR at the discharge. Conclusion: Tricuspid annular shape after TAP was not always round. Deformation of tricuspid annulus may be associated with residual TR.

Abstract 15817: Tricuspid Valve Imaging by 3D Transesophageal Echocardiography: Feasibility of Coaptation Length Measurement and Its Relationship With Severity of Regurgitation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kikuko Obase ◽  
Lynn Weinert ◽  
Victor Mor-Avi ◽  
Roberto M Lang
Keyword(s):  
Transesophageal Echocardiography ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
The Other ◽  
Tricuspid Valve Repair ◽  
Mitral Valve Leaflet ◽  
2D Echocardiography ◽  
3D Transesophageal Echocardiography ◽  
Leaflet Coaptation

Background: The coaptation length (CL) of the mitral valve leaflet decreases with increasing mitral regurgitation. Visualization of the CL of the tricuspid valve (TV) is challenging using conventional 2D echocardiography. The aims of this study were: (1) to test the feasibility of visualizing and quantifying the CL of the TV using three-dimensional (3D) transesophageal echocardiography (TEE), and (2) to study it relationship with the severity of tricuspid regurgitation (TR). Methods: Full-volume 3D TEE datasets of the TV were obtained in 24 patients from the transgastric approach. Using multiplanar reconstruction, short-axis plane depicting an en-face view of the TV was used to mark the central coaptation point (Fig. A). Three planes cutting through this point were then selected to view the 3 coaptation lines between: (1) anterior and posterior, (2) septal and anterior, and (3) septal and posterior TV leaflets (Figs. B-D). The CL was measured in each of these planes to obtain mean CL. The severity of tricuspid regurgitation was graded qualitatively as “none”, “trace”, “mild” and “moderate”. Results: Visualization of leaflet coaptation was feasible in 17/24 patients (71%). The mean CL was 0.89±0.03 cm in patients with no TR (N=4), 0.64±0.13 with trace TR (N=6), 0.50±0.07 with mild TR (N=3) and 0.13±0.11 with moderate TR (N=4). Since there was no overlap between the “moderate” group and the other 3 groups, the threshold of average CL for moderate TR was estimated to be between 0.25 (highest value in the “moderate” group) and 0.39 cm (lowest value in the other groups) (Fig. E). Conclusion: Visualization of the TV leaflet coaptation length from transgastric 3D TEE images is feasible in the majority of patients. TV coaptation length is inversely related to the severity of TR. The ability to visualize and quantify the CL of the TV may be useful when planning tricuspid valve repair surgery. Our findings suggest that CL below the threshold may indicate clinically significant TR.

scholarly journals Results after Repair of Functional Tricuspid Regurgitation with a Three-Dimensional Annuloplasty Ring

2021 ◽  
Vol 10 (21) ◽  
pp. 5080
Author(s):  
Elda Dzilic ◽  
Thomas Guenther ◽  
Amel Bouziani ◽  
Bernhard Voss ◽  
Stephanie Voss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
Annuloplasty Ring ◽  
Recommended Treatment ◽  
Functional Tricuspid Regurgitation ◽  
Cardiac Procedure ◽  
Wide Range ◽  
Reoperation Rates

Background: Tricuspid valve (TV) repair is the recommended treatment for severe functional tricuspid regurgitation (fTR) in patients undergoing left-sided surgery. For this purpose, a wide range of annuloplasty devices differing in form and flexibility are available. This study reports the results using a three-dimensional annuloplasty ring (Medtronic, Contour 3D Ring) for TV repair and analysis of risk factors. Methods: A cohort of 468 patients who underwent TV repair (TVr) with a concomitant cardiac procedure from December 2010 to January 2017 was retrospectively analyzed. Results: At follow-up, 96.1% of patients had no/trivial or mild TR. The 30-day mortality was 4.7%; it significantly differed between electively performed operations (2.7%) and urgent/emergent operations (11.7%). Risk factors for recurrent moderate and severe TR were LVEF < 50%, TAPSE < 16 mm, and moderate mitral valve (MV) regurgitation at follow-up. Preoperatively reduced renal function lead to a higher 30-day and overall mortality. Reoperation of the TV was required in six patients (1.6%). Risk factors for TV related reoperations were preoperative TV annulus over 50 mm and an implanted permanent pacemaker. Conclusions: TVr with the Contour 3D annuloplasty ring shows low TR recurrence and reoperation rates. Risk-factor analysis for the recurrence of TR revealed the importance of left- and right-ventricular function.

