Tricuspid leaflet kinematics after annular size reduction in ovine functional tricuspid regurgitation
| Autor: | Manuel K. Rausch, Tomasz A. Timek, Haley Ferguson, Tomasz Jazwiec, Jared Bush, Marcin Malinowski |
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| Rok vydání: | 2022 |
| Předmět: |
Pulmonary and Respiratory Medicine
congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty medicine.medical_treatment Diastole Regurgitation (circulation) 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Animals cardiovascular diseases Reduction (orthopedic surgery) Mitral regurgitation Sheep Tricuspid valve business.industry Hemodynamics Tricuspid Valve Insufficiency Biomechanical Phenomena medicine.anatomical_structure Sonomicrometry 030228 respiratory system Echocardiography Ventricle cardiovascular system Cardiology Surgery Tricuspid Valve Cardiology and Cardiovascular Medicine Range of motion business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 164:e353-e366 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2021.01.104 |
| Popis: | Objective Tricuspid annular size reduction with annuloplasty rings represents the foundation of surgical repair of functional tricuspid regurgitation. However, the precise effect of annular size reduction on leaflet motion and geometry remains unknown. Methods Ten sheep underwent surgical implantation of a pacemaker with an epicardial lead and were paced 200-240 beats/min to achieve biventricular dysfunction and functional tricuspid regurgitation. Subsequently, sonomicrometry crystals were implanted on the right ventricle, the tricuspid annulus, and on the belly of anterior, posterior, and septal tricuspid leaflets. Double-layer polypropylene suture was placed around the tricuspid annulus and externalized to a tourniquet. Simultaneous echocardiographic, hemodynamic, and sonomicrometry data were acquired with functional tricuspid regurgitation and during 5 consecutive annular reduction steps. Annular area, tenting height, and volume, together with each leaflet strain, radial length, and angles, were calculated from crystal coordinates. Results Rapid pacing reduced both left ventricle and right ventricle function and induced functional tricuspid regurgitation (0-3+) in all animals (from 0 ± 0 to 2.4 ± 0.7, P = .002), whereas tricuspid annulus diameter increased from 2.6 ± 0.3 cm to 3.3 ± 0.3 cm (P = .001). Tricuspid annular size reduction 1 to 5 resulted in 16% ± 7%, 37% ± 11%, 55% ± 11%, 66% ± 10%, and 76% ± 8% tricuspid annulus area reduction, respectively, and successively decreased tricuspid regurgitation. Tricuspid annular size reduction 2 to 5 induced anterior and posterior leaflet restricted motion and lower diastolic motion velocities. Tricuspid annular size reduction 5 perturbed septal leaflet range of motion but preserved its angle velocities. Tricuspid annular size reduction 3-5 generated compressive strains in all leaflets. Conclusions Tricuspid annular area reduction of 55% perturbed anterior and posterior leaflet motion while maintaining normal septal leaflet movement. More extreme reduction triggered profound changes in anterior and posterior leaflet motion, suggesting that aggressive undersizing impairs leaflet kinematics. |
| Databáze: | OpenAIRE |
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