Percutaneous establishment of tricuspid regurgitation: an experimental model for transcatheter tricuspid valve replacement.
BACKGROUND
Valve replacement or repair is recommended in patients with tricuspid regurgitation when deterioration of their clinical status occurs as a consequence of right ventricular dysfunction. Percutaneous valve replacement was developed in recent years. To investigate the feasibility, effectiveness and long-term results of percutaneous tricuspid valve replacement, an experimental model with tricuspid regurgitation is needed. We developed a simple and reproducible percutaneous approach for the creation of tricuspid regurgitation in sheep.


METHODS
A specially designed grasping forceps were used to grasp chordae tendineae or the tricuspid valve leaflets through a catheter. Transcatheter creation of tricuspid regurgitation was performed on 7 healthy sheep. These sheep were followed up shortly after the procedure and at 6th month post-procedure with echocardiography. Additionally, all the sheep were sacrificed for anatomic evaluation at 6th month after the procedure.


RESULTS
Creation of tricuspid regurgitation was successfully accomplished in all sheep. Necropsy confirmed that damage was done to the tricuspid valve apparatus in all animals (tearing of the anterior leaflet of the tricuspid valve in five animals and posterior leaflet of the tricuspid valve in two animals). At the six-month follow-up, there was no significant increase in the right ventricle dimension and ejection fraction measured by echocardiography. Autopsy examinations demonstrated the tearing of tricuspid valve leaflets.


CONCLUSIONS
The creation of an animal model of tricuspid regurgitation via a percutaneous approach using forceps to sever one or more tricuspid leaflets is feasible and will allow investigation of devices designed replace the tricuspid valve via a percutaneous approach. Despite significant tricuspid regurgitation, the hemodynamics did not change during the follow-up period in this model.
Bai
Yuan
Y
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Chen
Hai-Yan
HY
Zong
Gang-Jun
GJ
Jiang
Hai-Bing
HB
Li
Wei-Ping
WP
Wu
Hong
H
Zhao
Xian-Xian
XX
Qin
Yong-Wen
YW
D000818:Animals; D002404:Catheterization; D004195:Disease Models, Animal; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D008297:Male; D012756:Sheep; D014262:Tricuspid Valve Insufficiency / Q000628:therapy*