Usefulness of 3D echocardiographic parameters of tricuspid valve morphology to predict residual tricuspid regurgitation after tricuspid annuloplasty.
OBJECTIVE
Tricuspid valve (TV) annuloplasty is an effective treatment for tricuspid regurgitation (TR). However, the impact of TV morphology on outcome of TV annuloplasty remains unknown. We sought to investigate the relationship between preoperative TV morphology and residual TR after annuloplasty.


RESULTS
Two-dimensional transthoracic and three-dimensional (3D) transesophageal echocardiography were performed in 97 patients with functional TR before and after surgery. 3D quantitative assessment including annular dimension, tenting height and volume, and lengths and tethering angles of the 3 leaflets was performed. The TV morphological score was derived from the preoperative 3D echocardiography to score a leaflet mobility, leaflet thickening, subvalvular thickening, and calcification. TR severity was determined by the averaged vena contracta measured from the apical and parasternal inflow views. Multivariable analysis revealed that a shorter total leaflet length (P = 0.007), larger tenting volume (P < 0.001), and higher TV morphological score (P < 0.001) were independently associated with residual TR. A TV-Echo score was determined as a sum of points based on receiver operator characteristics analysis: total leaflet length >61.0 mm, 61.0 to 53.5 mm, and <53.5 mm; tenting volume <2.3 mL, 2.3 to 3.5 mL, and >3.5 mL; and TV morphological score <7, 7 to 18, and >18; each variable was associated with 0 and 1 point and 2 points, respectively. The TV-Echo score ≥2 was associated with significant residual TR with a sensitivity of 85.7% and a specificity of 71.0%.


CONCLUSIONS
In addition to tethering and short length of the leaflets, TV morphological abnormality predicted residual TR after TV annuloplasty.
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
Hiroto
H
Utsunomiya
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
Yuji
Y
Itabashi
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
Hirotsugu
H
Mihara
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
Sayuki
S
Kobayashi
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
Michele A
MA
De Robertis
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
Alfredo
A
Trento
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
Takahiro
T
Shiota
D000368:Aged; D000704:Analysis of Variance; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*
3D transesophageal echocardiography; annuloplasty; tricuspid regurgitation