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Tricuspid regurgitation (TR) interventions are under rapid development. The K-Clip? system is the first domestic transcatheter tricuspid annuloplasty system with unique clamping procedure to achieve annular reduction.Intraoperative echocardiographic monitoring procedures for transcatheter tricuspid annuloplasty have not been reported yet in China. Thus, this review aimed to propose the standard two-dimensional and three-dimensional transesophageal echocardiographic workplanes and procedures to guide and monitor the implantation of K-Clip system based on our experience in Zhongshan Hospital, Fudan University to provide a reference point for the intraoperative echocardiographic monitoring of future transcatheter tricuspid annuloplasty devices in China.
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Objective To evaluate the safety and clinical effect of radiofrequency catheter ablation below tricuspid valve using Carto3 system combined with SmartTouch contact force catheter in premature ventricular contraction (PVC) originating from tricuspid annulus. Methods The clinical data of 21 patients with PVC originating from tricuspid annulus from September 2016 to September 2018 were retrospectively analyzed. Radiofrequency catheter ablation below tricuspid valve was performed using Carto3 system combined with SmartTouch contact force catheter. Results The result of intraoperative mapping under Carto3 guidance showed that premature ventricular contraction in 12 cases originated from septal portion of the tricuspid annulus and in 9 cases originated from free wall of the tricuspid annulus. All patients′ ablation were successful, and no operative complications occurred. The patients were followed up for 1 to 23 months, and no recurrence occurred. However, there was 1 patient whose first radiofrequency ablation on the tricuspid valve was immediately successful, and PVC recurred 2 h after operation. Finally, radiofrequency ablation was performed successfully at 12 O′clock below the tricuspid valve 9 months later. Conclusions Radiofrequency catheter ablation below the tricuspid valve using carto3 guidance combined with SmartTouch contact force is safe in PVC originated from tricuspid annulus, and it can improve the success rate.
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In this retrospective study 420 echocardiograms from a single center were reviewed showing that TAPSE was acquired in 66% while TA TDI s’ signals were recorded in 98% of all echocardiograms. Based on these results greater efforts are required to standardize acquisition and reporting of objective measurements of RV function.
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Object@#To explore the electrocardiographic characteristics of ventricular arrhythmias (VAs) originating from tricuspid annulus region.@*Methods@#Present study included 169 consecutive patients undergoing catheter ablation of VAs from tricuspid annulus origin in our department from August 2007 to September 2016. Based on the origin sites, the patients were divided into two subgroups, the free wall group (81 cases) and septal wall group (88 cases). Based on the location, patients in the free wall group were classified into anterolateral (22 cases), lateral (26 cases) and posterolateral (33 cases) subgroups. Patients in the septal group were classified into anteroseptal (10 cases), midseptal (71 cases) and posteroseptal (7 cases) subgroups. We analyzed the electrocardiographic features of these patients and in 87 patients with PVCs/VT originating from right ventricular outflow tract.@*Results@#(1) A positive R wave inⅠ, aVL, V5-V6 leads were found among most of patients, only few cases originating from tricuspid annulus anteroseptum group and tricuspid annulus anterolateral group demonstrated qr or qs pattern in aVL lead. 97.53% (79/81) patients demonstrated rS pattern in V1-V3 leads with VAs originating from tricuspid annulus free wall, and 9/10 patients demonstrated rS pattern in V1 lead with VAs originating from anteroseptum, and 97.44% (76/78) patients demonstrated QS pattern in V1 lead with VAs originating from midseptum and posteroseptum. Precordial lead transition zone was on or behind V3 for tricuspid annulus free wall group (96.3%, 78/81), but in front of V3 for tricuspid annulus septum wall group (47.73%, 42/88) (P<0.01). The S wave's amplitude smaller than-1.81 mV in lead V2 can be used as a cutoff value to identify if PVC/VT is originating from free wall or septum of TA. R wave in inferior wall leads was found among 98.85% (86/87) patients with PVCs/VT originating from right ventricular outflow tract.@*Conclusion@#A positive R wave in Ⅰ, aVL, V5-V6 leads was found among most of patients with idiopathic ventricular arrhythmias originating from the tricuspid annulus regions, but VAs originating from different portions of tricuspid annulus area have distinct electrocardiographic characteristics.
