Tricuspid Annular Diameter Research Articles

Preoperative Predictors of Recurrent Tricuspid Regurgitation After Annuloplasty: Insights into the Role of 3D Echocardiography

Background: While tricuspid annuloplasty (TAP) is an effective treatment option for tricuspid regurgitation (TR), understanding the echocardiographic factors contributing to recurrent TR can help in developing more effective preventive measures to reduce the rate of recurrent TR after TAP. Methods: This study was designed as a prospective observational cohort study to investigate factors contributing to recurrent TR following surgical tricuspid valve (TV) repair in patients with moderate or severe functional TR caused by left heart valvular disease, with severe mitral regurgitation as the dominant pathology. The study included 66 patients who underwent preoperative two-dimensional (2D) and three-dimensional (3D) echocardiographic assessments. Patients were divided into two groups based on TAP outcomes: the effective TAP group and the recurrent TR group. Results: The analysis revealed that 3D-derived both septal–lateral diastolic and systolic tricuspid annulus (TA) diameter (odds ratio (OR) 1.77; 95% confidence interval (CI) 1.17–2.68 and OR 1.62; 95% CI 1.14–2.29, respectively), and major axis diastolic TA diameter (OR 1.59; 95% CI 1.15–2.2) had the highest OR among all echocardiographic parameters. The further univariate analysis of predefined echocardiographic values unveiled that the combined effect of heightened 3D-measured TA major axis diastolic diameter and increased right ventricle (RV) basal diameter exhibited the highest OR at 12.8 (95% CI 2.3–72.8) for a recurrent TR. Using ROC analysis, diastolic major axis (area under the curve (AUC) 0.848; cut-off 48.5 mm), septal-lateral systolic (AUC 0.840; cut-off 43.5 mm) and diastolic (AUC 0.840; cut-off 46.5 mm) TA diameter demonstrated the highest predictive value for recurrent TR from all TV parameters. Conclusions: Recurrent moderate or severe TR after TAP is associated with preoperative TA size, right atrium and RV geometry, but not with changes of RV function. The predictive capacity of 2D-assessed echocardiographic parameters was found to be lower when compared to their corresponding 3D parameters.

Incremental value of tricuspid annular enlargement to progressive tricuspid regurgitation in patients with longstanding persistent atrial fibrillation.

Tricuspid annular enlargement in patients with atrial fibrillation (AF) can induce tricuspid regurgitation (TR). However, risk factors associated with TR progression in patients with AF have not been defined. This study aimed to clarify an association between tricuspid annular diameter (TAD) and TR progression in patients with longstanding persistent AF. We retrospectively analyzed data from 228 patients who had longstanding persistent AF for > 1year and mild or less TR on baseline echocardiograms. We defined significant TR as moderate or greater TR, graded according to the jet area and vena contracta. The optimal cut-off value of the TAD index (TADI), based on body surface area for predicting progression to significant TR, was estimated using receiver operating characteristic (ROC) curves. The independence and incremental value of the TADI were evaluated using multivariate Cox proportional hazard regression analysis and likelihood ratio tests. Over a median follow-up of 3.7years, 55 (24.1%) patients developed significant TR. The optimal cut-off value of 21.1mm/m2 for the TADI at baseline and ROC curves predicted TR progression with 70.4% sensitivity and 86% specificity. Furthermore, TADI was an independent predictor of TR progression (hazard ratio, 1.32; 95% confidence interval, 1.17-1.49, P < 0.001) and had a significant incremental value that exceeded that of models constructed using clinical parameters. In conclusion, TADI was significantly associated with TR progression and was an independent predictor of TR progression in longstanding persistent AF.

The role of the right atrial appendage and right atrium in post-radiofrequency ablation recurrence in different types of atrial fibrillation

