Institute of Cardiology, Warsaw, Poland.
J Am Soc Echocardiogr. 2010 May;23(5):504-10. doi: 10.1016/j.echo.2010.01.007. Epub 2010 Mar 2.
Although the functional anatomy of mitral regurgitation has been thoroughly studied and is strongly predictive of postoperative outcome, the functional anatomy of tricuspid regurgitation (TR) in patients with systemic right ventricles has not been described.
We measured the indices of tricuspid valve deformation, right ventricular remodeling and function, and brain natriuretic peptide (BNP) concentrations in a series of 42 patients (mean age 20.8 +/- 3.7 years) with systemic right ventricles after atrial switch for complete transposition of the great arteries.
TR was present in 34 patients. It was associated with predominant annular dilatation in 5 patients (14.7%), valvular prolapse in 14 patients (41.1%), and systolic leaflet tethering in 15 patients (44.1%). Compared with patients with valve prolapse, patients with leaflet tethering had greater end-systolic right ventricular cavity area (21.1 +/- 3.6 cm(2) vs 27.3 +/- 7.9 cm(2); P < .05), lower right ventricular fractional area change (0.40 +/- 0.09 vs 0.34 +/- 0.09, P < .05), and higher BNP levels (14.6 +/- 13.5 pg/mL vs 25 +/- 24.3 pg/mL, P < .05). Intermediate values were observed in patients with annular dilatation (23.9 +/- 5.6 cm(2); 0.37 +/- 0.05 pg/mL and 19.0 +/- 0.07 pg/mL, respectively).
Three distinct types of TR, caused by predominant annular dilatation, valve prolapse, and valve tethering, were apparent in patients with systemic right ventricles. They were associated with diverse severity of right ventricular dysfunction and BNP activation. Further studies are needed to assess the impact of variable functional anatomy of the systemic tricuspid valve on the outcome of medical and surgical therapies.
尽管二尖瓣反流的功能解剖结构已经得到了深入研究，并对术后结果具有很强的预测性，但在具有系统性右心室的患者中，三尖瓣反流（TR）的功能解剖结构尚未得到描述。
我们测量了一系列 42 例接受房间隔转换术的完全性大动脉转位患者（平均年龄 20.8 ± 3.7 岁）的三尖瓣变形指数、右心室重构和功能以及脑利钠肽（BNP）浓度。
34 例患者存在 TR。其中 5 例（14.7%）存在主要瓣环扩张，14 例（41.1%）存在瓣叶脱垂，15 例（44.1%）存在收缩期瓣叶牵拉。与瓣叶脱垂患者相比，瓣叶牵拉患者的右心室收缩末期腔面积更大（21.1 ± 3.6 cm² vs. 27.3 ± 7.9 cm²；P <.05），右心室射血分数更低（0.40 ± 0.09 vs. 0.34 ± 0.09，P <.05），BNP 水平更高（14.6 ± 13.5 pg/mL vs. 25 ± 24.3 pg/mL，P <.05）。瓣环扩张患者的数值居中（23.9 ± 5.6 cm²；0.37 ± 0.05 pg/mL 和 19.0 ± 0.07 pg/mL）。
在具有系统性右心室的患者中，明显存在三种不同类型的 TR，由主要瓣环扩张、瓣叶脱垂和瓣叶牵拉引起。它们与右心室功能障碍和 BNP 激活的不同严重程度有关。需要进一步研究以评估系统性三尖瓣不同功能解剖结构对药物和手术治疗效果的影响。
