title: Tricuspid annulus: a three-dimensional deconstruction and reconstruction.
abstract: BACKGROUND
  Before clinical manifestation of regurgitation, the tricuspid annulus dilates and flattens when right ventricular dysfunction is potentially reversible. That makes the case for a prophylactic tricuspid annuloplasty even in the absence of significant tricuspid regurgitation. Owing to the appreciation of the favorable prognostic value of tricuspid annuloplasty, the geometry of the normal tricuspid annulus merits critical analysis.
  
  
  METHODS
  Three-dimensional transesophageal echocardiographic data from 26 patients were analyzed using Image Arena (TomTec, Munich, Germany) software. Cartesian coordinate data from tricuspid annuli were exported to MATLAB (Mathworks, Natick, MA) for further processing. Annular metrics related to size, shape, and motion were computed.
  
  
  RESULTS
  The tricuspid annulus demonstrated significant changes in area (p<0.01) and perimeter (p<0.03) during the cardiac cycle, with maximum values attained at end diastole. There was significant correlation between two- and three-dimensional area changes, indicating true expansion in the annulus. The anterolateral region of the annulus demonstrated the greatest dynamism (p<0.01), and the anteroseptal region showed the least. The anteroseptal region also displayed the most nonplanarity in the annulus. In addition, vertical translational motion was observed, with a mean distance of 11.3±3.7 mm between end systolic and end diastolic annular centroids.
  
  
  CONCLUSIONS
  The tricuspid annulus is a dynamic, multiplanar structure with heterogeneous regional behavior. These characteristics should be taken into account for optimal annuloplasty device design and efficacy.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Khurram
authors.initials: K
authors.lastname: Owais
authors.affiliation: Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, Louisiana.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Taylor
authors.affiliation: Department of Anesthesia, Peking University People's Hospital, Beijing, China.
authors.forename: Luyang
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: kkhabbaz@bidmc.harvard.edu.
authors.forename: Kamal R
authors.initials: KR
authors.lastname: Khabbaz
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Mario
authors.initials: M
authors.lastname: Montealegre-Gallegos
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Robina
authors.initials: R
authors.lastname: Matyal
authors.affiliation: Gorman Cardiovascular Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
authors.affiliation: Gorman Cardiovascular Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012984:Software; D014261:Tricuspid Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000151:congenital / Q000000981:diagnostic imaging* / Q000601:surgery