To quantitatively evaluate the relationship between the anatomical parameters of the right atrium and the recurrence of atrial fibrillation (AF) after radiofrequency ablation, considering different types of AF, utilizing 256-slice spiral computed tomography (CT). A total of 297 patients with AF who underwent initial radiofrequency ablation were enrolled, divided into the paroxysmal atrial fibrillation (PaAF) group (n=230) and the persistent atrial fibrillation (PeAF) group (n=67). Subsequently, patients in each group were further stratified into recurrent and non-recurrent subgroups. In addition, 100 healthy outpatients were selected as the normal group. All patients underwent preoperative cardiac CT (CCT) examination. The volumes of the right atrium (RA), right atrial appendage (RAA), and left atrial (LA), RAA height, the length, short diameter, perimeter, and area of the RAA base, anteroposterior diameter of the RA, tricuspid annulus diameter, crista terminalis, and inferior vena cavotricuspid isthmus (CTI) on CCT images were measured. In both the PaAF group and the PeAF group, except for the crista terminalis thickness, the other measured parameters were greater than those in the normal group, and recurrent patients exhibited larger RAA base, crista terminalis and LA volume. Recurrent patients with PeAF presented larger RAVI, while recurrent patients with PaAF did not. The short diameter of the RAA base was an independent predictor of recurrence in patients with PaAF (p=0.001), while the height of the RAA, thickness of the crista terminalis, and hypertension were independent predictors of recurrence in PeAF (p<0.05). The ROC curve was used to analysis the predictive model in PaAF and PeAF group, the corresponding sensitivity and specificity were 0.604 and 0.864 in PaAF group, respectively (AUC=0.840, P=0.001), in PeAF group, the corresponding sensitivity and specificity were 0.967 and 0.892, respectively (AUC=0.959, P=0.001). The short diameter of RAA base > 22.15 mm had the highest predictive value for recurrence in PaAF patients, with a sensitivity of 0.887, and a specificity of 0.520 (AUC: 0.743, p=0.001). The RAA height > 28.95 mm has the highest predictive value for recurrence in PeAF, with a sensitivity of 0.633, and a specificity of 0.865 (AUC: 0.816, p=0.001). Recurrent patients both in the PaAF and PeAF groups demonstrated larger RAA base and RA structural parameters. Compared to patients with PaAF, recurrent patients with PeAF presented larger RA volume.

Unenhanced computed tomography as a diagnostic tool in suspected pulmonary hypertension: a retrospective cross-sectional pilot study.

Computed tomography pulmonary angiography (CTPA) has been proposed to be diagnostic for pulmonary hypertension (PH) in multiple studies. However, the utility of the unenhanced CT measurements diagnosing PH has not been fully assessed. This study aimed to assess the diagnostic utility and reproducibility of cardiac and great vessel parameters on unenhanced computed tomography (CT) in suspected pulmonary hypertension (PH). In total, 42 patients with suspected PH who underwent unenhanced CT thorax and right heart catheterization (RHC) were included in the study. Three observers (a consultant radiologist, a specialist registrar in radiology, and a medical student) measured the parameters by using unenhanced CT. Diagnostic accuracy of the parameters was assessed by area under the receiver operating characteristic curve (AUC). Inter-observer variability between the consultant radiologist (primary observer) and the two secondary observers was determined by intra-class correlation analysis (ICC). Overall, 35 patients were diagnosed with PH by RHC while 7 patients were not. Main pulmonary arterial (MPA) diameter was the strongest (AUC 0.79 to 0.87) and the most reproducible great vessel parameter. ICC comparing the MPA diameter measurement of the consultant radiologist to the specialist registrar's and the medical student's were 0.96 and 0.92, respectively. Right atrial area was the cardiac measurement with highest accuracy and reproducibility (AUC 0.76 to 0.79; ICC 0.980, 0.950) followed by tricuspid annulus diameter (AUC 0.76 to 0.79; ICC 0.790, 0.800). MPA diameter and right atrial areas showed high reproducibility. Diagnostic accuracies of these were within the range of acceptable to excellent, and might have clinical value. Tricuspid annular diameter was less reliable and less diagnostic and was therefore not a recommended diagnostic measurement.

Mid-term outcomes of tricuspid annuloplasty using the Tri-Ad Adams tricuspid annuloplasty ring.

