The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, United States.
J Biomech. 2013 Feb 22;46(4):832-6. doi: 10.1016/j.jbiomech.2012.11.054. Epub 2013 Jan 11.
Tricuspid regurgitation (TR) is associated with increased mortality in patients undergoing mitral valve repair. In recent decades, TR has been addressed using annuloplasty concomitantly with mitral valve repair by some surgeons. However, repair efficacy and durability are often suboptimal. Increased understanding of tricuspid valve coaptation and the effects of pathological and repair conditions may be useful to inform future repair design. In the present study, we propose a two-dimensional in vitro technique, available coaptation area (ACA), to quantify the area of each tricuspid leaflet available for coaptation. Preliminary results showed that annular dilatation caused a significant (p<0.05) decrease in anterior leaflet ACA (0.92±0.18cm(2)), and combined annular dilatation and papillary muscle (PM) displacement resulted in a significant decrease in posterior leaflet ACA (0.87±0.15cm(2)). Isolated PM displacement did not have a significant effect on ACA, and the septal leaflet showed no changed in ACA under the conditions tested. In addition to quantifying ACA, our technique allows for the detailed mapping of leaflet coaptation, which may be used to reveal specific sites of malcoaptation on each leaflet. Application of the ACA method in future studies may lead to the development of specialized tricuspid repair strategies and annuloplasty ring designs that target specific regions of the tricuspid valve based on underlying pathological conditions.
三尖瓣反流（TR）与接受二尖瓣修复的患者死亡率增加有关。在最近几十年中，一些外科医生同时使用瓣环成形术来解决 TR 问题，同时进行二尖瓣修复。然而，修复效果和耐久性往往并不理想。增加对三尖瓣瓣叶对合和病理及修复条件影响的了解，可能有助于为未来的修复设计提供信息。在本研究中，我们提出了一种二维体外技术，即可用对合面积（ACA），以量化每个三尖瓣瓣叶的可用对合面积。初步结果表明，瓣环扩张导致前瓣叶 ACA 显著减少（p<0.05）（0.92±0.18cm²），而瓣环扩张和乳头肌（PM）移位的联合作用导致后瓣叶 ACA 显著减少（0.87±0.15cm²）。孤立的 PM 移位对 ACA 没有显著影响，在测试条件下，隔瓣的 ACA 没有变化。除了定量 ACA 外，我们的技术还允许详细映射瓣叶对合，这可能用于揭示每个瓣叶上的特定错位部位。在未来的研究中应用 ACA 方法可能会导致专门的三尖瓣修复策略和瓣环成形环设计的发展，这些策略和设计基于潜在的病理状况，针对三尖瓣的特定区域。
