Abstract 11751: Tricuspid Annular Dynamics Before and After Tricuspid Annuloplasty -real-time 3-dimensional Transesophageal Echocardiography Study
BACKGROUND Recent advances in full-volume real-time 3-dimensional echocardiography (RT3DE) allow for quantification of tricuspid size and motion. However, little is known about the impact of surgical reconstruction on annular dynamics. We assessed tricuspid annulus dynamics using transesophageal RT3DE before and after tricuspid annuloplasty (TAP) with different types of prosthetic rings.
METHODS RT3DE images of the tricuspid valve were acquired in 21 patients (TAP with rigid ring (RR): 6, TAP with flexible ring (FR): 7, control: 8). Tricuspid annular dimensions [circumference area and length, annular height, antero-posterior (AP) and septo-lateral (SL) diameter] were measured throughout the cardiac cycle.
RESULTS (1) All postoperative tricuspid annular dimension parameters were significantly reduced by TAP, while the AP/SL ratio was significantly increased (pre: 0.9±0.1, post: 1.1±0.1, p>0.05). (2) The difference in annular area between diastole and systole was significantly smaller in TAP patients (9.2%) than the normal subjects (17.7%, p>0.05). (3) Annular height in patients with a FR was significantly smaller than that in those with a RR (Table, p>0.05). (4) Postoperative AP/SL ratio was higher in FR than RR patients (Table, p>0.05) and similar to the normal subjects. (5) Dynamic diastolic to systolic change in SL diameter was lost in patients with a RR, while it was seen in the FR patients and normal subjects.
CONCLUSION TAP reduced annular dynamics. Although a rigid ring provided higher annular height, septo-lateral motion was lost, resulting in a more circular tricuspid valve orifice. A flexible ring retained septo-lateral motion and the tricuspid valve orifice shape was similar to normal subjects, though annular height was lost. Postoperative RT3DE may be useful for assessing tricuspid annular dynamics before and after TAP.
- © 2012 by American Heart Association, Inc.