The Tri-Ad Adams tricuspid annuloplasty ring is a recent innovative prosthesis characterized by a semi-rigid central component and fully flexible extremities. The goal of this study was to assess the short-term and mid-term results following implantation of the Tri-Ad Adams ring. A retrospective analysis was conducted on patients who underwent tricuspid annuloplasty using the Tri-Ad Adams ring between August 2016 and October 2021. Our study enrolled a total of 248 participants. The median age was 64.0 (interquartile range: 56.0-71.5) years. The median EuroSCORE II was 4.3% (2.7-7.5%), with 37 patients (14.9%) having a history of cardiac operations. Tricuspid regurgitation of grade 2-3 was observed in 63.7% of cases, and the median tricuspid annular diameter was 3.3 (2.8-3.6) cm. Concurrent procedures included mitral valve replacement (n = 160, 64.5%), mitral valve repair (n = 75, 30.2%), aortic valve replacement (n = 72, 29.0%) and the maze procedure (n = 170, 68.5%). Immediate postoperative tricuspid regurgitation≥moderate was present in 1 patient (0.4%). Early death occurred in 14 patients (5.6%). Major complications included low cardiac output syndrome (n = 18, 0.3%), acute kidney injury (n = 14, 5.6%) and permanent pacemaker placement (n = 15, 6.0%). According to the Kaplan-Meier analysis, the 4-year rates of freedom from overall mortality and moderate-to-severe tricuspid regurgitation were 96.9% and 91.6%, respectively. There were no incidents of tricuspid valve reoperations, ring detachment or significant tricuspid stenosis (trans-tricuspid valve gradient ≥ 5 mmHg). Tricuspid annuloplasty utilizing the Tri-Ad Adams ring demonstrated favourable outcomes in both the early and midterm periods. Further studies are warranted to confirm the long-term results.

A Novel Swine Model for Inducing Functional Tricuspid Valve Regurgitation

Functional tricuspid regurgitation (FTR) is the most common TR, although experimental models to effectively study it are scarce; therefore, this study aimed to establish a robust experimental swine model. A swine FTR model was developed using radiofrequency ablation, atrial septostomy, and right atrial volume overload. The baseline and follow-up echocardiography was performed to evaluate the progression FTR and changes in the heart. Autopsy was employed to verify the anatomy of tricuspid valve. One-month post intervention, among the subjects, one (8.3%) exhibited severe FTR, eight (66.7%) exhibited moderate TR, and three (25%) exhibited mild FTR. Each pig developed an atrial septal defect (diameter, 1.5 ± 0.5 cm). The tricuspid annular diameter significantly increased with enlargement of right heart (P < 0.05). No significant difference was found on left heart size and mitral regurgitation. We successfully developed a novel swine FTR model, providing a reliable and effective platform for further research on FTR.Graphical The procedure to induce the FTR model on swines

Effects of tricuspid transcatheter edge-to-edge repair on tricuspid annulus diameter - Data from the TriValve registry

AimsT-TEER is an effective therapy for the treatment of tricuspid regurgitation (TR). However, the effects of leaflets clipping on tricuspid valve annulus (TA) have not been investigated in detail.The aim of this study is to investigate the effects of tricuspid transcatheter edge-to-edge repair (T-TEER) on TA diameter. Methods and resultsThe TriValve registry (Transcatheter Tricuspid Valve Therapies, NCT03416166) collected 556 patients from 22 European and North American centres undergoing transcatheter tricuspid valve interventions from 2016 to 2022. Patients undergoing T-TEER with available pre- and post-procedural data on TA diameter measured in the apical 4-chamber view on transthoracic echocardiography were selected for this study. Primary end-point was the reduction of TA diameter after T-TEER.A total of 186 patients were included in the study. In 115 patients (62%) TA diameter was reduced by at least 1 mm as compared to baseline. A significant reduction of TA dimension was observed following T-TEER (mean 2.3 mm [from pre-procedural diameter 46.7 mm to post-procedural diameter 44.4 mm], p < 0.001). In particular, the greatest reduction was observed in those with T-TEER in antero-septal commissure (mean 2.7 mm [from 47.1 mm to 44.4 mm], p < 0.001) as compared to those combining both antero-septal and postero-septal commissures (mean 1.4, from 46.0 mm to 44.6 mm, P = 0.06). A significant reduction of TA dimension was recorded in patients with 1 or 2 clips implanted but not in those patients with ≥3 clips implanted. ConclusionsIn almost two third of patients T-TEER reduces TA diameter in addition to leaflet approximation. Condensed abstractThe effects of tricuspid transcatheter edge-to-edge repair (T-TEER) on tricuspid valve annulus (TA) have not been studied in details. This study investigates TA diameter as measured in apical 4-chamber view on transthoracic echocardiography before and after T-TEER.A total of 186 patients from the TriValve registry were included in the study. The study results show that 62% of patients have a TA reduction after T-TEER, especially in those receiving 1 or 2 clips in the antero-septal commissure. These suggest that T-TEER reduces tricuspid regurgitation not only by approximation of leaflets, but also by TA diameter reduction.

