Valvular complex and tissue remodelling in ovine functional tricuspid regurgitation.
Valvular complex and tissue remodelling in ovine functional tricuspid regurgitation.
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羊功能性三尖瓣反流的瓣膜复合体和组织重塑。
DOI：
10.1093/ejcts/ezad115
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Timek,TomaszA
中科院分区：
文献类型：
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作者：
Iwasieczko,Artur;Gaddam,Manikantam;Gaweda,Boguslaw;Goodyke,Austin;Mathur,Mrudang;Lin,Chien-Yu;Zagorski,Joseph;Solarewicz,Monica;Cohle,Stephen;Rausch,Manuel;Timek,TomaszA
功能性三尖瓣反流（FTR）的病理生理学尚不完全清楚。我们开始全面评估几何和组织重塑的三尖瓣复杂的羊FTR.METHODSTwenty成年羊进行左胸廓切开术和肺动脉结扎术（PAB），以诱导右心压力超负荷和FTR。8周后，17只存活动物和10只健康对照组（CTL）进行胸骨切开术，超声心动图检查和右心室和三尖瓣结构的声显微晶体植入。从体外循环中脱机后，采集所有动物的血流动力学和声显微测量数据。收获瓣叶组织用于五色组织学分析和生物力学测试。CTL和PAB的动物体重分别为62 ± 5和63 ± 3 kg（P= 0.6）。在终末手术时，CTL和PAB的收缩期肺动脉压分别为22 ± 3和40 ± 7 mmHg（P= 0.0001）。对照组和绑扎组动物的平均TR等级（+0-4）分别为0.8 ± 0.4和3.2 ± 1.2（P= 0.0001）。右心室容积（126 ± 13 vs 172 ± 34 ml，P= 0.0019），三尖瓣环面积（651 ± 109 vs 865 ± 247 mm 2，P= 0.037）和乳头肌尖端之间的面积（162 ± 51 vs 302 ± 75 mm 2，P= 0.001）显著增加，而前叶收缩期位移显著降低（23.8 ± 6.1° vs 7.4 ± 4.5°，P= 0.001）。总瓣叶表面积从806 ± 94增加到953 ± 148 mm 2（P= 0.009），瓣叶变厚变硬。结论三尖瓣复合体的详细分析显示，显著的心室、瓣环、瓣下和瓣叶重塑与绵羊功能性三尖瓣反流相关。严重FTR的持久手术修复可能需要对瓣膜装置进行多水平入路。
OBJECTIVESPathophysiology of function tricuspid regurgitation (FTR) is incompletely understood. We set out to comprehensively evaluate geometric and tissue remodelling of the tricuspid valve complex in ovine FTR.METHODSTwenty adult sheep underwent left thoracotomy and pulmonary artery banding (PAB) to induce right heart pressure overload and FTR. After 8 weeks, 17 surviving animals and 10 healthy controls (CTL) underwent sternotomy, echocardiography and implantation of sonomicrometry crystals on right ventricle and tricuspid valvular apparatus. Haemodynamic and sonomicrometry data were acquired in all animals after weaning from cardiopulmonary bypass. Leaflet tissue was harvested for pentachrome histologic analysis and biomechanical testing.RESULTSAnimal weight was 62 ± 5 and 63 ± 3 kg for CTL and PAB, respectively (P= 0.6). At terminal procedure, systolic pulmonary artery pressure was 22 ± 3 and 40 ± 7 mmHg for CTL and PAB, respectively (P= 0.0001). The mean TR grade (+0–4) was 0.8 ± 0.4 and 3.2 ± 1.2 (P= 0.0001) for control and banded animals, respectively. Right ventricle volume (126 ± 13 vs 172 ± 34 ml,P= 0.0019), tricuspid annular area (651 ± 109 vs 865 ± 247 mm2,P= 0.037) and area between papillary muscle tips (162 ± 51 vs 302 ± 75 mm2,P= 0.001) increased substantially while systolic excursion of anterior leaflet decreased significantly (23.8 ± 6.1° vs 7.4 ± 4.5°,P= 0.001) with banding. Total leaflet surface area increased from 806 ± 94 to 953 ± 148 mm2(P= 0.009), and leaflets became thicker and stiffer.CONCLUSIONSDetailed analysis of the tricuspid valve complex revealed significant ventricular, annular, subvalvular and leaflet remodelling to be associated with ovine functional tricuspid regurgitation. Durable surgical repair of severe FTR may require a multi-level approach to the valvular apparatus.