Bieliauskienė Gintarė, Kažukauskienė Ieva, Janušauskas Vilius, Zorinas Aleksejus, Ručinskas Kęstutis, Mainelis Antanas, Zakarkaitė Diana
Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21, 03101 Vilnius, Lithuania.
Faculty of Mathematics and Informatics, Vilnius University, Naugarduko 24, 03225 Vilnius, Lithuania.
J Clin Med. 2023 Jun 16;12(12):4093. doi: 10.3390/jcm12124093.
It is unclear to what degree of tricuspid annulus (TA) reduction is necessary to achieve good postoperative results in surgical bicuspidization. The study aimed to evaluate TA and right heart chamber's dimensions before and after heart surgery; and to compare TA parameters assessed by different modalities.
Forty patients underwent mitral valve surgery with or without concomitant tricuspid valve (TV) bicuspidization. Preoperative and postoperative measurements of TA dimensions were performed prospectively using two-dimensional (2D) and three-dimensional (3D) transthoracic echocardiography (TTE). Additionally, preoperative transesophageal echocardiography (TOE) was performed in the operating room prior to surgery.
All patients had no or mild TR immediately after surgery. There was a significant reduction in 2D and 3D parameters of the TV and right chambers in the TV bicuspidization group. However, TV leaflets' tethering parameters did not change significantly. Preoperative 3D TTE measurements were smaller than those obtained through 3D TOE in the operation room, before surgery under general anesthesia. The 2D systolic apical 4Ch diameter and the parasternal short axis diameter mainly represent the 3D minor axis of the TA and are smaller than its 3D major axis.
Although bicuspidization results in a one-third reduction of the TV area, tethering of the TV leaflets remains unchanged. Moreover, 3D TOE parameters of the TV under general anesthesia are larger than preoperative 3D TTE measurements. Conventional 2D measurements are insufficient for evaluating the maximum diameter of the TA.
在外科双叶化手术中，尚不清楚三尖瓣环（TA）缩小到何种程度才能取得良好的术后效果。本研究旨在评估心脏手术前后TA及右心腔的尺寸；并比较不同方式评估的TA参数。
40例患者接受了二尖瓣手术，部分患者同时进行了三尖瓣（TV）双叶化手术。术前和术后前瞻性地使用二维（2D）和三维（3D）经胸超声心动图（TTE）测量TA尺寸。此外，术前在手术室进行了经食管超声心动图（TOE）检查。
所有患者术后即刻均无或仅有轻度三尖瓣反流（TR）。TV双叶化组TV及右心腔的2D和3D参数均显著降低。然而，TV瓣叶的牵拉参数无显著变化。术前3D TTE测量值小于全麻下手术前在手术室通过3D TOE获得的测量值。2D收缩期心尖四腔心直径和胸骨旁短轴直径主要代表TA的3D短轴，小于其3D长轴。
尽管双叶化导致TV面积减少三分之一，但TV瓣叶的牵拉保持不变。此外，全麻下TV的3D TOE参数大于术前3D TTE测量值。传统的2D测量不足以评估TA的最大直径。
