Assessment of functional tricuspid regurgitation using 320-detector-row multislice computed tomography: risk factor analysis for recurrent regurgitation after tricuspid annuloplasty

Abstract

Objective: Functional tricuspid regurgitation (TR) often develops secondary to left heart disease. Tricuspid annuloplasty (TAP) is usually the treatment of choice for significant TRs, but recurrence of TR after surgery can occur. Previous studies have not clearly demonstrated the cause of the recurrent TR after TAP. By using an electrocardiogram-gated 320-detector-row multislice computed tomography (CT), we sought to delineate the morphologic cause of the incompetent tricuspid valve and identify the risk factors for recurrent TR.

Methods: From August 2010 to September 2011, 35 patients underwent preoperative CT of the tricuspid valve. The distance between each commissure, the tethering angle of each leaflet, and the tethering height were measured. TAP using a rigid annuloplasty ring was performed in 22 patients. Risk factors for recurrent TR were determined by multivariate analyses.

Results: End-diastolic and end-systolic tricuspid valve annular diameters (TVAD) correlated significantly with preoperative TR severity (R(2), 0.2734-0.4287; P < .05). However, compared with TVAD, tethering angles and height showed stronger correlation with preoperative TR severity (R(2): tethering angles, 0.5769-0.6810; tethering height, 0.6854). Multivariate analysis revealed that tethering height was an independent risk factor of postoperative recurrent TR (P = .0069).

Conclusions: TVAD, tethering angles, and tethering height correlated significantly with preoperative TR severity. The tethering height of the tricuspid valve showed significant correlation with recurrent TR.

Keywords: 35; 36.1; A; AP; AS; Aα; CT; ECG; LV; LVDd; LVDs; MR; P; Pα; S; SP; Sα; TAP; TR; TR jet area over the area of the right atrium; TR jet area/RA area; TRPG; TTE; TVAD; TVAD(op); anteroposterior commissure; anteroseptal commissure; computed tomography; dTVAD; dTVAD(AP-SP); dTVAD(AS-AP); dTVAD(TTE); electrocardiogram; end-diastolic tricuspid valve annular diameter; end-diastolic tricuspid valve annular diameter between anteroposterior commissure and septoposterior commissure; end-diastolic tricuspid valve annular diameter between anteroseptal commissure and anteroposterior commissure; end-diastolic tricuspid valve annular diameter on transthoracic echocardiogram; end-systolic tricuspid valve annular diameter; left ventricular; left ventricular diastolic diameter; left ventricular systolic diameter; middle of anterior leaflet annulus; middle of posterior leaflet annulus; middle of septal leaflet annulus; mitral regurgitation; sTVAD; septoposterior commissure; tethering angle of anterior leaflet; tethering angle of posterior leaflet; tethering angle of septal leaflet; transthoracic echocardiogram; tricuspid annuloplasty; tricuspid regurgitation; tricuspid regurgitation pressure gradient; tricuspid valve annular diameter; tricuspid valve annular diameter measured during surgery.