Dynamic Three-Dimensional Geometry of the Tricuspid Valve Annulus in Hypoplastic Left Heart Syndrome with a Fontan Circulation
Dynamic Three-Dimensional Geometry of the Tricuspid Valve Annulus in Hypoplastic Left Heart Syndrome with a Fontan Circulation
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DOI：
10.1016/j.echo.2019.01.002
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发表时间：
2019-05-01
影响因子：
6.5
通讯作者：
Jolley, Matthew A.
中科院分区：
文献类型：
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作者：
Nguyen, Alex V.;Lasso, Andras;Jolley, Matthew A.
背景：三尖瓣返流（TR）是左心发育不良综合征患者发病率和死亡率的重要因素。本研究的目的是描述与Fontan循环的HLHS患者的三尖瓣的动态环运动和评估与三尖瓣function.Methods的关系：HLHS与Fontan循环的48例患者的三尖瓣环进行建模，在结束时，收缩中期，收缩末期，并在3D Slicer中使用经胸三维超声心动图和自定义代码。结果：Fontan手术后5年（四分位距2-11年）进行影像学检查。三尖瓣环的形状在整个心动周期中变化很大，球形度变化（P <0.001），但环的高度或弯曲角度不变。在单变量模型中，与轻度或较少TR的患者相比，显著TR的患者在隔外侧直径、外侧象限面积和后象限面积方面的变化更大（P <0.05），并且APM角更小（更侧向）（P <0.001）。在多变量模型中，隔外侧直径最大变化增加1 mm/（体表面积）（0.5）与中度或更大TR增加1.7倍相关，而在收缩中期APM角减少10度与中度或更大TR增加近2.5倍相关（P
Background: Tricuspid regurgitation (TR) is a significant contributor to morbidity and mortality in patients with hypoplastic left heart syndrome. The goal of this study was to characterize the dynamic annular motion of the tricuspid valve in patients with HLHS with a Fontan circulation and assess the relation to tricuspid valve function.Methods: Tricuspid annuli of 48 patients with HLHS with a Fontan circulation were modeled at end-diastole, mid-systole, end-systole, and mid-diastole using transthoracic three-dimensional echocardiography and custom code in 3D Slicer. The angle of the anterior papillary muscle (APM) relative to the annular plane in each systolic phase was also measured.Results: Imaging was performed 5.0 years (interquartile range, 2-11 years) after Fontan operation. The tricuspid annulus varies in shape significantly throughout the cardiac cycle, changing in sphericity (P < .001) but not in annular height or bending angle. In univariate modeling, patients with significant TR had larger changes in septolateral diameter, lateral quadrant area, and posterior quadrant area (P < .05 for all) as well as lower (more laterally directed) APM angles (P < .001) than patients with mild or less TR. In multivariate modeling, a 1 mm/(body surface area)(0.5) increase in the maximum change in septolateral diameter was associated with a 1.7-fold increase in having moderate or greater TR, while a 10 degrees decrease in APM angle at mid-systole was associated with an almost 2.5-fold increase in moderate or greater TR (P