Valve repair for tricuspid valve regurgitation in pediatric patients: Midterm outcomes

BackgroundTricuspid valve regurgitation in pediatric patients has heterogeneous lesions, and surgical intervention is sometimes necessary. Tricuspid valve repair is the preferred treatment for tricuspid valve regurgitation. ObjectivesThis study aimed to review the midterm outcomes of tricuspid valve repair for tricuspid valve regurgitation in pediatric patients. MethodsA total of 26 patients aged < 18 years who underwent tricuspid valve repair for tricuspid valve regurgitation at our institute between January 2005 and September 2022 were retrospectively reviewed. Their median age was 3.7 years (range, 1 month–16.2 years), and 15 were males. 23 had congenital heart diseases. Among them, 35 % of patients had tetralogy of Fallot or pulmonary atresia with ventricular septal defect (9/26), followed by ventricular septal defect (23 %, 6/26). ResultsSeveral reparative techniques were used according to valve lesions. Commissural edge-to-edge suture was the most frequently used technique. There were two cases of hospital death, and no late death occurred. During the median follow-up period of 7.8 years (range, 5 months–17.5 years), reoperation was performed in one patient with pulmonary atresia with intact ventricular septum. At the last follow-up, all survivors had mild or less tricuspid valve regurgitation. No patient had tricuspid valve stenosis. Postoperative tricuspid annular diameter increased within the normal range in all patients. Survival and reoperation-free rates at both 5 and 10 years were 92.3 % and 95.8 %, respectively. ConclusionTricuspid valve repair for tricuspid valve regurgitation in pediatric patients is safe and feasible with satisfactory midterm outcomes.

Initial experience of transcatheter edge-to-edge repair guided by only transesophageal echocardiography in the treatment of tricuspid insufficiency

Objective: To evaluate the feasibility and safety of transcatheter tricuspid valve edge-to-edge repair guided by only transesophageal echocardiography (TEE). Methods: Patients with severe tricuspid regurgitation in Fuwai Yunnan Cardiovascular Hospital who met the inclusion criteria based on clinical and echocardiographic evaluationand underwent transcatheter tricuspid valve edge-to-edge repair between January 2022 and May 2023 were prospectively enrolled. The procedure was performed under general anesthesia with endotracheal intubation and solely guided by TEE. The patients underwent clinical evaluation, electrocardiogram and transthoracic echocardiography one month after the procedure. Results: A total of 22 patients (12 males and 10 females) were included, with an average age of (71.3±6.7) years. All 22 patients successfully underwent the transcatheter tricuspid valve edge-to-edge repair under TEE guidance, with an average of (1.5±0.6) clips implanted. Immediately after procedure, six patients had no or trace regurgitation, 15 patients had mild regurgitation, and one patient had moderate regurgitation. All 22 patients completed 30-day follow-up, with four patients having trace regurgitation, 17 patients having mild regurgitation, and one patient having moderate regurgitation. Echocardiographic measurements revealed that effective regurgitant orifice area, regurgitant volume, vena contracta width, and proximal isovelocity surface area radius significantly decreased after the procedure (all P<0.05). In addition, inferior vena cava width, right atrial volume, tricuspid annular diameter, and right ventricular end-diastolic diameter significantly improved (all P<0.05), but tricuspid annular plane systolic excursion and right ventricular fractional area change did not show significant differences compared with those before the procedure (both P>0.05). Conclusion: It has been preliminarily confirmed that transcatheter tricuspid valve edge-to-edge repair solely guided by TEE is feasible and safe, but requires more large-scale studies for further validation.

Annular remodelling predicts outcome in isolated severe tricuspid regurgitation: a registry-based echocardiographic analysis.

