Abstract
BackgroundTo investigate changes in tricuspid annulus (TA) and tricuspid valve (TV) morphology among chronic thromboembolic pulmonary hypertension (CTEPH) patients before and 12 months after pulmonary thromboendarterectomy (PEA) and compare these findings to normal control subjects.Methods20 CTEPH patients and 20 controls were enrolled in the study. The patients were examined with echocardiography, right heart catherization and cardiac magnetic resonance imaging prior to PEA and 12 months after.ResultsRight atrium (RA) volume was significantly reduced from baseline to 12 months after PEA (30 ± 9 vs 23 ± 5 ml/m2, p < 0.005). TA annular area in systole remained unchanged (p = 0.11) and was comparable to controls. The leaflet area, tenting volume and tenting height in systole were significantly increased at baseline but decreased significantly with comparable values to controls after 12 months (p < 0.005). There was correlation between the changes of right ventricular-pulmonary artery coupling and changes of TV tenting height (r = − 0.54, p = 0.02), TV tenting volume (r = − 0.73, p < 0.001) and TV leaflet area (− 0.57, p = 0.01) from baseline to 12 months after PEA. Tricuspid regurgitation jet area/RA area was significantly (p < 0.01) reduced from baseline (30 ± 13%) to 12 months after PEA (9 ± 10%).ConclusionIn CTEPH patients selected for PEA, TV tenting height, volume and valve area are significantly increased whereas annulus size and shape are less affected. The alterations in TV morphology are fully reversed after PEA and correlates to improvements of right ventricular-pulmonary arterial coupling.
Highlights
To investigate changes in tricuspid annulus (TA) and tricuspid valve (TV) morphology among chronic thromboembolic pulmonary hypertension (CTEPH) patients before and 12 months after pulmonary thromboendarterectomy (PEA) and compare these findings to normal control subjects
We aimed to investigate the changes of TA and TV morphology assessed by Cardiac Magnetic Resonance Imaging (CMR) with relation to changes in pulmonary arterial pressures by right heart catherization (RHC) in CTEPH patients before and 12 months after PEA and compare these findings to normal control subjects
Mild tricuspid regurgitation (TR) was noted in 60% and moderate-severe TR was noted in 40% of the patients at baseline with an average effective regurgitant orifice (ERO) of 0.30 ± 0.30 cm2 and a TR jet area/ Right atrium (RA) area of 30 ± 13% for all patients
Summary
To investigate changes in tricuspid annulus (TA) and tricuspid valve (TV) morphology among chronic thromboembolic pulmonary hypertension (CTEPH) patients before and 12 months after pulmonary thromboendarterectomy (PEA) and compare these findings to normal control subjects. The subsequent annular and atrial dilatation with development of right sided heart failure carries a poor prognosis [4, 5]. Patients with chronic thromboembolic pulmonary hypertension (CTEPH) suffer from varying degrees of functional TR in combination with right sided heart failure. Post-operative examination by twodimensional (2D) echocardiography and right heart catherization have demonstrated that reduction in PA systolic pressures after PEA is associated with a significant 70% reduction in the number of patients with severe TR. This reduction occurs despite of persistent tricuspid annular dilation [8]. Cardiac Magnetic Resonance Imaging (CMR) is considered as the gold standard for accurate assessment of RV and RA dimension, volumes and function
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