Korean Circ J.  2010 Sep;40(9):448-453. 10.4070/kcj.2010.40.9.448.

Right Ventricular Remodeling Determines Tricuspid Valve Geometry and the Severity of Functional Tricuspid Regurgitation: A Real-Time 3-Dimensional Echocardiography Study

• Song JM
• Jang MK
• Kim YJ
• Kim DH
• Kang DH
• Song JK

• KMID: 1456137
• DOI: http://doi.org/10.4070/kcj.2010.40.9.448

Abstract

BACKGROUND AND OBJECTIVES
Right ventricle (RV) remodeling can determine tricuspid valve (TV) geometry and the severity of functional tricuspid regurgitation (TR).
SUBJECTS AND METHODS
In 53 patients with various degrees of functional TR and in sinus rhythm, RV and TV geometries were analyzed using real-time 3-dimensional echocardiography, including tenting angles of 3 leaflets, septal-lateral and antero-posterior tricuspid annulus diameters and inlet RV dimensions, mid-RV septal-lateral dimension, and the distance between annulus and apex. A mid-systole frame when the TV tenting is smallest was selected for the analysis. RV end-diastolic and end-systolic volumes were measured. The severity of functional TR was determined by distal jet area.
RESULTS
TR distal jet area was mainly determined by septal-lateral annulus diameter (p<0.001) RV inlet dimension (p=0.015), RV end-systolic volume (p=0.010), septal (p=0.019), and anterior leaflet tenting angles (p=0.045) by multiple stepwise linear regression analysis. Leaflet tenting angles were mainly determined by septal-lateral RV inlet dimension. Septal-lateral annulus diameter was determined by septal-lateral RV inlet dimension (p<0.001) and mid RV dimension (p=0.033), whereas antero-posterior annulus diameter was determined by antero-posterior RV inlet dimension (p<0.001).
CONCLUSION
Functional TR severity is determined by septal-lateral annulus and RV dilation, and tenting of septal and anterior leaflets. TV leaflet tenting is mainly determined by septal-lateral RV inlet dilation, and tricuspid annulus dilation is closely linked with inlet RV dilation.

Keyword

Tricuspid regurgitation; Right ventricle; 3-dimensional echocardiography

MeSH Terms

Bays
Echocardiography
Heart Ventricles
Humans
Linear Models
Tricuspid Valve
Tricuspid Valve Insufficiency
Ventricular Remodeling

Figure

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  Fig. 1 Geometric measurements using real-time 3-dimensional echocardiography. A: three longitudinal planes that perpendicularly cross the middle of each leaflet are generated by guidance on the short axis image of the tricuspid valve (upper panel). On each of these three longitudinal planes, the leaflet tenting angle between the tricuspid annulus line and the leaflet is measured on a mid-systole frame (lower panel). B: mutually perpendicular septal-lateral and antero-posterior longitudinal planes are created to measure septal-lateral and antero-posterior tricuspid annulus diameters, inlet right ventricular (RV) dimensions and mid RV septal-lateral dimension.

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  Fig. 2 Right ventricular (RV) volume measurement using real-time 3-dimensional echocardiography. RV end-systolic and end-diastolic volumes, and ejection fraction were measured using 4-dimensional RV analysis program.

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  Fig. 3 Correlations between distal jet area of tricuspid regurgitation (TR) and geometric variables of tricuspid valve and right ventricle (RV).

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  Fig. 4 Correlations between septal-lateral right ventricular (RV) inlet dimension and tenting angles of the 3 leaflets.

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  Fig. 5 Correlations between annulus diameters and right ventricular (RV) inlet dimensions of the corresponding directions.

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