Sukmawan Renan, Watanabe Nozomi, Ogasawara Yasuo, Yamaura Yasuko, Yamamoto Katsunori, Wada Nozomi, Kume Teruyoshi, Okura Hiroyuki, Yoshida Kiyoshi
Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan.
J Am Soc Echocardiogr. 2007 May;20(5):470-6. doi: 10.1016/j.echo.2006.10.001.
Geometric changes of tricuspid valve, particularly leaflets configuration, in functional tricuspid regurgitation (TR) remain to be defined. We sought to investigate geometric changes of tricuspid valve tenting in functional TR secondary to pulmonary hypertension by transthoracic real-time 3-dimensional echocardiography (3DE). Real-time 3DE was performed in 30 individuals (17 patients with TR and 13 control subjects). We used a novel software system with 3DE to reconstruct tricuspid geometry at midsystole. In patients with TR, tricuspid leaflets were tethered into right ventricle with apparent tenting showing a mountain-like bulging. Maximum tenting site was mostly located at the center of the tenting. Tenting volume was larger (4.2 +/- 2.4 vs 1.1 +/- 0.6 cm(3), P < .001), and the maximum and mean tenting lengths were longer, than in control subjects. Annular area was also larger (11.3 +/- 2.3 vs 8.7 +/- 1.8 cm(2), P = .003) than in control subjects. Geometric changes in functional TR secondary to pulmonary hypertension were characterized by enlargement of tricuspid tenting volume and dilatation of annulus. This study suggested usefulness of the novel system with 3DE in evaluation of tricuspid valve geometry.
三尖瓣的几何形态变化，尤其是瓣叶结构，在功能性三尖瓣反流（TR）中仍有待明确。我们试图通过经胸实时三维超声心动图（3DE）研究继发于肺动脉高压的功能性TR中三尖瓣帐篷样改变的几何形态变化。对30例个体（17例TR患者和13例对照者）进行了实时3DE检查。我们使用一种新型的3DE软件系统在收缩中期重建三尖瓣几何形态。在TR患者中，三尖瓣瓣叶被牵拉至右心室，出现明显的帐篷样改变，呈山峰样凸起。最大帐篷样改变部位大多位于帐篷的中心。与对照者相比，帐篷样改变体积更大（4.2±2.4 vs 1.1±0.6 cm³，P<.001），最大和平均帐篷样改变长度更长。瓣环面积也比对照者更大（11.3±2.3 vs 8.7±1.8 cm²，P=.003）。继发于肺动脉高压的功能性TR的几何形态变化特征为三尖瓣帐篷样改变体积增大和瓣环扩张。本研究提示新型3DE系统在评估三尖瓣几何形态方面具有实用性。
