Usefulness of 3D echocardiographic parameters of tricuspid valve morphology to predict residual tricuspid regurgitation after tricuspid annuloplasty
Usefulness of 3D echocardiographic parameters of tricuspid valve morphology to predict residual tricuspid regurgitation after tricuspid annuloplasty
复制标题
DOI：
10.1093/ehjci/jew323
复制
发表时间：
2017-07-01
影响因子：
6.2
通讯作者：
Shiota, Takahiro
中科院分区：
文献类型：
--
作者：
Utsunomiya, Hiroto;Itabashi, Yuji;Shiota, Takahiro
目的 三尖瓣 (TV) 瓣环成形术是治疗三尖瓣反流 (TR) 的有效方法。然而，电视形态对电视瓣环成形术结果的影响仍不清楚。我们试图探讨术前TV形态与瓣环成形术后残余TR之间的关系。方法和结果对97例功能性TR患者术前和术后进行二维经胸超声心动图和三维(3D)经食管超声心动图检查。进行了 3D 定量评估，包括 3 个小叶的环形尺寸、隆起高度和体积以及长度和系绳角度。 TV形态学评分源自术前3D超声心动图，对小叶活动性、小叶增厚、瓣膜下增厚和钙化进行评分。 TR 严重程度由心尖和胸骨旁流入视图测量的平均收缩静脉决定。多变量分析显示，较短的小叶总长度 (P = 0.007)、较大的隆起体积 (P < 0.001) 和较高的 TV 形态评分 (P < 0.001) 与残余 TR 独立相关。 TV-Echo 评分根据接收者操作员特征分析确定为分数总和：瓣叶总长度 >61.0 mm、61.0 至 53.5 mm 和 = 2 与显着的残余 TR 相关，敏感性为 85.7%，特异性为 71.0%。 结论 除了瓣叶系留和长度短之外，TV 形态异常还预测 TV 瓣环成形术后的残余 TR。
Aims Tricuspid valve (TV) annuloplasty is an effective treatment for tricuspid regurgitation (TR). However, the impact of TV morphology on outcome of TV annuloplasty remains unknown. We sought to investigate the relationship between preoperative TV morphology and residual TR after annuloplasty.Methods and results Two-dimensional transthoracic and three-dimensional (3D) transesophageal echocardiography were performed in 97 patients with functional TR before and after surgery. 3D quantitative assessment including annular dimension, tenting height and volume, and lengths and tethering angles of the 3 leaflets was performed. The TV morphological score was derived from the preoperative 3D echocardiography to score a leaflet mobility, leaflet thickening, sub-valvular thickening, and calcification. TR severity was determined by the averaged vena contracta measured from the apical and parasternal inflow views. Multivariable analysis revealed that a shorter total leaflet length (P = 0.007), larger tenting volume (P < 0.001), and higher TV morphological score (P < 0.001) were independently associated with residual TR. A TV-Echo score was determined as a sum of points based on receiver operator characteristics analysis: total leaflet length >61.0 mm, 61.0 to 53.5 mm, and = 2 was associated with significant residual TR with a sensitivity of 85.7% and a specificity of 71.0%.Conclusion In addition to tethering and short length of the leaflets, TV morphological abnormality predicted residual TR after TV annuloplasty.