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Muraru D, Gavazzoni M, Heilbron F, Mihalcea DJ, Guta AC, Radu N, Muscogiuri G, Tomaselli M, Sironi S, Parati G, Badano LP. Reference ranges of tricuspid annulus geometry in healthy adults using a dedicated three-dimensional echocardiography software package. Front Cardiovasc Med 2022; 9:1011931. [PMID: 36176994 PMCID: PMC9513148 DOI: 10.3389/fcvm.2022.1011931] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTricuspid annulus (TA) sizing is essential for planning percutaneous or surgical tricuspid procedures. According to current guidelines, TA linear dimension should be assessed using two-dimensional echocardiography (2DE). However, TA is a complex three-dimensional (3D) structure.AimIdentify the reference values for TA geometry and dynamics and its physiological determinants using a commercially available three-dimensional echocardiography (3DE) software package dedicated to the tricuspid valve (4D AutoTVQ, GE).MethodsA total of 254 healthy volunteers (113 men, 47 ± 11 years) were evaluated using 2DE and 3DE. TA 3D area, perimeter, diameters, and sphericity index were assessed at mid-systole, early- and end-diastole. Right atrial (RA) and ventricular (RV) end-diastolic and end-systolic volumes were also measured by 3DE.ResultsThe feasibility of the 3DE analysis of TA was 90%. TA 3D area, perimeter, and diameters were largest at end-diastole and smallest at mid-systole. Reference values of TA at end-diastole were 9.6 ± 2.1 cm2 for the area, 11.2 ± 1.2 cm for perimeter, and 38 ± 4 mm, 31 ± 4 mm, 33 ± 4 mm, and 34 ± 5 mm for major, minor, 4-chamber and 2-chamber diameters, respectively. TA end-diastolic sphericity index was 81 ± 11%. All TA parameters were correlated with body surface area (BSA) (r from 0.42 to 0.58, p < 0.001). TA 3D area and 4-chamber diameter were significantly larger in men than in women, independent of BSA (p < 0.0001). There was no significant relationship between TA metrics with age, except for the TA minor diameter (r = −0.17, p < 0.05). When measured by 2DE in 4-chamber (29 ± 5 mm) and RV-focused (30 ± 5 mm) views, both TA diameters resulted significantly smaller than the 4-chamber (33 ± 4 mm; p < 0.0001), and the major TA diameters (38 ± 4 mm; p < 0.0001) measured by 3DE. At multivariable linear regression analysis, RA maximal volume was independently associated with both TA 3D area at mid-systole (R2 = 0.511, p < 0.0001) and end-diastole (R2 = 0.506, p < 0.0001), whereas BSA (R2 = 0.526, p < 0.0001) was associated only to mid-systolic TA 3D area.ConclusionsReference values for TA metrics should be sex-specific and indexed to BSA. 2DE underestimates actual 3DE TA dimensions. RA maximum volume was the only independent echocardiographic parameter associated with TA 3D area in healthy subjects.
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Affiliation(s)
- Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- *Correspondence: Mara Gavazzoni
| | - Francesca Heilbron
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Diana J. Mihalcea
- University of Medicine and Pharmacy Carol Davila Bucharest, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Andrada C. Guta
- Department of Cardiology, Methodist DeBakey Heart Center, Houston Methodist Hospital, Houston, TX, United States
| | - Noela Radu
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- University of Medicine and Pharmacy Carol Davila Bucharest, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Giuseppe Muscogiuri
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sandro Sironi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Radiology Department, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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Zhingre Sanchez JD, Iaizzo PA. Computationally Assessed 3D Anatomical Proximities and Spatial Relationships Among the Tricuspid Valve Annulus, Right Coronary Artery, and Triangle of Koch: Implications for Transcatheter Tricuspid Annuloplasty Repair. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100033. [PMID: 37273741 PMCID: PMC10236799 DOI: 10.1016/j.shj.2022.100033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 06/06/2023]
Abstract
Background Transcatheter-based annuloplasty therapies for tricuspid regurgitation have demonstrated significant development over recent years. However, the tricuspid valve and neighboring vasculature and conductive tissue regions can present anatomical and device deployment challenges. This present study investigated the anatomical dimensions and spatial relationships of the cardiac structures essential to percutaneous annuloplasty procedures: the tricuspid annulus (TA), right coronary artery (RCA), and triangle of Koch border region. Methods Measurements were derived from computational three-dimensional reconstructions of static magnetic resonance imaging scans of perfusion-fixed human hearts (n = 82) with preserved right-sided heart anatomies. This specimen set included heart samples presenting with prediagnosed atrioventricular valvular regurgitation. Results Our anatomical assessments demonstrated that the TA to RCA proximities were intensified with the presence of atrioventricular valvular regurgitation, compared with healthy heart specimens. The minimal distances were frequently located between the lateral and posterior annular points. This annular region corresponds to the RCA distal segments and posterior descending branch origins. Greater portions and incidences of the RCA coursing parallel or inferior to the TA plane were recorded for these diseased hearts. Patient demographic variables (gender, age, and body mass index) were insignificant determinants of change for a majority of our results. Conclusions These three-dimensional reconstructions provide insights to guide the development and future iterations of transcatheter tricuspid valve annuloplasty systems with regards to device anchoring, annular geometry, tissue proximities, and implantation considerations.
