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.

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

scholarly journals Research on The Frame of Reference with The Downward Displacement of The Posterior Leaflet and Anterior Leaflet of Tricuspid Valve in Children by Ultrasound

2021 ◽  
Author(s):  
Jun-jian Yu ◽  
Kang Liu ◽  
Rong-cheng Tian ◽  
Xuehong Zhong ◽  
Bei Li
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Color Doppler ◽  
Frame Of Reference ◽  
Posterior Leaflet ◽  
Anterior Leaflet ◽  
Tricuspid Annulus ◽  
Color Doppler Flow Imaging ◽  
Chamber View ◽  
Downward Displacement

To investigate the frame of reference with the downward displacement of the posterior leaflet and anterior leaflet of tricuspid valve in children by ultrasound.The downward degree of anterior and posterior tricuspid valve was evaluated with tricuspid annulus and coronary sinus as reference structures under ultrasound, and the position of tricuspid regurgitation orifice was shown by color ultrasound. Color Doppler flow imaging showed that the position of tricuspid regurgitation orifice moved down obviously in all 42 children. One case showed 2.2cm from the root of the anterior valve to the tricuspid annulus in the two-chamber and four-chamber view of the apical right heart. Color Doppler can show that the position and direction of tricuspid regurgitation orifice are obviously deviated to the anterolateral side. The obvious deviation of the tricuspid regurgitation orifice to the anterolateral direction may be an ultrasonic sign for diagnosing the downward displacement of the anterior tricuspid valve in children.

Abstract 3183: Clinical Utility of 3-Dimensional Echocardiography in Evaluation of Severe Tricuspid Regurgitation Caused by Pacemaker or Implantable Cardioverter-Defibrillator Leads

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Yoshihiro Seo ◽  
Tomoko Ishizu ◽  
Hideki Nakajima ◽  
Kiyoko Uno ◽  
Ryou Kawamura ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Right Atrium ◽  
Clinical Utility ◽  
Posterior Leaflet ◽  
Anterior Leaflet ◽  
Severe Tricuspid Regurgitation ◽  
3 Dimensional ◽  
Icd Leads ◽  
Dimensional Echocardiography

Background. Pacemaker or implantable cardiovascular-defibrillator (ICD) leads may be a primary cause of symptomatic tricuspid regurgitation (TR). The aim of this study was to evaluate the utility of 3-dimensional echocardiography (3-DE) in identifying intracardiac routes of pacemaker or ICD leads in relation to TR. Methods. 3-DE examinations were performed to evaluate intracardiac lead routes from right atrium to ventricle and positions at the tricuspid valve in 73 patients: 53 patients with pacemaker and 20 patients with ICD. TR severity was assessed by 2-dimensional echocardiography and classified as mild, moderate, or severe based on the ratio of TR area to right atrium area. Results 3-DE identified the lead route and position at the tricuspid valve in 68 patients (93.1%). In the remaining 5 patients, an appropriate image could not be obtained due to artifacts caused by the lead. TR severity was classified as mild in 47 patients, moderate in 18 patients, and severe in 8 patients. In 7 of the 8 patients with severe TR, obstruction to tricuspid valve closing caused by the lead was identified (Figure ): obstruction of septal leaflet in 3 patients, posterior leaflet in 3 patients, and anterior leaflet in 1 patient. However, in all patients with mild to moderate TR, the lead was positioned at the annulus side between leaflets, and no closing obstruction was identified. Conclusion. 3DE can identify pacemaker or ICD lead route and position at the tricuspid valve and the obstruction to closing caused by the lead in patients with severe TR. Therefore, 3DE may be useful to evaluate the cause of severe TR in patients receiving a pacemaker or ICD.

Perimeter of The Tricuspid Valve: A Cadaveric Human Heart Study

2020 ◽  
Vol 11 (3) ◽  
pp. 3424-3428
Author(s):  
Kirti Chaudhary ◽  
Amey Dhatrak ◽  
Brij Raj Singh ◽  
Ujwal Gajbe
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Right Ventricular Dysfunction ◽  
Mean Value ◽  
Female Population ◽  
Functional Tricuspid Regurgitation ◽  
Lv Dysfunction ◽  
Heart Study ◽  
Males And Females ◽  
The Right

Historically, the research on the right ventricle (RV) has been neglected by his left equivalent because of the complexity of left ventricle (LV) dysfunction. Tricuspid regurgitation (TR) can be classified as linked to primary valve disease or functional in nature, but most are functional. Although it was historically assumed that such functional Tricuspid regurgitation, i.e. arising from leftsided disease, and it can be resolved after corrective surgery, but after successful surgery, on the aortic or mitral valve annular dilatation, the Tricuspid regurgitation and right ventricular dysfunction may persist.To study the circumference of tricuspid orifice and it’s the diameter in two perpendicular planes and its comparison among the male and female population. The material for the present study comprised of 50 formalin fixed human hearts (35 males and 15 females) which were obtained from the department of anatomy. In this study, it is observed that: The mean value of circumference of a tricuspid orifice is 11.01+/-0.63 cm. The diameter of tricuspid orifice along the frontal dimension is 3.06+/-0.38 cm, and the diameter along the sagittal dimension is 2.26+/-0.23 cm. The measurements of the circumference of tricuspid orifice reported for males and females in western countries were higher than the present study and the diameter along the frontal dimension is greater than the diameter along the sagittal dimension. The tricuspid valve diameter along the frontal dimension was more than the diameter along the sagittal dimension in both males and females.

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

2019 ◽  
Vol 1 (4) ◽  
pp. 133-139
Author(s):  
Yasser Hamdy ◽  
Mohammed Mahmoud Mostafa ◽  
Ahmed Elminshawy
Keyword(s):  
Right Ventricular ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Early Postoperative Period ◽  
Tricuspid Valve Repair ◽  
Ring Annuloplasty ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Right

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

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.

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