Geometric Changes of Tricuspid Valve Tenting in Tricuspid Regurgitation Secondary to Pulmonary Hypertension Quantified by Novel System with Transthoracic Real-time 3-Dimensional Echocardiography

摘要

Geometric changes of tricuspid valve, particularly leaflets configuration, in functional tricuspid regurgitation (TR) remain to be defined. We sought to investigate geometric changes of tricuspid valve tenting in functional TR secondary to pulmonary hypertension by transthoracic real-time 3-dimen-sional echocardiography (3DE). Real-time 3DE was performed in 30 individuals (17 patients with TR and 13 control subjects). We used a novel software system with 3DE to reconstruct tricuspid geometry at midsystole. In patients with TR, tricuspid leaflets were tethered into right ventricle with apparent tenting showing a mouhtainlike Functional tricuspid regurgitation (TR) is caused by impaired valve cooptation in the absence of primary valve diseases.1,2 Functional TR secondary to pulmonary hypertension (PH) is seen in patients with significant left-sided heart disease, primary PH, and pulmonary disease leading to cor pulmonale.3 A significant functional TR is associated with an increase in future morbidity andmortality risks.4,5 Previously, assessment of functional TR was mostly done by 2-dimen-sional (2D) echocardiography (2DE) despite unique configuration of tricuspid leaflets and annulus and anatomic complexity of right ventricle (RV) geometry. Limited views of 2DE made it difficult to appreciate the geometry of tricuspid valve.6 It is conceivable that application of real-time 3-dimensional (3D) echocardiography (3DE) may provide more comprehensive information regarding valve geometry. Geometric changes of tricuspid valve, particularly leaf- bulging. Maximum tenting site was mostly located at the center of the tenting. Tenting volume was larger (4.2 +- 2.4 vs 1.1 +- 0.6 cm3, P < .001), and the maximum and mean tenting lengths were longer, than in control subjects. Annular area was also larger (11.3 +- 2.3 vs 8.7 +- 1.8 cm2, P = .003) than in control subjects. Geometric changes in functional TR secondary to pulmonary hypertension were characterized by enlargement of tricuspid tenting volume and dilatation of annulus. This study suggested usefulness of the novel system with 3DE in evaluation of tricuspid valve geometry.