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Affiliation(s)
- Jorge D Zhingre Sanchez
- Departments of Surgery and Biomedical Engineering, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paul A Iaizzo
- Departments of Surgery and Biomedical Engineering, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Qureshi NQ, Sharkey A, Mufarrih SH, Baribeau V, Quraishi I, Bose R, Matyal R, Khabbaz KR, Mahmood F. Dynamic Geometric Tricuspid Valve Assessment: Extending from Bench to Bedside. J Cardiothorac Vasc Anesth 2021; 36:3244-3249. [PMID: 34969563 DOI: 10.1053/j.jvca.2021.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/22/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Nada Qaisar Qureshi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Aidan Sharkey
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Syed Hamza Mufarrih
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Vincent Baribeau
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ibrahim Quraishi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ruma Bose
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kamal R Khabbaz
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Ortiz-Leon XA, Posada-Martinez EL, Trejo-Paredes MC, Ivey-Miranda JB, Pereira J, Crandall I, DaSilva P, Bouman E, Brooks A, Gerardi C, Ugonabo I, Chen W, Houle H, Akar JG, Lin BA, McNamara RL, Lombo-Lievano B, Arias-Godinez JA, Sugeng L. Understanding tricuspid valve remodelling in atrial fibrillation using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 2021; 21:747-755. [PMID: 32372089 DOI: 10.1093/ehjci/jeaa058] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/10/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Atrial fibrillation (AF) has been associated with tricuspid annulus (TA) dilation in patients with severe functional tricuspid regurgitation (TR); however, the impact of AF is less clear in patients without severe TR. Our aim was to characterize TA remodelling in patients with AF in the absence of severe TR using 3D transoesophageal echocardiography (TOE). METHODS AND RESULTS Ninety patients underwent clinically indicated transthoracic and TOE: non-structural (NS)-AF (n = 30); AF with left heart disease (LHD) (n = 30), and controls in sinus rhythm (n = 30). Three-dimensional TOE datasets were analysed to measure TA dimensions using novel dedicated tricuspid valve software. The NS-AF group showed biatrial dilatation and normal right ventricular (RV) size with decreased longitudinal function compared to controls, whereas the LHD-AF group showed biatrial dilatation, RV enlargement, decreased biventricular function, and higher systolic pulmonary artery pressure compared with the other groups. Indexed TA area, minimum diameter, maximum diameter, and total perimeter were significantly larger in the NS-AF group than in controls (measurements in end-diastole: 6.4 ± 1.1 vs. 5.0 ± 0.6 cm2/m2, 1.8 ± 0.3 vs. 1.6 ± 0.2 cm/m2, 2.1 ± 0.3 vs. 1.9 ± 0.2 cm/m2, and 6.6 ± 0.9 vs. 5.9 ± 0.7 cm/m2, respectively, all P < 0.05). There was no significant difference in any indexed TA parameter between AF groups. TA circularity index (ratio between minimum and maximal diameters) and TA fractional area change between end-diastole and end-systole were no different among the three groups. CONCLUSION AF is associated with right atrial and tricuspid annular remodelling independent of the presence of LHD in patients with intrinsically normal tricuspid leaflets without severe TR.
