The Insight Into Secondary Tricuspid Regurgitation From Two And Three-dimensional Echocardiography

Object The geometric and hemodynamic determinants of secondary tricuspid regurgitation (TR) associated with left-sided valve diseases have not been established clearly. The goal of this study is to explore the determinants with two-dimensional (2D) and three-dimensional (3D) echocardiography, to establish the fundamental theory for surgical consideration. Methods51normal subjects and172patients with left-sided valular diseases and tricuspid regurgitation underwent2D and3D echo examinations. In the apical4chamber views, right ventricular inflow views and great vessel short-axis views, tricuspid annulus diameters and the valvular tethering distances were measured. Left atrial, right ventricular dimensions and pulmoanry artery pressure were also measured.3D echo observed the tricuspid leaflets. Totally, left heart valve replacement or repair were performed on139patients in following two days after echo exams, and all documents and records were complete. Results The experiment had shown that the LA/RA equal to1.35could identify the best echo views to evaluate the real tricuspid annulus as compared with those measured by the prosthetic obturator in the operations which served as a golden standard. Based on the degrees of TR, all of the subjects were grouped into normal (group1), mild (group2) and moderate to severe group (group3). Comparing group3with group1, the tricuspid annulus diameter (TAD), TAD adjusted by body surface area (BSA-TAD) and valvular tethering distances had significantly enlarged (P<0.01). Further, the annulus diameter, tethering distance and pulmonary artery systolic pressure were emerged as independent predictors of TR in multiple logistic regression analysis. Also, the3D echocardiography revealed there were some valvular pathologies such as rheumatic changes, cleft, prolapse and leaflet deficiency aggravating regurgitation in48patients. Conclusion The annulus diameter and tethering distance could provide compact evidences of the pathologies of tricuspid valve, guide the operations, and predict the outcomes, more accurately than the degrees of TR. Furthermore, the3D echocardiography can give us more details of the valves.