The most common cause of tricuspid regurgitation (TR) is the dilation of tricuspid annulus (TA). In patients with left-sided valve disease, an enlarged TA is currently regarded as a more reliable sign of associated tricuspid valve (TV) dysfunction, reflecting better the chronicity and the hemodynamic consequences of TR on TV apparatus over time than the actual severity of TR, which may vary significantly with loading conditions, respiration and technical factors. This paradigm shift has led to the more liberal indications for surgical annuloplasty at the time of left-sided valve surgical intervention and to the adoption of “prophylactic” TV annuloplasty if the TA diameter exceeds 40 mm (or 21 mm/m2 body surface area), irrespective of TR severity. Due to limitations of conventional two-dimensional echocardiography in assessing maximal TA diameter, three-dimensional echocardiography is emerging as the future standard technique for accurately measuring the TA size. This chapter is focused on the characterization of TA geometry and function as a key component for maintaining the competency of the normal TV, and on its role in the pathophysiology and development of functional TR.
Muraru, D., Badano, L. (2017). Tricuspid Annulus Measurements: Dynamic Changes in Health and Disease. In O.I. Soliman, C.J. Folkert (a cura di), Practical Manual of Tricuspid Valve Diseases (pp. 205-220). Springer International Publishing [10.1007/978-3-319-58229-0_10].
Tricuspid Annulus Measurements: Dynamic Changes in Health and Disease
Muraru D.Primo
;Badano L. P.Ultimo
2017
Abstract
The most common cause of tricuspid regurgitation (TR) is the dilation of tricuspid annulus (TA). In patients with left-sided valve disease, an enlarged TA is currently regarded as a more reliable sign of associated tricuspid valve (TV) dysfunction, reflecting better the chronicity and the hemodynamic consequences of TR on TV apparatus over time than the actual severity of TR, which may vary significantly with loading conditions, respiration and technical factors. This paradigm shift has led to the more liberal indications for surgical annuloplasty at the time of left-sided valve surgical intervention and to the adoption of “prophylactic” TV annuloplasty if the TA diameter exceeds 40 mm (or 21 mm/m2 body surface area), irrespective of TR severity. Due to limitations of conventional two-dimensional echocardiography in assessing maximal TA diameter, three-dimensional echocardiography is emerging as the future standard technique for accurately measuring the TA size. This chapter is focused on the characterization of TA geometry and function as a key component for maintaining the competency of the normal TV, and on its role in the pathophysiology and development of functional TR.
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