Kapadia Sohum, Krishnaswamy Amar, Layoun Habib, Griffin Brian P, Wierup Per, Schoenhagen Paul, Harb Serge C
Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH, USA.
Cardiovasc Diagn Ther. 2021 Feb;11(1):68-80. doi: 10.21037/cdt-20-903.
Concomitant TV repair during mitral valve (MV) surgery based on tricuspid valve annulus (TVA) dilation, rather than the degree of tricuspid regurgitation (TR), is beneficial and supported by the valve guidelines. We sought to determine TVA geometry and dimensions in controls and assess the changes that occur in patients with severe primary (PMR) and secondary (SMR) mitral regurgitation without TR.
We analyzed cardiac computed tomographic angiography (CCTA) of 125 consecutive subjects: 50 controls with normal coronary CCTA and no valvular dysfunction, 50 PMR patients referred for robotic repair, and 25 SMR patients referred for transcatheter therapy. Patients with >2+ TR on echocardiography were excluded. Annular measurements were performed using dedicated software and compared. Correlations and determinants of TVA dimensions were analyzed.
Patients with SMR were older and had significantly more comorbidities. In controls, the TVA was larger and more planar and eccentric compared to the MV annulus (all P<0.01). Dimensions of both annuli correlated significantly (r≥0.5; P<0.001 for all dimensions) in controls and patients with severe MR. In both PMR and SMR, the TVA enlarged in all dimensions (P<0.01) with a trend towards becoming more circular. On multivariable regression, the MV annular area was the primary determinant of the TVA area (adjusted β=0.430, P<0.001).
Substantial changes in TVA dimensions are encountered in patients with severe MR even in the absence of severe TR such that TVA and MVA dimensions remain correlated. Close attention to the TVA in patients with severe MR is warranted.
在二尖瓣（MV）手术期间，基于三尖瓣环（TVA）扩张而非三尖瓣反流（TR）程度进行同期三尖瓣修复是有益的，且得到瓣膜指南的支持。我们试图确定对照组中TVA的几何形状和尺寸，并评估重度原发性（PMR）和继发性（SMR）二尖瓣反流且无TR患者中发生的变化。
我们分析了125例连续受试者的心脏计算机断层血管造影（CCTA）：50例冠状动脉CCTA正常且无瓣膜功能障碍的对照组，50例接受机器人修复的PMR患者，以及25例接受经导管治疗的SMR患者。排除超声心动图显示TR>2+的患者。使用专用软件进行瓣环测量并比较。分析TVA尺寸的相关性和决定因素。
SMR患者年龄较大且合并症明显更多。与MV瓣环相比，对照组中的TVA更大、更呈平面状且更偏心（所有P<0.01）。在对照组和重度二尖瓣反流患者中，两个瓣环的尺寸均显著相关（r≥0.5；所有尺寸的P<0.001）。在PMR和SMR中，TVA在所有维度上均增大（P<0.01），并有变得更圆的趋势。在多变量回归中，MV瓣环面积是TVA面积的主要决定因素（调整后β=0.430，P<0.001）。
即使在没有严重TR的情况下，重度二尖瓣反流患者的TVA尺寸也会发生显著变化，使得TVA和MVA尺寸仍保持相关。对于重度二尖瓣反流患者，有必要密切关注TVA。