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Objective To assess the morphological changes of tricuspid annulus in patients with functional tricuspid regurgitation(FTR)by real-time three-dimensional echocardiography.Methods Seventy-five FTR patients were divided into 4 groups according to the tricuspid regurgitation and transverse diameter of tricuspid annulus,which were group A(regurgitation more than moderate and dilated transverse diameter,n=21),group B(regurgitation less than moderate and dilated transverse diameter,n =18), group C(regurgitation more than moderate and normal transverse diameter,n = 1 9),group D (regurgitation less than moderate and normal transverse diameter,n =17).And 21 healthy controls were chosen to be group E.The 3D parameters including annular anterior-posterior diameter(AP),annular left-right diameter(SM),sphericity index(SI),non-planar angle(NPA),anterior annular length(Ant Ann), posterior annular length(Post Ann),annular circumference(Ann)and annular area(Area)were analyzed. Results SM,AP,Post Ann,Ann and Area of group A and B were larger than those in group E,whereas SI and Ant Ann only larger in group A(P<0.05).There were positive correlations between SM,AP,Post Ann,Ann,Area and the degree of regurgitation in group A(P <0.05).The patients of group C showed larger SM,Ant Ann,Post Ann,Ann and Area compared with patients in group E(P <0.05).There were no significant difference in all 3D parameters between group D and E(P >0.05).Conclusions FTR patients with regurgitation more than moderate or dilated transverse diameter are accompanied with changes of 3D annular parameters. The real-time three-dimensional echocardiography is helpful to judge morphological changes of tricuspid annulus in patients with FTR.
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The dynamic characteristics of the area of the atrial septal defect (ASD) were evaluated using the technique of real-time three-dimensional echocardiography (RT 3DE),the potential factors re sponsible for the dynamic characteristics of the area of ASD were observed,and the overall and local volume and functions of the patients with ASD were measured,RT 3DE was performed on the 27 normal controls and 28 patients with ASD.Based on the three-dimensional data workstations,the area of ASD was measured at P wave vertex,R wave vertex,T wave starting point,and T wave terminal point and in the T-P section.The right atrial volume in the same time phase of the cardiac cycle and the motion displacement distance of the tricuspid annulus in the corresponding period were measured.The measured value of the area of ASD was analyzed.The changes in the right atrial volume and the motion displacement distance of the tricuspid annulus in the normal control group and the ASD group were compared.The right ventricular ejection fractions in the normal control group and the ASD group were compared using the RT 3DE long-axis eight-plane (LA 8-plane) method.Real-time three-dimensional volume imaging was performed in the normal control group and ASD group (n=30).The right ventricular inflow tract,outflow tract,cardiac apex muscular trabecula dilatation,end-systolic volume,overall dilatation,end-systolic volume,and appropriate local and overall ejection fractions in both two groups were measured with the four-dimensional right ventricular quantitative analysis method (4D RVQ) and compared.The overall right ventricular volume and the ejection fraction measured by the LA 8-plane method and 4D RVQ were subjected to a related analysis.Dynamic changes occurred to the area of ASD in the cardiac cycle.The rules for dynamic changes in the area of ASD and the rules for changes in the right atrial volume in the cardiac cycle were consistent.The maximum value of the changes in the right atrial volume occurred in the end-systolic period when the peak of the curve appeared.The minimum value of the changes occurred in the end-systolic period and was located at the lowest point of the volume variation curve.The area variation curve for ASD and the motion variation curve for the tricuspid annulus in the cardiac cycle were the same.The displacement of the tricuspid annulus exhibited directionality.The measured values of the area of ASD at P wave vertex,R wave vertex,T wave starting point,T wave terminal point and in the T-P section were properly correlated with the right atrial volume (P＜0.001).The area of ASD and the motion displacement distance of the tricuspid annulus were negatively correlated (P＜0.05).The right atrial volumes in the ASD group in the cardiac cycle in various time phases increased significantly as compared with those in the normal control group (P=0.0001).The motion displacement distance of the tricuspid annulus decreased significantly in the ASD group as compared with that in the normal control group (P=0.043).The right ventricular ejection fraction in the ASD group was lower than that in the normal control group (P=0.032).The ejection fraction of the cardiac apex trabecula of the ASD patients was significantly lower than the ejection fractions of the right ventricular outflow tract and inflow tract and overall ejection fraction.The difference was statistically significant (P=0.005).The right ventricular local and overall dilatation and end-systolic volumes in the ASD group increased significantly as compared with those in the normal control group (P=0.031).The aRVEF and the overall ejection fraction decreased in the ASD group as compared with those in the normal control group (P=0.0005).The dynamic changes in the area of ASD and the motion curves for the right atrial volume and tricuspid annulus have the same dynamic characteristics.RT 3DE can be used to accurately evaluate the local and overall volume and functions of the right ventricle.The local and overall volume loads of the right ventricle in the ASD patients increase significantly as compared with those of the normal people.The right ventricular cardiac apex and the overall systolic function decrease.
