Owais Khurram, Taylor Charles E, Jiang Luyang, Khabbaz Kamal R, Montealegre-Gallegos Mario, Matyal Robina, Gorman Joseph H, Gorman Robert C, Mahmood Feroze
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, Louisiana.
Ann Thorac Surg. 2014 Nov;98(5):1536-42. doi: 10.1016/j.athoracsur.2014.07.005. Epub 2014 Sep 22.
Before clinical manifestation of regurgitation, the tricuspid annulus dilates and flattens when right ventricular dysfunction is potentially reversible. That makes the case for a prophylactic tricuspid annuloplasty even in the absence of significant tricuspid regurgitation. Owing to the appreciation of the favorable prognostic value of tricuspid annuloplasty, the geometry of the normal tricuspid annulus merits critical analysis.
Three-dimensional transesophageal echocardiographic data from 26 patients were analyzed using Image Arena (TomTec, Munich, Germany) software. Cartesian coordinate data from tricuspid annuli were exported to MATLAB (Mathworks, Natick, MA) for further processing. Annular metrics related to size, shape, and motion were computed.
The tricuspid annulus demonstrated significant changes in area (p<0.01) and perimeter (p<0.03) during the cardiac cycle, with maximum values attained at end diastole. There was significant correlation between two- and three-dimensional area changes, indicating true expansion in the annulus. The anterolateral region of the annulus demonstrated the greatest dynamism (p<0.01), and the anteroseptal region showed the least. The anteroseptal region also displayed the most nonplanarity in the annulus. In addition, vertical translational motion was observed, with a mean distance of 11.3±3.7 mm between end systolic and end diastolic annular centroids.
The tricuspid annulus is a dynamic, multiplanar structure with heterogeneous regional behavior. These characteristics should be taken into account for optimal annuloplasty device design and efficacy.
在反流临床表现出现之前，当右心室功能障碍可能可逆时，三尖瓣环会扩张并变平。这使得即使在没有明显三尖瓣反流的情况下，也有理由进行预防性三尖瓣环成形术。由于认识到三尖瓣环成形术具有良好的预后价值，正常三尖瓣环的几何形状值得进行批判性分析。
使用Image Arena（德国慕尼黑TomTec公司）软件分析了26例患者的三维经食管超声心动图数据。将三尖瓣环的笛卡尔坐标数据导出到MATLAB（美国马萨诸塞州纳蒂克Mathworks公司）进行进一步处理。计算了与大小、形状和运动相关的瓣环指标。
在心动周期中，三尖瓣环的面积（p<0.01）和周长（p<0.03）有显著变化，在舒张末期达到最大值。二维和三维面积变化之间存在显著相关性，表明瓣环有真正的扩张。瓣环的前外侧区域显示出最大的动态变化（p<0.01），前间隔区域显示的动态变化最小。前间隔区域在瓣环中也表现出最大的非平面性。此外，观察到垂直平移运动，收缩末期和舒张末期瓣环质心之间的平均距离为11.3±3.7 mm。
三尖瓣环是一个动态的、多平面的结构，具有异质性的区域行为。在设计最佳的瓣环成形术装置和评估其疗效时，应考虑这些特征。
