title: Tricuspid valve tethering predicts residual tricuspid regurgitation after tricuspid annuloplasty.
abstract: BACKGROUND
  Tricuspid valve (TV) annuloplasty is recommended for functional tricuspid regurgitation (TR), which is caused by TV annulus dilatation and tethering of the leaflets. However, the impact of TV deformations on the outcome of TV annuloplasty remains unknown. The goal of this study was to investigate the relationship between preoperative TV deformation and residual TR after TV annuloplasty.
  
  
  RESULTS
  Two hundred sixteen patients with functional TR had 2D echocardiography before and after TV annuloplasty. Right ventricular fractional area change and left ventricular ejection fraction were determined with the apical views. Minimal TV annulus diameter was determined by frame-by-frame analysis. The distance of TV tethering was measured from the annulus plane to the coaptation point and tethering area by tracing the leaflets from the annulus plane. TR severity was determined by the ratio of the maximal jet area to the corresponding right atrial area. The severity of residual TR was associated with age, right and left ventricular dysfunction, tethering distance and area, and severity of preoperative TR (all P<0.05). TV annular dimension was not associated with outcome of TV annuloplasty. Multivariate analysis revealed that age, tethering distance, and severity of preoperative TR (all P<0.001) were independent parameters predicting residual TR. The sensitivity and specificity in predicting residual TR after surgery were 86% and 80% for tethering distances >0.76 cm and 82% and 84% for tethering areas >1.63 cm2, respectively.
  
  
  CONCLUSIONS
  Severe TV tethering predicted residual TR after TV annuloplasty, whereas preoperative TV annular dimension was not associated with outcome of TV annuloplasty.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Shota
authors.initials: S
authors.lastname: Fukuda
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
authors.forename: Masao
authors.initials: M
authors.lastname: Daimon
authors.forename: Vorachai
authors.initials: V
authors.lastname: Kongsaerepong
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology; D015203:Reproducibility of Results; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000503:physiopathology* / Q000601:surgery*