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Background: Traditional two‑dimensional (2D) echocardiographic evaluation of tricuspid annulus (TA) dilation is based on single‑frame measurements of the septolateral (S‑L) dimension. This may not represent either the axis or the extent of dynamism through the entire cardiac cycle. In this study, we used real‑time 3D transesophageal echocardiography (TEE) to analyze geometric changes in multiple axes of the TA throughout the cardiac cycle in patients without right ventricular abnormalities. Materials and Methods: R‑wave‑gated 3D TEE images of the TA were acquired in 39 patients undergoing cardiovascular surgery. The patients with abnormal right ventricular/tricuspid structure or function were excluded from the study. For each patient, eight points along the TA were traced in the 3D dataset and used to reconstruct the TA at four stages of the cardiac cycle (end‑ and mid‑systole, end‑ and mid‑diastole). Statistical analyses were applied to determine whether TA area, perimeter, axes, and planarity changed significantly over each stage of the cardiac cycle. Results: TA area (P = 0.012) and perimeter (P = 0.024) both changed significantly over the cardiac cycle. Of all the axes, only the posterolateral‑anteroseptal demonstrated significant dynamism (P < 0.001). There was also a significant displacement in the vertical axis between the points and the regression plane in end‑systole (P < 0.001), mid‑diastole (P = 0.014), and mid‑systole (P < 0.001). Conclusions: The TA demonstrates selective dynamism over the cardiac cycle, and its axis of maximal dynamism is different from the axis (S‑L) that is routinely measured with 2D TEE.
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Current knowledge of functional tricuspid regurgitation (FTR) as a progressive entity, worsening the prognosis of patients irrespective of its aetiology, has led to renewed interest in the pathophysiology and assessment of FTR. For the proper management of FTR, not only its severity, but also the mechanisms, the mode of leaflet coaptation, the degree of tricuspid annulus enlargement and leaflet tenting, and the haemodynamic consequences for right atrial and right ventricular morphology and function have to be taken into account. A better assessment of the anatomy and function of tricuspid apparatus and tricuspid regurgitation severity should help with the appropriate selection of patients who will benefit from either surgical tricuspid valve repair/replacement or a percutaneous procedure, especially among patients who are to undergo or have undergone primary left-sided valvular surgery. In this article, we review the anatomy, pathophysiology and the use of imaging techniques to assess patients with FTR, as well as the various treatment options for FTR, including emerging transcatheter procedures. The limitations affecting the current approach to FTR patients and the unmet clinical needs for their management have also been discussed.
Subject(s)
Humans , Diagnosis , Echocardiography , Prognosis , Tricuspid Valve , Tricuspid Valve InsufficiencyABSTRACT
Current knowledge of functional tricuspid regurgitation (FTR) as a progressive entity, worsening the prognosis of patients irrespective of its aetiology, has led to renewed interest in the pathophysiology and assessment of FTR. For the proper management of FTR, not only its severity, but also the mechanisms, the mode of leaflet coaptation, the degree of tricuspid annulus enlargement and leaflet tenting, and the haemodynamic consequences for right atrial and right ventricular morphology and function have to be taken into account. A better assessment of the anatomy and function of tricuspid apparatus and tricuspid regurgitation severity should help with the appropriate selection of patients who will benefit from either surgical tricuspid valve repair/replacement or a percutaneous procedure, especially among patients who are to undergo or have undergone primary left-sided valvular surgery. In this article, we review the anatomy, pathophysiology and the use of imaging techniques to assess patients with FTR, as well as the various treatment options for FTR, including emerging transcatheter procedures. The limitations affecting the current approach to FTR patients and the unmet clinical needs for their management have also been discussed.