Depending on volume status, secondary tricuspid regurgitation (sTR) has a strong dynamic component. In contrast, associated structural dilatation of the tricuspid annulus and the right heart chambers may be less volume dependent. This study aimed to assess the prognostic value of right heart remodelling in isolated severe sTR (isoTR). A total of 36 000 patients from the longitudinal echocardiographic database of our tertiary centre were screened for severe isoTR [vena contracta (VC) ≥ 7 mm] in the absence of atrial fibrillation (AF), other valve disease, and/or reduced systolic left ventricular function. Echocardiographic examinations were re-read, focusing on right ventricular (RV) parameters and on quantitative and qualitative parameters of isoTR. All-cause mortality was defined as the primary endpoint. Two hundred and sixteen patients fulfilled the inclusion criteria. Severe TR was predominant; only few were classified in the new grades massive [n = 23 (10%)] and torrential TR [n = 4 (2%)]. During a median follow-up of 35 months (20-53), all-cause mortality was 31% (n = 67). Multivariate Cox regression analysis revealed no association of VC, effective regurgitant orifice area, or regurgitant volume with all-cause mortality. However, indexed RV end-diastolic diameter (P < 0.001), indexed right atrial dimensions (P = 0.019), and particularly tricuspid valve (TV) annulus diameter diastole index (P = 0.002) and TV annulus diameter systole index (P = 0.001) were significantly associated with outcome. Severe isolated TR in the absence of AF is a rare finding with a grim prognosis. Tricuspid annular diameter dimensions rather than quantitative measures of TR proved to be of significant prognostic value indicating a continuous remodelling leading to a 'point of no return' with a dismal outcome.

Atrial functional tricuspid regurgitation in patients undergoing transcatheter aortic valve replacement

Abstract Introduction Recently, a novel entity of tricuspid regurgitation (TR) – atrial functional TR, which is caused by enlargement of the right atrium – has gained in awareness. In comparison, ventricular functional TR occurs in the setting of left heart disease with pulmonary hypertension and subsequent enlargement of the right ventricle. While it could be demonstrated that in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), an improvement of moderate or severe tricuspid regurgitation (TR) can be observed in many patients, knowledge about the association between entity and improvement of TR is scarce. Purpose The aim of this study was to analyse if atrial functional TR, defined by the enlargement of the right atrium is associated with the persistence of TR after TAVR in patients with severe AS and at least moderate concomitant TR at baseline. Moreover, 3-year all-cause mortality in patients with atrial and ventricular TR was assessed. Methods We retrospectively examined 363 patients with at least moderate tricuspid regurgitation undergoing TAVR from January 2013 to December 2020 due to severe AS. Patients with primary TR, a history of tricuspid valve surgery or with TAVR due to severe aortic regurgitation were excluded. Endsystolic area of the right atrium (RA) and enddiastolic area of the right ventricle (RV) were assessed in transthoracic echocardiography and atrial TR was defined as RA/RV area ratio above the median value of 1.125. Results TR improvement of at least one grade after transcatheter aortic valve replacement was significantly less frequent in patients with atrial compared to patients with ventricular TR (29.2% vs. 60.3%, p &amp;lt; 0.001, Figure 1). Multivariate logistic regression analysis with adjustment for left ventricular ejection fraction, Vena contracta and CT-determined tricuspid annulus diameter confirmed that atrial functional TR was an independent predictor for absence of TR improvement after TAVR (adjusted odds ratio: 3.03, 95% CI 1.65-5.64; p&amp;lt;0.001). Moreover, improvement of TR was associated with a significantly lower 3-year all-cause mortality compared to patients with persistence of TR (log rank test p&amp;lt;0.001, Figure 2A). However, no difference could be observed regarding 3-year all-cause mortality between patients with atrial and ventricular TR (log-rank test p=0.500, Figure 2B). Conclusion In patients undergoing TAVR for severe AS and at least moderate concomitant TR, atrial functional TR is an independent predictor for TR persistence. In addition, TR persistence is associated with increased 3-year all-cause mortality.Figure 1:Development of TR after TAVRFigure 2:3-year all-cause mortality

Reduction of moderate to severe tricuspid regurgitation after catheter ablation for atrial fibrillation

ObjectiveTricuspid regurgitation (TR) is a progressive disease with high mortality and limited medical treatment options, and its association with atrial fibrillation (AF) has been documented. This study aimed to investigate...

