| Part Ⅰ Comprehensive Imaging Evaluation of Tricuspid Annulus and its Role in Tricuspid Valve Procedure:A Comparative Study of 3D Echocardiography and CT Objective This study aimed to investigate the methodological differences between echocardiography and CT,two commonly used techniques for tricuspid annular evaluation,and the role of comprehensive imaging evaluation in tricuspid valve procedure.Methods From June 2020 to August 2022,enrolled the patients admitted to Fuwai Hospital with symptomatic tricuspid regurgitation for isolated tricuspid valve procedure.Select transthoracic echocardiography(TTE),transesophageal echocardiography(TEE),and CT with complete separability analysis of imaging data.Using 2D/3D TTE,TEE,and CT,the major axis diameter(maximum diameter),minor axis diameter.circumference,and area of the tricuspid annulus was measured in the middle diastolic period.The measured values of the echocardiographic methods were compared with the values of CT,respectively.Then the different echocardiographic methods were compared.Intra-observer and inter-observer differences between various imaging methods were analyzed.Results A total of 40 patients(average age 66.1±7.7 yr,83%females)with severe tricuspid regurgitation were included.90%of the patients(36/40 patients)had secondary tricuspid regurgitation,and the rest had primary.The average maximum diameter of the tricuspid annulus measured by 3D TEE was 44.09±4.45 mm,and the maximum diameter index of the tricuspid annulus normalized by body surface area was 21 mm/m2 in all patients.The long-axis diameter of the tricuspid annulus measured by the 2D and 3D TTE has a good correlation with the CT results,but they are about 11%smaller than the CT value(2D-TTE vs.CT difference 5.45 mm,P<0.01,R=0.64;3D-TTE vs.CT difference 5.25 mm,P<0.01,R=0.62).The long-axis diameter,minor axis diameter,circumference and area of the tricuspid annulus measured by 2D and 3D TEE were all consistent with the result of the CT measurement.There is a moderate degree of correlation,R is 0.53,0.61,0.52,0.59,respectively,CT values are greater than echocardiographic values,P values are<0.01.Using TTE and TEE techniques respectively,there was no significant difference in the long-axis diameter of the annulus measured by comparing the 2D and 3D methods R is 0.86,0.84,and the consistency is good.When the 3D method is used to measure the long-axis diameter of the tricuspid annulus,comparing the measurement results of TTE and TEE has no significant difference,R=0.753,and the consistency is good.When TTE,TEE and CT measured the size of the tricuspid annulus,the intra-and inter-observer differences were small,and the repeatability was good.Conclusion In the evaluation of tricuspid annular in patients with severe tricuspid regurgitation,TTE,TEE and CT are both effective.It can accurately assess the size of the tricuspid annulus.The long-axis diameter measured by TTE,the short-axis diameter and the area measured by TEE has a good correlation with CT.CT measurements are higher than the echocardiographic value.A combination of methods is required for the imaging evaluation of the tricuspid annulus.Part Ⅱ Echocardiographic Evaluation of a Novel Transcatheter Tricuspid Valve Replacement Device for Severe Tricuspid RegurgitationObjective To evaluate the echocardiographic and clinical outcomes of a novel transcatheter tricuspid valve replacement device in the treatment of symptomatic severe tricuspid regurgitation(TR).Methods Between Jun 2020 and Aug 2021,high-risk patients with NYHA functional class Ⅲ or Ⅳ and symptomatic severe tricuspid regurgitation were enrolled.All patients had no significant improvement with guideline-directed medical therapy.The patients underwent transcatheter tricuspid valve replacement through right thoracotomy.Multimodal imaging and clinical evaluation were performed at baseline,the early period of the procedure,and follow-up.Results A total of 36 patients(average age 65.4±7.8 yr,86%females)were enrolled.67%(24/36 patients)of the patients had a history of left heart valve surgery,and 78%(28/36 patients)had atrial fibrillation.89%were secondary TR,and 11%were primary TR.Thirty-six patients underwent successful transcatheter tricuspid valve replacement with no death during or 72 hours after the procedure.The procedural success rate was 88.9%(32/36 patients),and 4 cases underwent cardiopulmonary bypass operation due to the abnormal position of instruments.In-hospital mortality is 0,and 2 patients were discharged with seriously ill.During 350[IQR 196-386]days of follow-up,three patients died of multiple systemic organ failures.All-cause mortality had occurred in three(8.3%)of 36 patients.During the follow-up,66.7%(22/33 patients)of patients had improved NYHA function class I or II,and 72.7%(24/33 patients)had a 1+TR or less.There have been significant reductions in the right chamber volumes compared with the baseline 161.08±95.50 ml→115.58±67.74 ml,136.65±55.44 ml→118.76±50.45 ml,all P<0.05),body surface area standardized left ventricular stroke volume increased significantly(27.06±6.55 ml/m2→30.19±8.83 ml/m2,P=0.038).The change in right ventricular ejection fraction was not statistically significant,and the FAC,TAPSE and the right vent rial strain were lower than before the operation.The preoperative mean mitral valve pressure difference was an independent risk factor affecting the surgical outcome(adjusted HR=1.514,95%CI:1.009-2.273,P=0.045).Conclusions Transcatheter tricuspid valve replacement with the LuX-Valve system in high-risk patients with symptomatic severe tricuspid regurgitation shows the feasibility and a med-term safety profile,which can effectively reduce tricuspid regurgitation,improve clinical symptoms,and reduce right heart chamber enlargement. |
PDF Full Text Request