Abstract 17914: Early Tricuspid Regurgitation in Hypoplastic Left Heart Syndrome Had Greater Tricuspid Valve Annulus and Tethering Volume
Introduction: Tricuspid regurgitation (TR) is a major risk factor for morbidity and mortality in hypoplastic left heart syndrome (HLHS). Significant TR prior to stage 1 surgical palliation (S1P) may alter management strategies in HLHS. There is limited data on causes of TR prior to S1P. We hypothesized that tricuspid valve (TV) and right ventricular (RV) dysfunction contribute to the degree of TR.
Methods: Selected infants with HLHS were assessed with two (2DE) and three-dimensional echo (3DE) prior to S1P. 2DE was used to assess degree of TR (grade 0-4; nil to severe), mitral valve (MV) annulus size, RV fractional area change (FAC), RV sphericity index (SI) and RV end-diastolic area (RVEDa). The TV 3DE data sets were analyzed off-line to extract spatial coordinates of TV annulus and leaflets (TomTec Inc, Unterschleissheim, Germany), with annulus size, leaflet areas, prolapse and tethering volumes calculated using customized MatLab-based software (MathWorks Inc, Natick, Mass).
Results: Of 21 patients, 3 patients had moderate TR, 5 had mild TR and 13 had trivial or no TR. The severity of TR grade correlated with increasing tethering volume (R=0.64; P<0.01), TV annulus (R=0.69; P<0.01) and leaflet size (R=0.78; P<0.01) and decreased RV FAC (R=-0.52, P<0.05). In turn tethered volume correlated with RV size (R=0.54; P=0.01), FAC (R= -0.47; P=0.03), MV annulus (R=-0.57; P<0.01) and TV leaflet (R=0.8, P<0.01) and annulus size (R=0.9, P<0.01). RV FAC was associated with decreased RV size (R=-0.59, P<0.01). TV prolapse volumes were not related to RV function or size, degree of TR or TV size.
Conclusion: Early TR, prior to S1P, is moderately associated with both TV morphology and leaflet tethering and RV function. TV tethering forces in turn appears to be influenced by RV size and function as well as TV morphology. Further investigation into the important interplay between TV and RV function in HLHS is needed.
- © 2012 by American Heart Association, Inc.