Failure of Tricuspid Annuloplasty for Functional Tricuspid Regurgitation: Impact of Patient's Body Size

Tricuspid repair is recommended for significant functional tricuspid regurgitation (FTR) or tricuspid annulus (TA) dilation, based on TA >40mm or >21mm/m². The concordance between both TA dimensions related to the patient's body size has not been investigated. Patients who underwent rigid ring tricuspid annuloplasty for FTR between 2009 and 2017 were included. Assuming equality between both TA diameter criteria, patients were divided per body surface area (BSA): group 1=BSA ≤1.9m² and group 2=BSA >1.9m². The primary outcome was TR recurrence at 5years. Tricuspid annuloplasty was performed in 186 patients (group 1: 130 patients [69.9%]; group 2: 56 patients [30.1%]). Group 1 comprised more female (70.8% to 23.2%, p <0.001) and older patients (77.1 ± 9.3 years; 74.2 ± 8.2 years, p=0.048). Group 1 had a smaller absolute TA diameter (group 1: 45.3 ± 5.2mm; group 2: 48.2 ± 5.6mm, p <0.001), whereas the indexed TA size was inversely higher (group 1: 26.3 ± 3.4mm/m²; group 2: 24.2 ± 2.7mm/m², p <0.001). The tenting height was comparable (group 1: 7.8 ± 3.0mm; group 2: 8.0 ± 2.7mm, p=0.714). The median ring size was 30 (interquartile range 28 to 32) and 32 (interquartile range 30 to 34) for groups 1 and 2, respectively (p <0.001). TR recurrence at 5years was noticed in 20.2% and 6.5% of group 1 and 2 (p=0.035). Indexed TA diameter (hazard ratio 1.43, 95% confidence interval 1.10 to 1.87, p=0.008) and tenting height (hazard ratio 5.52, 95% confidence interval 1.87 to 14.57, p=0.002) were independent predictors of TR recurrence. In conclusion, when the absolute TA diameter is used as the primary criterion, smaller patients are at a higher risk for TR recurrence by having a proportionally larger TA at the time of repair. An individualized approach guided by patient's body size might be more appropriate to indicate FTR correction to adjust for the annuloplasty sizing method.

Three-dimensional analysis of the tricuspid annular geometry in healthy subjects and in patients with different grades of functional tricuspid regurgitation

BackgroundAccurate sizing of the tricuspid valve annulus is essential for determining the optimal timing of tricuspid valve (TV) intervention. Two-dimensional (2D) echocardiography has limitations for comprehensive TV analysis. Three-dimensional (3D) imaging of the valve provides a better understanding of its spatial anatomy and enables more accurate measurements of TV structures.ObjectivesThe study aimed to analyze tricuspid annulus (TA) parameters in normal heart and in different grades of functional tricuspid regurgitation (TR); to compare TA measurements obtained by 2D and 3D echocardiography.MethodsOne hundred fifty-five patients (median age 65 years, 57% women) with normal TV and different functional TR grades underwent 2D and 3D transthoracic echocardiography. The severity of TR was estimated using multiparametric assessment according to the guidelines. Mid-systolic 3D TA parameters were calculated using TV dedicated software. The conventional 2D systolic TA measurements in a standard four-chamber view were performed.ResultsIn mid-systole, the normal TA area was 9.2 ± 2.0 cm2 for men and 7.4 ± 1.6 cm2 for women. When indexed to body surface area (BSA), there were no significant differences in the 3D parameters between genders. The 2D TA diameters were smaller than those measured in 3D. The ROC curve analysis identified that all 3D TA parameters can accurately differentiate between different functional TR grades. Additionally, the optimal cut-off values were identified for each TA parameter.ConclusionsGender, body size, and age have an impact on the TA parameters in healthy subjects. 2D measurements are smaller than 3D parameters. The reference values for 3D metrics according to TR severity can help in identifying TA dilation and distinguishing between different functional TR grades.Graphical

Tricuspid annular and right atrial volume changes are associated in healthy adults-insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study.

