Abstract 12037: Tricuspid Annular Area and Leaflets Stretch Are Associated With Functional Tricuspid Regurgitation - Insights From Three-Dimensional Transesophageal Echocardiography

Abstract

Background: The presence of functional tricuspid regurgitation (TR) is associated with mortality and morbidity. Although uniform management with a tricuspid annuloplasty ring is currently considered as a standard surgical procedure, high rates of residual TR despite annuloplasty are reported. Therefore, the identification of the TR mechanisms would be necessary to provide personalized treatment for each TR patient. Methods: This study population consisted of 106 patients with mitral regurgitation (MR) who were scheduled for procedure. Transthoracic and transesophageal echocardiography were performed prior to mitral valve intervention. We performed three-dimensional quantitative assessment including tricuspid annular (TA) area and the distance between the three commissures of tricuspid valve. Results: Moderate or greater TR was detected in 23 (22%). TA area (P < 0.01) and the distance between septum length (SL) (P = 0.02) and posterior length (PL) (p = 0.02) were significantly associated with moderate or greater TR, while TA diameter assessed using trans thoracic echocardiography was not. When patients were divided into four groups according to SL and PL, the group with longer SL and PL had greater risk of moderate or greater TR (P <0.01). Conclusions: Larger TA area and longer SL and PL, which represents limiting the amount of leaflet coaptation resulting from greater stretch of leaflets, are associated with functional TR in in patients with severe MR. The restoration of leaflet coaptation with autologous pericardial patch in addition to tricuspid annuloplasty ring may avoid or delay progression of residual TR and improve prognosis in patients with severe MR.