Geometric changes after tricuspid annuloplasty and predictors of residual tricuspid regurgitation: a real-time three-dimensional echocardiography study

AIMS: We sought to demonstrate geometric changes in the tricuspid valve (TV) apparatus after tricuspid annuloplasty (TAP) and to identify predictors of residual tricuspid regurgitation (TR) in patients with functional TR using real-time three-dimensional echocardiography (RT3DE). METHODS AND RESULTS: RT3DE and two-dimensional colour Doppler echocardiography were performed in 59 consecutive patients before and 4.7 ± 2.1 days after TAP. The tenting angles of the three leaflets were significantly increased, whereas tenting volume, annulus diameters, and septal-lateral right ventricular inlet dimension decreased after TAP. By multiple stepwise linear regression analysis, tenting volume (P < 0.001) and antero-posterior annulus diameter (P = 0.043) before TAP were major predictors of residual TR assessed using distal jet area. When TR severity was quantified by vena contracta width, tenting volume (P < 0.001) before TAP was the only independent predictor. Pre-TAP tenting volume ≥1.68 mL (sensitivity of 86%, specificity of 73%), and ≥2.30 mL (sensitivity of 100%, specificity of 84%) were the best cut-off values predicting severe residual TR quantified using distal jet area and vena contracta width, respectively. After TAP, tenting volume and pulmonary artery systolic pressure were major determinants of residual TR. CONCLUSION: Tenting angles of all three leaflets increase, whereas annulus diameters decrease, after TAP. Pre-TAP tenting volume and antero-posterior annulus diameter measured using RT3DE are independent predictors of residual TR severity, and measurement of these parameters may help to identify patients at high risk for severe residual TR, for whom TV replacement should possibly be initially considered.