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Affiliation(s)
- Xochitl A Ortiz-Leon
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Edith L Posada-Martinez
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Maria C Trejo-Paredes
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Juan B Ivey-Miranda
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Jason Pereira
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Ian Crandall
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Paul DaSilva
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Eileen Bouman
- Ultrasound Business Unit, Advanced Development, Siemens Healthineers, 685 Middlefield Road Mountain View, CA 94043, USA
| | - Alyssa Brooks
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Christine Gerardi
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Ifeoma Ugonabo
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Wanwen Chen
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Helene Houle
- Ultrasound Business Unit, Advanced Development, Siemens Healthineers, 685 Middlefield Road Mountain View, CA 94043, USA
| | - Joseph G Akar
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Ben A Lin
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Robert L McNamara
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Bernardo Lombo-Lievano
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Jose A Arias-Godinez
- Laboratory of Echocardiography, National Institute of Cardiology, Juan Badiano 1, Belisario Domínguez Secc 16, Mexico City 14080, Mexico
| | - Lissa Sugeng
- Laboratory of Echocardiography, Cardiovascular Division, Yale New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
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Khoche S, Hashmi N, Bronshteyn YS, Choi C, Poorsattar S, Maus TM. The Year in Perioperative Echocardiography: Selected Highlights from 2020. J Cardiothorac Vasc Anesth 2021; 35:2559-2568. [PMID: 33934985 DOI: 10.1053/j.jvca.2021.03.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/11/2022]
Abstract
This article is the fifth of an annual series reviewing the research highlights of the year pertaining to the subspecialty of perioperative echocardiography for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank Editor-in-Chief Dr. Kaplan and the editorial board for the opportunity to continue this series. In most cases, these will be research articles that are targeted at the perioperative echocardiography diagnosis and treatment of patients after cardiothoracic surgery; but in some cases, these articles will target the use of perioperative echocardiography in general.
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Affiliation(s)
- Swapnil Khoche
- Department of Anesthesiology, University of California San Diego Medical Center - Sulpizio Cardiovascular Center, La Jolla, CA
| | - Nazish Hashmi
- Department of Anesthesiology, Duke University, School of Medicine, Durham, NC
| | - Yuriy S Bronshteyn
- Department of Anesthesiology, Duke University, School of Medicine, Durham, NC
| | - Christine Choi
- Department of Anesthesiology, University of California San Diego Medical Center - Sulpizio Cardiovascular Center, La Jolla, CA
| | - Sophia Poorsattar
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, CA
| | - Timothy M Maus
- Department of Anesthesiology, University of California San Diego Medical Center - Sulpizio Cardiovascular Center, La Jolla, CA.
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Tan CO, Hu R, Weinberg L. Application of a Series of Two-Dimensional Transesophageal Echocardiographic (2D TEE) Views Across Multiple Axes Improves the Accuracy of Tricuspid Annular Measurements. J Cardiothorac Vasc Anesth 2021; 35:2715-2722. [PMID: 33858749 DOI: 10.1053/j.jvca.2021.02.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/14/2021] [Accepted: 02/28/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Quantification of the tricuspid annulus (TA) is an important factor in determining the requirement for tricuspid annuloplasty in cardiac surgery. Three-dimensional echocardiography (3DE) has shown that the TA is biplanar with an antero-posterior longaxis and septo-lateral shortaxis, and that the commonly used 2D TEE (two-dimensional transesophageal echocardiography) four-chamber view (4ChV) underestimates the true TA longaxis. The authors hypothesized that the use of multiple 2D TEE TA views could attain greater TA long-axis measurements and smaller TA short-axis measurements than the 4ChV, and that the 4ChV has a significant but inconsistent bias relative to the maximal TA diameter measured by these views. DESIGN Prospective observational study. SETTING Adult tertiary teaching hospital. PARTICIPANTS 45 adult patients. INTERVENTIONS Multiplanar 2D TEE assessment of the tricuspid annulus. MEASUREMENTS AND MAIN RESULTS Multiplanar assessment reliably produced larger TA long-axis measurements (93% of patients, 95% confidence interval: 81-98%) of (mean [95% confidence interval]) 40 mm (28-50 mm) compared with the 4ChV (34mm [25-44 mm], p < 0.0001) and smaller TA short-axis measurements (29 mm [20-38 mm], p < 0.0001) compared with the 4ChV. TA diameter by 4ChV assessment yielded an average bias of -5.6 mm, with 95% limits of agreement -15 to +3.9 mm compared with the largest TA long-axis measurement by multiplanar assessment. CONCLUSIONS Multiplanar 2D TEE assessment of the TA long- and short-axis consistently achieves larger and smaller measurements, respectively, than the 4ChV. The 4ChV also is not a reliable index of the TA longaxis. If the time, proficiency, or equipment required for 3DE TA assessment are unavailable, the use of multiple standard and non-standard 2D TEE TA views may offer an alternative for TA assessment.
