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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 - Korean Circ J (2010)

Bottom Line: Leaflet tenting angles were mainly determined by septal-lateral RV inlet dimension.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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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Figure 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.

Mentions: Using dedicated software (Tomtec, Munich, Germany), three longitudinal planes that perpendicularly crossed the middle of each leaflet were generated using guidance on the short axis image of the TV (Fig. 1A). On each of the three longitudinal planes, the leaflet tenting angles between the tricuspid annulus line and the three leaflets (anterior: Aα, posterior: Pα, septal: Sα) were measured on a mid-systole frame. Septal-lateral and antero-posterior longitudinal planes, which were mutually perpendicular, were created to measure septal-lateral and antero-posterior tricuspid annulus diameters (Fig. 1B). RV inlet dimensions were also measured 1 cm away from, and parallel to, the annulus lines, on both septal-lateral and antero-posterior planes. The septal-lateral mid RV dimension was measured at the mid portion between the TV annulus and RV apex. The antero-posterior mid RV dimension could not be measured because the RV flow tract is located on the anterior side. The distance between TV annulus and RV apex were measured on the septal-lateral and antero-posterior longitudinal planes. When these two values are not equal, the larger one was chosen. All measurement points marked on RT3DE still frames were verified by overlap with moving images. RV end-systolic and end-diastolic volumes were measured using 4D RV analysis (Tomtec, Munich, Germany) (Fig. 2), and RV ejection fraction was calculated.


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 - Korean Circ J (2010)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2957637&req=5

Figure 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.
Mentions: Using dedicated software (Tomtec, Munich, Germany), three longitudinal planes that perpendicularly crossed the middle of each leaflet were generated using guidance on the short axis image of the TV (Fig. 1A). On each of the three longitudinal planes, the leaflet tenting angles between the tricuspid annulus line and the three leaflets (anterior: Aα, posterior: Pα, septal: Sα) were measured on a mid-systole frame. Septal-lateral and antero-posterior longitudinal planes, which were mutually perpendicular, were created to measure septal-lateral and antero-posterior tricuspid annulus diameters (Fig. 1B). RV inlet dimensions were also measured 1 cm away from, and parallel to, the annulus lines, on both septal-lateral and antero-posterior planes. The septal-lateral mid RV dimension was measured at the mid portion between the TV annulus and RV apex. The antero-posterior mid RV dimension could not be measured because the RV flow tract is located on the anterior side. The distance between TV annulus and RV apex were measured on the septal-lateral and antero-posterior longitudinal planes. When these two values are not equal, the larger one was chosen. All measurement points marked on RT3DE still frames were verified by overlap with moving images. RV end-systolic and end-diastolic volumes were measured using 4D RV analysis (Tomtec, Munich, Germany) (Fig. 2), and RV ejection fraction was calculated.

Bottom Line: Leaflet tenting angles were mainly determined by septal-lateral RV inlet dimension.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus