This Article Full Text Full Text (PDF) All Versions of this Article: 114/2/143    most recent CIRCULATIONAHA.106.611889v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ton-Nu, T.-T. Articles by Hung, J. Search for Related Content PubMed PubMed Citation Articles by Ton-Nu, T.-T. Articles by Hung, J. Related Collections Congestive Valvular heart disease Echocardiography CV surgery: valvular disease Related Article

(Circulation. 2006;114:143-149.)
© 2006 American Heart Association, Inc.

Imaging

Geometric Determinants of Functional Tricuspid Regurgitation

Insights From 3-Dimensional Echocardiography

Thanh-Thao Ton-Nu, MD, FRCP; Robert A. Levine, MD; Mark D. Handschumacher, BA; David J. Dorer, PhD; Chaim Yosefy, MD; Dali Fan, MD, PhD; Lanqi Hua, RDCS; Leng Jiang, MD; Judy Hung, MD

From the Cardiac Ultrasound Laboratory (T.-T.T.-N., R.A.L., M.D.H., C.Y., D.F., L.H., J.H.) and the Center for Biostatistics (D.J.D.), Massachusetts General Hospital, Boston, Mass; and Cardiology Medicine (L.J.), Baystate Medical Center, Springfield, Mass.

Correspondence to Judy Hung, MD, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, MA 02114. E-mail Jhung{at}partners.org

Received July 18, 2005; de novo received January 2, 2006; revision received April 24, 2006; accepted May 10, 2006.

Background— Tricuspid regurgitation (TR) is an important predictor of morbidity and mortality in heart failure. We aimed to examine the 3D geometry of the tricuspid valve annulus (TVA) in patients with functional TR, comparing them with patients with normal tricuspid valve function and relating annular geometric changes to functional TR.

Methods and Results— TVA shape was examined by real-time 3D echocardiography in 75 patients: 35 with functional TR and 40 with normal tricuspid valve function (referent group). The 3D shape of the TVA was reconstructed from rotated 2D planes, and the annular plane was computed by least-squares fitting. Annular area and mediolateral, anteroposterior, and high (superior)-low (inferior) distances were calculated. TR was assessed by vena contracta width. The normal TVA has a bimodal pattern (high-low distance=7.23±1.05 mm). High points were located anteroposteriorly, and low points were located mediolaterally. With moderate or greater TR (vena contracta width 5.80±2.62 mm), the TVA became dilated (17.24±4.75 versus 9.83±2.18 cm², P<0.0001, TR versus referent), more planar with decreased high-low distance (4.14±1.05 mm), and more circular with decreased ratio of mediolateral/anteroposterior (1.11±0.09 versus 1.32±0.09, P<0.0001, TR versus referent).

Conclusions— The normal TVA has a bimodal shape with distinct high points located anteroposteriorly and low points located mediolaterally. With functional TR, the annulus becomes larger, more planar, and circular. These changes in annular shape with TR have potentially important mechanistic and therapeutic implications for tricuspid valve repair.

---

 

CLINICAL PERSPECTIVE

Related Article:

Issue Highlights
Circulation 2006 114: 97. [Full Text]

This article has been cited by other articles:

				S. H. Rahimtoola The Year in Valvular Heart Disease. J. Am. Coll. Cardiol., February 19, 2008; 51(7): 760 - 770. [Full Text] [PDF]

				L. A. Bockeria, I. I. Skopin, and I. M. Tsiskaridze Tricuspid valve prosthetic annuloplasty Interactive CardioVascular and Thoracic Surgery, December 1, 2007; 6(6): 735 - 736. [Full Text] [PDF]

				A. E. Weyman The Year in Echocardiography J. Am. Coll. Cardiol., March 20, 2007; 49(11): 1212 - 1219. [Full Text] [PDF]