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Affiliation(s)
- Chong Oon Tan
- Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia.
| | - Raymond Hu
- Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Laurence Weinberg
- Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia
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7
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Fatima H, Mahmood F, Sehgal S, Belani K, Sharkey A, Chaudhary O, Baribeau Y, Matyal R, Khabbaz KR. Artificial Intelligence for Dynamic Echocardiographic Tricuspid Valve Analysis: A New Tool in Echocardiography. J Cardiothorac Vasc Anesth 2020; 34:2703-2706. [DOI: 10.1053/j.jvca.2020.04.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 11/11/2022]
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Rausch MK, Mathur M, Meador WD. Biomechanics of the Tricuspid Annulus: A Review of the Annulus' In Vivo Dynamics With Emphasis on Ovine Data. MITTEILUNGEN DER GESELLSCHAFT FUR ANGEWANDTE MATHEMATIK UND MECHANIK 2019; 42:e201900012. [PMID: 38690196 PMCID: PMC11058966 DOI: 10.1002/gamm.201900012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/28/2019] [Indexed: 05/02/2024]
Abstract
The tricuspid annulus forms the boundary between the tricuspid valve leaflets and their surrounding perivalvular tissue of the right atrioventricular junction. Its shape changes throughout the cardiac cycle in response to the forces from the contracting right heart myocardium and the blood-valve interaction. Alterations to annular shape and dynamics in disease lead to valvular dysfunctions such as tricuspid regurgitation from which millions of patients suffer. Successful treatment of such dysfunction requires an in-depth understanding of the normal shape and dynamics of the tricuspid annulus and of the changes following disease and subsequent repair. In this manuscript we review what we know about the shape and dynamics of the normal tricuspid annulus and about the effects of both disease and repair based on non-invasive imaging studies and invasive fiduciary marker-based studies. We further show, by means of ovine data, that detailed engineering analyses of the tricuspid annulus provide regionally-resolved insight into the kinematics of the annulus which would remain hidden if limiting analyses to simple geometric metrics.
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Affiliation(s)
- Manuel K. Rausch
- Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, Institute for Computational Engineering and Sciences, University of Texas at Austin, TX, USA
| | - Mrudang Mathur
- Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, Institute for Computational Engineering and Sciences, University of Texas at Austin, TX, USA
| | - William D. Meador
- Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, Institute for Computational Engineering and Sciences, University of Texas at Austin, TX, USA
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Echocardiographic Assessment of the Tricuspid Annulus: The Effects of the Third Dimension and Measurement Methodology. J Am Soc Echocardiogr 2019; 32:238-247. [DOI: 10.1016/j.echo.2018.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Indexed: 01/04/2023]
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10
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Bhatt HV, Spivack J, Patel PR, El-Eshmawi A, Amir Y, Adams DH, Fischer GW. Correlation of 2-Dimensional and 3-Dimensional Echocardiographic Analysis to Surgical Measurements of the Tricuspid Valve Annular Diameter. J Cardiothorac Vasc Anesth 2019; 33:137-145. [DOI: 10.1053/j.jvca.2018.05.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 01/25/2023]
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11
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Li Y, Wang Y, Yang Y, Liu M, Meng X, Shi Y, Zhu W, Lu X. Tricuspid annular displacement measured by 2-dimensional speckle tracking echocardiography for predicting right ventricular function in pulmonary hypertension: A new approach to evaluating right ventricle dysfunction. Medicine (Baltimore) 2018; 97:e11710. [PMID: 30045334 PMCID: PMC6078723 DOI: 10.1097/md.0000000000011710] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study aimed to determine the ability of tricuspid annular displacement measured by 2-dimensional speckle tracking echocardiography (STE) to predict right ventricular (RV) dysfunction in pulmonary hypertension (PH) patients. Here, we present a new method for assessing RV function that also employs STE and is based on measurement of tricuspid annular displacement.A total of 225 patients were divided into 2 groups according to the pulmonary artery systolic blood pressure (PASP), estimated by echocardiographic measurement of tricuspid regurgitation: group I (PASP ≥50 mm Hg) and group II (36 mm Hg ≤ PASP <50 mm Hg). The tricuspid annular plane systolic excursion (TAPSE), RV index of myocardial performance (RIMP), RV fractional area change (RVFAC), tissue Doppler-derived tricuspid lateral annular systolic velocity (s'), and the tricuspid annular longitudinal displacement (TMAD) parameters were measured. Thirty patients underwent cardiac magnetic resonance (CMR) examination, and right ventricular ejection fraction (RVEF) was calculated.The conventional parameters as well as the TMAD parameters differed significantly between the 2 groups (all P < .01). Good correlation was observed between the TMAD parameters and CMR-derived RVEF (all P < .01). The TMAD parameters had moderate predictive value for predicting RV dysfunction in PH patients (all P < .01). From receiver operating characteristic curves, we determined the optimal cut-off values for TMAD parameters for detecting RV dysfunction with good sensitivity and specificity.The TMAD parameters can predict the decline of RV function in patients with PH and thus provide new diagnostic indices for clinical management of these patients.