Subject(s)
Humans , Diagnosis , Echocardiography , Prognosis , Tricuspid Valve , Tricuspid Valve InsufficiencyABSTRACT
BACKGROUND: Measurement of right ventricular (RV) systolic function is important for patients with acute pulmonary embolism (PE). However, assessment of RV function is a challenge due to its complex anatomy. We measured RV systolic function with analysis of tricuspid annular motion in acute PE patients. METHODS: From August 2007 to May 2011, all consecutive PE patients were prospectively included. Tricuspid annular motion was analyzed with tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV). RESULTS: We analyzed total 50 patients (38 females, 68 +/- 14 years). Mean RV fractional area change (RVFAC) was 26.2 +/- 10.8%; RV Tei index 0.78 +/- 0.35; TR Vmax 3.8 +/- 0.5 m/sec; pulmonary vascular resistance (PVR) 3.5 +/- 1.2 WU. TAPSE was 16 +/- 4 mm and TASV was 11.7 +/- 4.0 cm/sec. TAPSE showed significant correlations with RVFAC (r = 0.841, p < 0.001), RV Tei index (r = -0.347, p = 0.018), Log B-type natriuretic peptide (BNP) (r = -0.634, p < 0.001) and PVR (r = -0.635, p < 0.001). TASV also revealed significant correlations with RVFAC (r = 0.605, p < 0.001), RV Tei index (r = -0.380, p = 0.009), LogBNP (r = -0.477, p = 0.001) and PVR (r = -0.483, p = 0.001). The best cutoff of TAPSE for detection of RV systolic dysfunction (defined as RVFAC < 35%) was 1.75 cm [Areas under the curve (AUC) = 0.96, p < 0.001] with a sensitivity of 87% and specificity 91%. The best cutoff for TASV was 13.8 cm/sec (AUC = 0.90, p < 0.001), sensitivity 86% and specificity 78%. However, there was no statistical significance in the detection of RV dysfunction (difference = 0.07, 95% CI = -0.21-0.17, p = 0.130) between TAPSE and TASV. CONCLUSION: TAPSE and TASV showed significant correlations with conventional echocardiographic parameters of RV function and LogBNP value. These values can be used to detect RV systolic dysfunction more easily in patients with acute PE.
Subject(s)
Female , Humans , Echocardiography , Heart Ventricles , Natriuretic Peptide, Brain , Prospective Studies , Pulmonary Embolism , Sensitivity and Specificity , Vascular ResistanceABSTRACT
BACKGROUND AND OBJECTIVES: This study was performed to identify echocardiographic parameters related to postoperative clinical outcome (PCO) in patients undergoing surgery for severe tricuspid regurgitation (TR) following mitral valve surgery. The indications for surgery due to severe TR following mitral valve surgery are not well defined largely because of a lack of knowledge of the prognostic factors of PCO in these patients. SUBJECTS AND METHODS: Eighteen patients (male/female; 2/16, mean age 58 years) with severe TR associated with prior mitral valve surgery were prospectively enrolled. Comprehensive echocardiographic examinations were performed before and 15+/-7 months after surgery. Favorable PCO was defined as an improvement of > or =1 in New York Heart Association (NYHA) functional class or a >25% increase in respiratory variation of IVC diameter. Non-survivors and survivors without a favorable PCO were defined as having an unfavorable PCO. RESULTS: The operative mortality was 11% (2/18). Of the 16 survivors, nine (9/16, 56%) achieved a favorable PCO. NYHA functional class, age, left ventricular ejection fraction, right ventricular fractional area change, severity of TR and pulmonary artery pressure were not related to PCO. Only systolic tricuspid annulus velocity (ST') was found to be associated with PCO (favorable vs unfavorable PCO; 12.9+/-2.1cm/s vs 9.7+/-1.7cm/s, p<0.05). For ST' value (9.5 cm/s, the sensitivity, specificity, positive and negative predictive values for predicting an unfavorable PCO were 67%, 100%, 100% and 75%, respectively. CONCLUSION: This study shows that ST' can predict PCO in patients undergoing surgery for severe TR following mitral valve surgery.