Reverse Remodeling of Tricuspid Valve Morphology and Function in Chronic Thromboembolic Pulmonary Hypertension Patients Following Pulmonary Thromboendarterectomy – A Cardiac Magnetic Resonance Imaging and Invasive Hemodynamic Study

BackgroundTo investigate changes in tricuspid annulus (TA) and tricuspid valve (TV) morphology among chronic thromboembolic pulmonary hypertension (CTEPH) patients before and 12 months after pulmonary thromboendarterectomy (PEA) and compare these findings to normal control subjects. Methods20 CTEPH patients and 20 controls were enrolled in the study. The patients were examined with echocardiography, right heart catherization and cardiac magnetic resonance imaging prior to PEA and 12 months after.ResultsRight atrium (RA) volume was significantly reduced from baseline to 12 months after PEA (30 ±9 versus 23 ±5ml/m2, p<0.005). TA base area in systole remained unchanged (p=0.11) and was comparable to controls. The leaflet area, tenting volume and tenting height in systole were significantly increased at baseline but decreased significantly with comparable values to controls after 12 months (p<0.005). There was correlation between the changes of right ventricular-pulmonary artery coupling and changes of TV tenting height (r = -0.54, p=0.02), TV tenting volume (r = -0.73, p<0.001) and TV leaflet area (-0.57, p = 0.01) from baseline to 12 months after PEA. Tricuspid regurgitation jet area/RA area was significantly (p<0.01) reduced from baseline (30 ±13%) to 12 months after PEA (9 ±10%).ConclusionsIn CTEPH patients selected for PEA, TV tenting height, volume and valve area are significantly increased whereas annulus size and shape are less affected. The alterations in TV morphology are fully reversed after PEA and correlates to improvements of right ventricular-pulmonary arterial coupling.