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Affiliation(s)
- Yidan Li
- Department of Echocardiography, Heart Center
| | - Yidan Wang
- Department of Echocardiography, Heart Center
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine
| | - Mingxi Liu
- Department of Radiology, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | | | - Yanping Shi
- Department of Echocardiography, Heart Center
| | - Weiwei Zhu
- Department of Echocardiography, Heart Center
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center
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12
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Hai T, Amador Y, Mahmood F, Jeganathan J, Khamooshian A, Knio ZO, Matyal R, Nicoara A, Liu DC, Senthilnathan V, Khabbaz KR. Changes in Tricuspid Annular Geometry in Patients with Functional Tricuspid Regurgitation. J Cardiothorac Vasc Anesth 2017; 31:2106-2114. [PMID: 29100836 DOI: 10.1053/j.jvca.2017.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine whether the indices of tricuspid annular dynamics that signify irreversible tricuspid valvular remodeling can improve surgical decision making by helping to better identify patients with functional tricuspid regurgitation who could benefit from annuloplasty. DESIGN Retrospective analysis study. SETTING Tertiary hospital. PARTICIPANTS A total number of 55 patients were selected, 18 with functional tricuspid valve (TV) regurgitation and 37 normal nonregurgitant TVs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS When comparing the basal, mid, and longitudinal diameters of the right ventricle between the nonregurgitant valve (NTR) group and the functional tricuspid regurgitation (FTR) group, tricuspid annulus was more dilated (p < 0.001, p = 0.001, and p = 0.006, respectively) and less nonplanar (p < 0.001) in the FTR group. At end-systole (ES), the posterolateral-anteroseptal axis was significantly greater in the FTR group than in the NTR group (mean difference = 7.15 mm; p < 0.001). The right ventricle in the FTR group was also significantly dilated with greater leaflet restriction (p = 0.015). CONCLUSIONS As compared to NTR TVs, FTR is associated with identifiable indices of tricuspid annular structural changes that are indicative of irreversible remodeling.
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Affiliation(s)
- Ting Hai
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Yannis Amador
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Anesthesia, Hospital México, University of Costa Rica, San José, Costa Rica
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Jelliffe Jeganathan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Arash Khamooshian
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ziyad O Knio
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alina Nicoara
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - David C Liu
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Venkatachalam Senthilnathan
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kamal R Khabbaz
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Besler C, Meduri CU, Lurz P. Transcatheter Treatment of Functional Tricuspid Regurgitation Using the Trialign Device. Interv Cardiol 2017; 13:8-13. [PMID: 29593830 DOI: 10.15420/icr.2017:21:1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Functional tricuspid regurgitation (TR) represents an important unmet need in clinical cardiology given its prevalence, adverse prognostic impact and symptom burden associated with progressive right heart failure. Several transcatheter techniques are currently in early clinical testing to provide alternative treatment options for patients deemed unsuitable for tricuspid valve surgery. Amongst them, the TrialignTM device (Mitralign, Inc.) represents a novel percutaneous tricuspid valve annuloplasty technique, which aims to reduce tricuspid annular dilatation in functional TR by delivering and cinching two pledgeted sutures to the posterior portion of the tricuspid annulus via transjugular access. Early clinical data suggest the Trialign technique is safe and feasible, and associated with an improvement in quality-of-life measures. However, further studies are needed to confirm these data in larger cohorts of patients with longer follow up. In addition, future trials need to address the question whether TR reduction with the Trialign and other devices leads to an improvement in the patient`s functional status and prognosis, over and above medical treatment alone.
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Affiliation(s)
- Christian Besler
- Department of Cardiology, University of Leipzig - Heart CenterLeipzig, Germany
| | | | - Philipp Lurz
- Department of Cardiology, University of Leipzig - Heart CenterLeipzig, Germany
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