Abstract 3408: Geometric Changes and Predictors of Residual Tricuspid Regurgitation After Tricuspid Annuloplasty: A Real-Time 3-Dimensional Echocardiography Study
Background: A significant tricuspid regurgitation (TR) was reported to persist after tricuspid annuloplasty (TAP). We aimed to demonstrate the geometric changes of tricuspid valve (TV) apparatus after TAP and identify predictors of residual TR in patients with functional TR using real-time 3D echocardiography (RT3DE).
Methods: RT3DE and 2D color Doppler echocardiography were performed in 59 patients before and within 10 days after TAP.
Results: Tenting angles of 3 leaflets were significantly increased, while tenting volume, annulus diameters and septal-lateral RV inlet dimension were decreased after TAP. By multiple linear regression analysis, tenting volume before TAP was the only independent predictor of residual TR (p<0.001). When tenting volume was removed from the variables, pre-TAP tenting angle of septal leaflet (Sα, p=0.01) and antero-posterior (A-P) annulus diameter (p=0.007) were independent predictors, while TR jet area before TAP was not. After TAP, 7 patients (12%) showed residual severe TR (distal jet area ≥10 cm2). Pre-TAP tenting volume ≥1.68 ml (sensitivity of 86%, specificity of 73%), Sα ≥19.4° (sensitivity of 86%, specificity of 75%), and A-P annulus diameter ≥36 mm (sensitivity of 100%, specificity of 65%) were best cut-off values for predicting severe residual TR.
Conclusions: Tenting angles of 3 leaflets increase, while annulus diameters decrease after TAP. Pre-TAP tenting volume, Sα, and A-P annulus diameter measured using RT3DE are independent predictors of residual TR severity, and these parameters may help to identify high-risk patients of severe residual TR, in whom TV replacement can be initially considered.