Abstract 16979: Hemodynamic Comparison of Tricuspid Ring Annuloplasty vs. Hetzer Annuloplasty Technique to Repair Functional Tricuspid Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alan Amedi ◽  
Daisuke Onohara ◽  
Muralidhar Padala
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Ex Vivo ◽  
Working Fluid ◽  
Posterior Leaflet ◽  
Anterior Leaflet ◽  
Ex Vivo Model ◽  
Functional Tricuspid Regurgitation ◽  
Ring Annuloplasty ◽  
Valve Function

Introduction: Surgical repair of functional tricuspid regurgitation (FTR) is increasingly performed, and the techniques are evolving. Annuloplasty is currently the technique of choice, with different techniques yielding varied results, and thus require optimization. Objective: In this study, we sought to compare tricuspid valve function and kinematics after ring annuloplasty and Hetzer’s double orifice repair in an ex vivo model of FTR. Methods: Ten pig hearts were mounted into a right heart simulator, and studied at 70 bpm while maintaining the total volume of working fluid. FTR was created by increasing afterload, which caused acute right ventricular dilation and TV tethering. Tricuspid valve annuloplasty (TVA) was performed with a 26mm MC 3 ring. Hetzer procedure was performed with pledgeted sutures that approximated the anteroposterior and septal annular segments. Flow probes were used to measure FTR, and leaflet kinematics with echocardiography. Results: FTR of 17.7±9.2mL(p<0.0001) after RV dilation. Repair with TVA and Hetzer reduced FTR to 8.8±6.8ml(p=0.7142) and 7.8±6.9ml(p=0.0919), respectively, but did not eliminate it. Septal leaflet excursion angle decreased by 48.1% with FTR (p=0.04 vs. baseline ) . Repair with TVA and Hetzer increased the angle to 17.3±6.7°(p=0.0312) and 21.5±8.3°(vs FTR, p=0.0034), respectively. The Hetzer improved septal leaflet mobility better than TVA (p=0.0145). The posterior leaflet excursion angle decreased by 49.2% compared to baseline to 18.4±10.5° (p=0.0060) and both TVA and Hetzer significantly improved mobility to 33.6±8.4° (p=0.0081) and 31.6±15.6° (p=0.0256), respectively. Anterior leaflet mobility decreased after FTR by 60.7% to 18.1±8.2°. The effect of these repairs on the sub-valvular apparatus was negligible. Conclusion: TVA and Hetzer both reduced regurgitation but did not eliminate it. Septal and posterior leaflet mobility was improved, while the anterior leaflet remained tethered.

Early Experiences With a New Three-Dimensional Annuloplasty Ring for the Treatment of Functional Tricuspid Regurgitation

2014 ◽  
Vol 98 (6) ◽  
pp. 2039-2044 ◽  
Author(s):  
Thomas Ratschiller ◽  
Thomas Guenther ◽  
Ralf Guenzinger ◽  
Christian Noebauer ◽  
Victoria Kehl ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Three Dimensional ◽  
Annuloplasty Ring ◽  
Functional Tricuspid Regurgitation ◽  
Early Experiences

Morphometric Characterization and Finite Element Modeling of the Physiological Tricuspid Valve

2009 ◽  
Author(s):  
Marco Stevanella ◽  
Emiliano Votta ◽  
Massimo Lemma ◽  
Carlo Antona ◽  
Alberto Redaelli
Keyword(s):  
Finite Element ◽  
Tricuspid Valve ◽  
Heart Valves ◽  
Heart Surgery ◽  
Biomechanical Analysis ◽  
Left Heart ◽  
Mortality And Morbidity ◽  
Functional Tricuspid Regurgitation ◽  
Underlying Mechanisms ◽  
The Right

The tricuspid valve (TV) is the right atrio-ventricular valve. The most common TV disease is secondary or functional tricuspid regurgitation (FTR), an important complication of left-sided valvular heart lesions, which frequently persists after mitral and aortic valve operations. FTR is associated with high mortality and morbidity and requires surgical intervention, the preferential solution being TV repair through techniques such as annuloplasty performed during left heart surgery. However, significant residual regurgitation persists or recurs in 10% to 20% after annuloplasty, thus highlighting the incomplete understanding of the underlying mechanisms and the need for deeper insight into TV pathophysiology. At this purpose finite element models (FEMs) could be adopted, as suggested by their effective application to the biomechanical analysis of left heart valves. However, while for those several data are available regarding morphology and tissue mechanical properties, such information is missing for the TV, making it difficult to implement a FEM of the TV.

Heart valve disease: tricuspid valve disease

2016 ◽  
Author(s):  
Denisa Muraru ◽  
Ashraf M. Anwar ◽  
Jae-Kwan Song
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Imaging Modality ◽  
Three Dimensional ◽  
Valve Disease ◽  
Heart Valve Disease ◽  
Functional Tricuspid Regurgitation ◽  
Valve Pathology ◽  
Three Dimensional Echocardiography ◽  
The Right

The tricuspid valve is currently the subject of much interest from echocardiographers and surgeons. Functional tricuspid regurgitation is the most frequent aetiology of tricuspid valve pathology, is characterized by structurally normal leaflets, and is due to annular dilation and/or leaflet tethering. A primary cause of tricuspid regurgitation with/without stenosis can be identified only in a minority of cases. Echocardiography is the imaging modality of choice for assessing tricuspid valve diseases. It enables the cause to be identified, assesses the severity of valve dysfunction, monitors the right heart remodelling and haemodynamics, and helps decide the timing for surgery. The severity assessment requires the integration of multiple qualitative and quantitative parameters. The recent insights from three-dimensional echocardiography have greatly increased our understanding about the tricuspid valve and its peculiarities with respect to the mitral valve, showing promise to solve many of the current problems of conventional two-dimensional imaging. This chapter provides an overview of the current state-of-the-art assessment of tricuspid valve pathology by echocardiography, including the specific indications, strengths, and limitations of each method for diagnosis and therapeutic planning.

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