Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia.
Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia.
J Cardiothorac Vasc Anesth. 2021 Sep;35(9):2715-2722. doi: 10.1053/j.jvca.2021.02.067. Epub 2021 Mar 10.
Quantification of the tricuspid annulus (TA) is an important factor in determining the requirement for tricuspid annuloplasty in cardiac surgery. Three-dimensional echocardiography (3DE) has shown that the TA is biplanar with an antero-posterior longaxis and septo-lateral shortaxis, and that the commonly used 2D TEE (two-dimensional transesophageal echocardiography) four-chamber view (4ChV) underestimates the true TA longaxis. The authors hypothesized that the use of multiple 2D TEE TA views could attain greater TA long-axis measurements and smaller TA short-axis measurements than the 4ChV, and that the 4ChV has a significant but inconsistent bias relative to the maximal TA diameter measured by these views.
Prospective observational study.
Adult tertiary teaching hospital.
45 adult patients.
Multiplanar 2D TEE assessment of the tricuspid annulus.
Multiplanar assessment reliably produced larger TA long-axis measurements (93% of patients, 95% confidence interval: 81-98%) of (mean [95% confidence interval]) 40 mm (28-50 mm) compared with the 4ChV (34mm [25-44 mm], p < 0.0001) and smaller TA short-axis measurements (29 mm [20-38 mm], p < 0.0001) compared with the 4ChV. TA diameter by 4ChV assessment yielded an average bias of -5.6 mm, with 95% limits of agreement -15 to +3.9 mm compared with the largest TA long-axis measurement by multiplanar assessment.
Multiplanar 2D TEE assessment of the TA long- and short-axis consistently achieves larger and smaller measurements, respectively, than the 4ChV. The 4ChV also is not a reliable index of the TA longaxis. If the time, proficiency, or equipment required for 3DE TA assessment are unavailable, the use of multiple standard and non-standard 2D TEE TA views may offer an alternative for TA assessment.
三尖瓣环（TA）的定量是确定心脏手术中三尖瓣环成形术需求的重要因素。三维超声心动图（3DE）显示 TA 是双平面的，有前后长轴和隔侧短轴，而常用的二维经食管超声心动图（2D TEE）四腔心切面（4ChV）低估了真实的 TA 长轴。作者假设，使用多个 2D TEE TA 切面可以获得比 4ChV 更大的 TA 长轴测量值和更小的 TA 短轴测量值，并且 4ChV 与这些切面测量的最大 TA 直径之间存在显著但不一致的偏差。
前瞻性观察性研究。
成人三级教学医院。
45 名成年患者。
三尖瓣的多平面 2D TEE 评估。
多平面评估可靠地产生了更大的 TA 长轴测量值（93%的患者，95%置信区间：81-98%）（平均值[95%置信区间]）40mm（28-50mm），与 4ChV（34mm[25-44mm]，p<0.0001）相比，并且与 4ChV 相比，TA 短轴测量值更小（29mm[20-38mm]，p<0.0001）。4ChV 评估的 TA 直径产生了平均偏差-5.6mm，95%置信区间为-15 到+3.9mm，与多平面评估的最大 TA 长轴测量值相比。
多平面 2D TEE 评估 TA 的长轴和短轴分别比 4ChV 实现了更大和更小的测量值。4ChV 也不是 TA 长轴的可靠指标。如果 3DE TA 评估所需的时间、熟练程度或设备不可用，使用多个标准和非标准 2D TEE TA 切面可能是 TA 评估的替代方法。
