Key result
Patients with dilated right hearts had a significantly larger tricuspid annular area (mean 1566 vs 1097 mm2; P<0.01) and a more circular orifice compared to controls.
Why the study?
How do the dimensions and dynamics of the tricuspid valve annulus differ between normal and dilated right hearts when assessed by 3D TOE?
Cross-Sectional (n=50)
How do the dimensions and dynamics of the tricuspid valve annulus differ between normal and dilated right hearts when assessed by 3D TOE?
Absolute Event Rate: 1566% vs 1097%
p-value: p=<0.01
Three-dimensional TOE demonstrates that in dilated right hearts, the tricuspid valve annulus dilates primarily in the septo-lateral direction and loses its dynamic changes, becoming more circular and potentially contributing to functional tricuspid regurgitation.
3D TOE reveals annular changes in right heart dilation; leaves open their role in functional TR and need for prospective validation.
BACKGROUND: The tricuspid valve annulus (TVA) is a complex three-dimensional structure that is incompletely understood. Three-dimensional transoesophageal echo (TOE) provides us with the opportunity to examine this structure in detail. METHODS AND RESULTS: Fifty patients were included, divided into two groups: controls (n = 20), and dilated right hearts (DRH, n = 30). Three-dimensional zoom images of the TVA were acquired using an iE33 machine and X7-2t transducer. Antero-posterior (AP) diameter, septo-lateral (SL) diameter, area, circumference, and height were measured at 6 points of the cardiac cycle adapting commercially available software designed for assessing the mitral valve (MVQ, Philips). The eccentricity ratio was calculated as AP/SL. The tricuspid annular area decreases during systole in both groups, and is greatest in mid-diastole. The area is significantly larger in the DRH group (mean 1566 mm(2) DRH vs. 1097 mm(2) controls; P < 0.01). The SL diameter increases proportionately more in the DRH group, resulting in a more circular orifice and lower eccentricity ratios (eccentricity ratio mean 1.01 DRH vs. 1.24 controls; P < 0.01). The dynamic diastolic to systolic change in the SL diameter is lost in patients with DRH, contributing to the more circular TVA orifice throughout systole. CONCLUSION: Three-dimensional TOE allows us to examine the TVA in great detail. In patients with DRH, the TVA dilates in a SL direction, resulting in a more circular orifice. The dynamic changes of the TVA are lost in patients with DRH, potentially contributing to functional tricuspid regurgitation.
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Ring et al. (2012) conducted a cross-sectional in Dilated right hearts (n=50). Dilated right hearts vs. Controls was evaluated on Tricuspid annular area (mm2) (p=<0.01). Patients with dilated right hearts had a significantly larger tricuspid annular area (mean 1566 vs 1097 mm2; P<0.01) and a more circular orifice compared to controls.
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