The tricuspid valve and its annulus (TA) and the right atrium (RA) play a significant role in regulating blood flow in the right heart. However, their effect on each other is not fully understood even in normal circumstances. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is able to simultaneously assess TA and RA at the same time in a non-invasive way. The present study aimed to examine associations between tricuspid annular (TA) dimensions and right atrial (RA) volumes in healthy adults by 3DSTE. The present study comprised 144 healthy subjects (mean age: 34.4 ± 12.6 years, 72 males), who participated in this study on a voluntary basis for screening between 2011 and 2015. In all subjects, electrocardiography, two-dimensional Doppler echocardiography and 3DSTE have been performed. With increasing end-systolic maximum RA volume, all end-systolic and end-diastolic TA dimensions showed simultaneous increase, but in various degrees resulting in (non-significant) reduction of TA functional properties. Similarly, with increasing diastolic pre-atrial contraction and minimum RA volumes, TA dimensions increased simultaneously (except end-diastolic TA diameter), but in various degrees resulting in reduced TA fractional shortening and fractional area change. With increasing RA dimensions, end-systolic and end-diastolic TA dimensions showed simultaneous increase, but in different, sometimes not significant degrees. While RA stroke volumes showed increasing pattern with TA dilation, RA emptying fractions have not changed substantially. 3DSTE is suitable for non-invasive assessment of TA dimensions and RA volumes at the same time using the same 3D echocardiographic dataset. Significant associations between TA size and RA volumes exist in healthy circumstances. Strong associations in case of dilation of TA in the presence of higher RA volumes could partly explain functional tricuspid regurgitation later developing in subjects in sinus rhythm.

Computed tomographic analysis of the morphometrics and dynamics of the tricuspid annulus in secondary functional tricuspid regurgitation

ObjectivesSecondary functional tricuspid regurgitation (FTR) management remains controversial mainly due to the lack of knowledge in its pathogenesis and the difficulties to measure the actual dimensions of tricuspid annulus (TA) with current imaging methods. Using a novel method based on multiphase cardiac computed tomography (CT) scan acquisition to accurately analyze the right atrioventricular junction size, we sought to explore modifications of TA morphometry and dynamics in secondary FTR. MethodsEchocardiographic and cardiac CT studies were obtained from 21 patients with severe mitral regurgitation (MR group) and 21 patients with dilated cardiomyopathy (DCMP group). Using an in-house software, a 3-dimensiontal (3D) semiautomated delineation of the TA perimeter was assessed. Modifications of diameters, 2-dimensional/3D areas and perimeters were analyzed through time. These 2 groups of patients were compared with 30 healthy subjects, considering the presence of a significant (≥2+) versus nonsignificant (<2+) FTR in each group. ResultsMaximum TA 3D areas were 7.0 ± 1.2 cm2/m2 in healthy subjects at mid-to-late diastole and were smaller than in the MR group (9.8 ± 2.1 cm2/m2, P < .001) and the DCMP group (9.2 ± 3.0 cm2/m2, P < .001). In the MR group, patients with FTR <2+ had also larger TA areas and diameters than healthy patients (P < .01 for all 3D/2-dimensional parameters). TA shape was more circular only in the DCMP group with FTR ≥2+ compared with other patients (P < .05 for eccentricity). In multivariate analysis, both RA area (P < .001) and RV volume (P = .002) were independently related to TA dilatation. ConclusionsBased on multiphase CT image analyses, TA dilatation was directly related to RV and RA enlargement. Patients with severe mitral myxomatous disease and nondysfunctional tricuspid valve had yet dilated TA, which questioned the current cut-off recommendation for concomitant tricuspid annuloplasty in this specific population.

Tricuspid annular area and leaflets stretch are associated with functional tricuspid regurgitation - insights from three-dimensional transesophageal echocardiography.

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. 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. Significant TR, which is defined as moderate or greater TR, was detected in 23 (22%). TA area (P < 0.01), the distance of septal-leaflet length (SL) (P = 0.03) and posterior-leaflet length (PL) (p = 0.02) were significantly associated with significant TR, while TA diameter assessed by transthoracic echocardiography was not. When patients were divided into four groups according to SL and PL, the group with longer SL and PL had a significantly higher incidence of significant TR (P < 0.01). Greater stretch of the septal and posterior leaflet between commissures and larger TA area are associated with significant TR in patients with severe MR. In order to prevent TR recurrence, the intervention of the septal leaflet in tricuspid annuloplasty may be beneficial. The precise implement of three-dimensional transesophageal echocardiography of tricuspid valve is valuable for a personalized strategy of tricuspid annuloplasty.

