Abstract
ObjectivesUnderstanding of changes in tricuspid annulus (TA) during secondary or functional tricuspid regurgitation (TR) is currently limited and its surgical management relies on limited 2-dimensional (2D) imaging. The aims of the study were to: 1) track and measure changes in TA using 3-dimensional (3D) echocardiography during complete cardiac cycle in patients with functional TR when compared to no TR, and 2) compare TAPSE derived from 2D and 3D coordinates as a measure of RV function when compared to standard method of fractional area change (FAC). DesignIntraoperative 3D echocardiography data was collected prospectively followed by post processing software analysis to track and reconstruct changes throughout the cardiac cycle. SettingData was collected from 108 patients undergoing left sided heart surgery at two large academic centers – Beth Israel Deaconess Medical Center in Boston, MA and Rhode Island Hospital, Providence, RI between from November 2018 to April 2020. ParticipantsFinal dataset (n=92) included two groups: no significant functional tricuspid regurgitation (NTR) group (n=74), defined as ≤ mild tricuspid regurgitation (TR) and TA < 35 mm, and a significant functional TR (FTR) group (n=18), defined as ≥ moderate TR. Interventions3D TEE datasets were analyzed, and the motion of TA coordinates was tracked during complete cardiac cycle in 2D and 3D planes using post-processing and software analysis. Computational modeling of TA motion was performed using computer-aided design. In further analysis, reconstructed and 3D printed models of TV were developed for the two groups. Measurements and Main ResultsPatients in FTR group had larger TA size during the cardiac cycle with less overall excursion and reduced annular dynamism. 3D motion of TA for lateral (L), anterolateral (AL) and posterolateral (PL) coordinates was lower in FTR group compared to NTR group [(18±6.8 vs 13.6±8.5, p=0.02), (15.2±5.5 vs 11.3±6.0, p=0.009) and (17.6±6.6 vs 12.3±5.2, p=0.002) respectively]. TAPSE derived from 3D planes was more accurate for RV function assessment (AUC 0.704, p = 0.011) than 2D TAPSE (AUC 0.625, p = 0.129). Finally, in the FTR group, the anteroseptal-posterolateral (AS-PL) diameter was consistently larger during all phases of cardiac cycle, in comparison with septo-lateral (S-L) diameter. Conclusion3D echocardiographic assessment of TA helps better understand its geometry and dynamism in functional TR, and is more accurate than 2D measurements for RV function assessment.
Published Version
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