Tricuspid Valve Tethering Is Associated with Residual Regurgitation after Valve Repair in Hypoplastic Left Heart Syndrome: A Three-Dimensional Echocardiographic Study
| Autor: | Justin Grenier, Kandice Mah, Nee Scze Khoo, Richard B. Thompson, Mirza Vamiq Rasool Beigh, Amal Silmi, Lily Lin, Timothy Colen, Sachie Shigemitsu |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Echocardiography Three-Dimensional Regurgitation (circulation) Hypoplastic left heart syndrome Internal medicine Hypoplastic Left Heart Syndrome medicine Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Child Papillary muscle Surgical repair Leaflet (botany) Tricuspid valve business.industry medicine.disease Tricuspid Valve Insufficiency medicine.anatomical_structure Echocardiography Ventricle cardiovascular system Cardiology lipids (amino acids peptides and proteins) Tricuspid Valve Tricuspid Valve Regurgitation Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of the American Society of Echocardiography. 34:1199-1210 |
| ISSN: | 0894-7317 |
| DOI: | 10.1016/j.echo.2021.06.007 |
| Popis: | Background Tricuspid valve regurgitation (TR) is a risk factor for morbidity and mortality in children with hypoplastic left heart syndrome (HLHS). Surgical tricuspid valve (TV) repair is common, but durable repair remains challenging. The aim of this study was to examine mechanisms of TR requiring surgery, features associated with unsuccessful repair, and TV changes after surgical repair. Methods Thirty-six patients with HLHS requiring TV repair (TVR) and 36 matched control subjects with HLHS were assessed using two-dimensional and three-dimensional echocardiography. Using three-dimensional echocardiography, TV coordinates from the annulus, leaflet, and ventricle were used to measure annular, leaflet, prolapse, and tethering values and anterior papillary muscle angle. TR grade and ventricular size, function, and shape were assessed using two-dimensional echocardiography. Results Patients requiring TVR had greater total leaflet prolapse, larger TV annular and leaflet areas, and flatter annuli, with no difference in tethering, coaptation index, or anterior papillary muscle angle. In patients with HLHS, successful TVR at follow-up (58%) was associated with preoperative total leaflet prolapse (especially posterior). Unsuccessful repair was associated with preoperative tethering of the septal leaflet. TVR in patients with HLHS caused a reduction of total annular and leaflet size and reduced prolapse and tethering of the posterior leaflet but did not affect anterior leaflet prolapse or septal leaflet tethering. Conclusions Features associated with TVR include a flattened and dilated TV annulus with leaflet prolapse. The additional presence of a tethered septal leaflet before TVR is associated with significant postoperative TR. Current surgical techniques, predominantly posterior annuloplasty and commissuroplasty, adequately address annular size and posterior leaflet pathology, but not septal leaflet tethering. Individualized and innovative surgical techniques are vital to improve surgical repair success. |
| Databáze: | OpenAIRE |
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