The prognostic significance of right ventricular basal diameter in addition to tricuspid annulus diameter in patients underwent to tricuspid valve surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background Functional tricuspid valve regurgitation occurs as a result of enlargement of the tricuspid annulus (TA) despite the normal valve structure (1). However, the tendency of the tricuspid annulus to enlarge in the posterior annular part suggests that the mediolateral diameter measurement measured by 2-dimensional (2-D) echocardiography does not provide an accurate anatomical evaluation (2). Inaccuracies in these measurements also affect the selection of the tricuspid ring in patients undergoing surgery and thus affect the short- and long-term outcomes (3). Therefore, new methods and reference points have developed in the measurement of the tricuspid annulus. Purpose In this study, we aimed to investigate the importance of apical 4-chamber tricuspid annulus diameter and right ventricular basal diameter measurements in choosing a surgical tricuspid ring size. Methods The records of 359 patients who underwent tricuspid ring annuloplasty for functional tricuspid valve regurgitation between 2018 and 2022 were retrospectively reviewed. Tricuspide anulus and right ventricular basal diameter measurements were re-evaluated echocardiographically, and surgical tricuspid ring sizes were recorded. Results There was no significant relationship between 2-D measurement of tricuspid annulus diameter and choosing surgical ring sizes (OR 0.74, 95% CI 0.51 – 1.09, p = 0.257), however, the increase in RV basal diameter size was associated with larger ring size selection (OR 2.63, 95%). CI 1.72 – 4.02, p&amp;lt;0.0001). Among the 5 models that predicted the surgical ring size according to the ordinal regression analysis, the models that most accurately predicted the surgical ring size were model-4, which included RV basal diameter, and model-5, which included RV basal diameter and TA diameter. (Table 1). Also, in model-5, RV basal diameter was superior to TA-diameter in showing variation in surgical ring size. Also, when the TA diameter is &amp;lt; 40 mm and the RV basal diameter is &amp;lt; 45 mm, the large ring selection rate (34 or 36) is 36.2%, but this rate is 70.9% when the TA diameter is &amp;lt; 40 mm and the RV basal diameter is ≥ 45. Conclusions In conclusion, when the measurements in the apical 4-chamber were compared, the effectiveness of the measurement of the tricuspid annulus in determining the surgical ring size was lower than the RV basal diameter. During pre-operative evaluation, RV basal measurement in addition to the tricuspid annulus may help in the selection of patients who require tricuspid valve annuloplasty and in determining the ring sizes.

Comparison of functional tricuspid regurgitation after transcatheter closure of atrial septal defect in patients with sinus rhythm and atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Significant tricuspid regurgitation (TR) often improves during the long-term follow-up period after transcatheter atrial septal defect (ASD) closure. However, It is unknown whether ASD closure improves TR in patients with atrial fibrillation (AF). Methods Between 2016 and 2021, 66 consecutive patients (66% males, mean age 58 +/- 16 years, 30% with AF, 68% with severe/moderate TR) underwent transcatheter ASD closure and were evaluated with transthoracic echocardiography at baseline, 1day, 1 month and 1 year. Results Sinus rhythm(SR) group showed an improvement in TR one month after ASD closure, which persisted at 12 months, whereas AF group demonstrated no improvement in TR after one month and 1 year.(figure1) Right atrial volume index improved in both groups, but tricuspid annular diameter showed no improvement in AF group.(figure2)(figure3) Conclusion Decrease in tricuspid annular diameter was significantly associated with TR improvement after ASD closure. Our findings suggest that TR is less likely to improve in patients with AF since ASD closure had less impact in tricuspid annular diameter.

Functional tricuspid regurgitation after transcatheter closure of atrial septal defect

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): none Background Significant functional tricuspid regurgitation (FTR) often improves during the long-term follow-up after transcatheter atrial septal defect (ASD) closure. However, the timing of TR improvement and its relationship with right ventricle (RV) reverse remodeling are unknown. Methods A total of 50 patients (age: mean age 58 +/- 16 years old, range:18–88; male: 66%) who underwent transcatheter ASD closure were enrolled. Echocardiography was performed at baseline, 1month and 1year after transcatheter ASD closure. Results TR improved significantly 1month after treatment compared to baseline, but no further significant improvement in TR severity was observed up to 1 year after treatment. Tricuspid annulus diameter decreased gradually over 1 year, while RV diameter decreased significantly at 1 month and throughout 1 year after treatment. (Figure). Conclusion Reverse remodeling of the RV was achieved immediately after ASD closure and continued thereafter, whereas significant improvement in TR severity was demonstrated only immediately after ASD closure. Meticulous follow-up with more intensive therapies should be considered for patients with residual significant TR after ASD closure.