New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.
Medizinische Klinik und Poliklinik I, Klinikum der Universität München, and Munich Heart Alliance, Munich, Germany.
JACC Cardiovasc Imaging. 2021 Jul;14(7):1299-1305. doi: 10.1016/j.jcmg.2021.01.012. Epub 2021 Mar 17.
The purpose of this study was to introduce a novel clinically relevant nomenclature system for the TV and determine the relative incidence of each morphological type.
With the rapid development of transcatheter tricuspid valve (TV) repair techniques, there is a growing recognition of the variability in leaflet morphology and a need for a unified nomenclature, which could aid in procedural planning and execution.
Patients from 4 medical centers (2 in Europe, 2 in the United States) referred for transesophageal echocardiography (TEE) to assess native TV function, were retrospectively analyzed for leaflet morphology with the use of a novel classification scheme. Four morphological types were identified: type I, 3 leaflets; type II, 2 leaflets; type IIIA, 4 leaflets with 2 anterior; type IIIB, 4 leaflets with 2 posterior; type IIIC, 4 leaflets with 2 septal; and type IV, >4 leaflets.
A total of 579 patients were analyzed: mean age 78.1 ± 8.0 years, 50.4% female, 70.9% in atrial fibrillation, and 32.2% with previous left heart surgery or transcatheter intervention. Tricuspid regurgitation was moderate or less in 9.4%, severe in 40.5%, massive in 32.3%, and torrential in 17.7%. The etiology of tricuspid regurgitation was primary in 9.4%, mixed in 10.8%, and secondary in all of the other patients (18.6% atriogenic/isolated). The incidence of type I morphology was 312 of 579 (53.9%), type II was 26 of 579 (4.5%), type IIIA was 15 of 579 (2.6%), type IIIB was 186 of 579 (32.1%), type IIIC was 22 of 579 (3.8%), and type IV was 14 of 579 (2.4%).
A novel TV leaflet nomenclature classification scheme can be used to identify 4 types of TV morphologies with the use of TEE imaging. From this multinational retrospective study, the TV has 3 well defined leaflets in only ∼54% of patients and 4 functional leaflets in ∼39% of patients, with type IIIB (2 posterior leaflets) being the most common of the latter. The utility of this classification scheme deserves further study.
本研究旨在介绍一种新的临床相关三尖瓣（TV）命名系统，并确定每种形态类型的相对发生率。
随着经导管三尖瓣修复技术的快速发展，人们越来越认识到瓣叶形态的可变性，需要一种统一的命名法，这有助于程序规划和执行。
对来自 4 个医疗中心（欧洲 2 个，美国 2 个）的因评估原生 TV 功能而接受经食管超声心动图（TEE）检查的患者进行回顾性分析，使用一种新的分类方案评估瓣叶形态。确定了 4 种形态类型：I 型，3 个瓣叶；II 型，2 个瓣叶；IIIa 型，4 个瓣叶，前 2 个；IIIb 型，4 个瓣叶，后 2 个；IIIC 型，4 个瓣叶，2 个隔瓣；IV 型，>4 个瓣叶。
共分析了 579 例患者：平均年龄 78.1±8.0 岁，50.4%为女性，70.9%为心房颤动，32.2%有左心手术或经导管介入史。三尖瓣反流中度或以下占 9.4%，重度占 40.5%，大量反流占 32.3%， torrential 反流占 17.7%。三尖瓣反流的病因原发性占 9.4%，混合性占 10.8%，其余均为继发性（18.6%为心源性/孤立性）。I 型形态的发生率为 579 例中的 312 例（53.9%），II 型为 26 例（4.5%），IIIa 型为 15 例（2.6%），IIIb 型为 579 例中的 186 例（32.1%），IIIC 型为 22 例（3.8%），IV 型为 579 例中的 14 例（2.4%）。
使用 TEE 成像，可采用一种新的 TV 瓣叶命名分类方案来识别 4 种 TV 形态。从这项多中心回顾性研究来看，TV 只有约 54%的患者有 3 个明确的瓣叶，约 39%的患者有 4 个功能瓣叶，其中 IIIb 型（2 个后瓣叶）最为常见。这种分类方案的实用性值得进一步研究。
