Rausch Manuel K, Mathur Mrudang, Meador William D
Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, Institute for Computational Engineering and Sciences, University of Texas at Austin, TX, USA.
Mitt Ges Angew Math Mech. 2019 Sep;42(3). doi: 10.1002/gamm.201900012. Epub 2019 May 14.
The tricuspid annulus forms the boundary between the tricuspid valve leaflets and their surrounding perivalvular tissue of the right atrioventricular junction. Its shape changes throughout the cardiac cycle in response to the forces from the contracting right heart myocardium and the blood-valve interaction. Alterations to annular shape and dynamics in disease lead to valvular dysfunctions such as tricuspid regurgitation from which millions of patients suffer. Successful treatment of such dysfunction requires an in-depth understanding of the normal shape and dynamics of the tricuspid annulus and of the changes following disease and subsequent repair. In this manuscript we review what we know about the shape and dynamics of the normal tricuspid annulus and about the effects of both disease and repair based on non-invasive imaging studies and invasive fiduciary marker-based studies. We further show, by means of ovine data, that detailed engineering analyses of the tricuspid annulus provide regionally-resolved insight into the kinematics of the annulus which would remain hidden if limiting analyses to simple geometric metrics.
三尖瓣环构成了三尖瓣小叶与其右房室交界处周围瓣周组织之间的边界。在心动周期中,其形状会因右心心肌收缩力和血液与瓣膜相互作用而发生变化。疾病状态下瓣环形状和动力学的改变会导致瓣膜功能障碍,如数百万患者所患的三尖瓣反流。成功治疗此类功能障碍需要深入了解三尖瓣环的正常形状和动力学,以及疾病和后续修复后的变化。在本手稿中,我们基于非侵入性成像研究和基于侵入性 fiducial 标记的研究,回顾了我们对正常三尖瓣环的形状和动力学以及疾病和修复影响的了解。我们还通过绵羊数据表明,对三尖瓣环进行详细的工程分析可提供对瓣环运动学的区域分辨见解,而如果仅将分析局限于简单的几何指标,这些见解将被忽略。