Transthoracic 3D echo showed 45% of adults with systemic right ventricle had tricuspid valve variants, with 50% having moderate-to-severe regurgitation.
Can transthoracic three-dimensional echocardiography characterize tricuspid valve anatomy and tricuspid regurgitation grading in adults with a systemic right ventricle?
Transthoracic 3D echocardiography is feasible for assessing tricuspid valve morphology in adults with a systemic right ventricle, revealing a higher prevalence of anatomical variants than the general population.
Absolute Event Rate: 0% vs 0%
Abstract Background Tricuspid regurgitation(TR) to heart failure(HF) progression in individuals with congenital heart disease(CHD) and a systemic right ventricle (sRV). Morphological variants of tricuspid valve(TV) have been described in the general population, however proportion of those anomalies in ACHD is still unknown. We aim to systematically describe TV anatomy and TR grading using transthoracic three-dimensional echocardiography in a group of adults with a sRV. Methods Digital archive of our tertiary CHD centre was retrospectively searched for patients meeting with a sRV including those with transposition of the great arteries(TGA) following atrial switch repair and and congenitally corrected TGA aging18 years. Stored echocardiographic exams were reviewed by 2 independent observers, trained in 3D echocardiography. 3D reconstructions focused of the TV were obtained from full-volumes or zoomed 3D acquisitions using commercially available software. Patients with inadequate images quality for 3D assessment of the TV or those with previous TV procedures were excluded. Results Eighty-four patients were included (mean age 41±17 years, 43%male, 50% ccTGA). Overall, patients showed mildly depressed sRV systolic function (TAPSE 11±3 mm, s wave 6.5±2 cm/s, fractional area change 30.7±5%). TV anatomy assessment by 3D echo was feasible in 60 (71%) patients: 3 patients were excluded due to previous TV replacement, 1 had undergone previous TV clip implant, 1 had Ebstein-like TV and 19 had no sufficient images quality. TV morphology variants including bi, quadri and pentacuspid TV, were demonstrated in 8 ccTGA patients and in 19 TGA patients (Table1). Despite normal tricuspid anatomy was found in the majority of cases (55%), some TV variants were more frequent in our cohort compared to previously described prevalence in the general population: Bicuspid and pentacuspid TV was more frequent in TGA, while quadricuspid TV was found more frequently in ccTGA (Figure). Interobserver agreement for TV anatomy was good with an ICC of 0.98(95%CI:0.96-0.98). Moderate-to-severe TR was present in 30(50%) of patients: among them 12(40%) had either a bicuspid or quadricuspid TV morphology. Conclusions Transthoracic 3D echo assessment of TV morphology is feasible in individuals with a sRV and provides additional data on the mechanism of TR with a good interobserver agreement between expert operators. In this population, TV variants may be more common than reported proportions in the general population. Further studies are required to investigate the clinical relevance of TV anatomical variants, and to ascertain whether the presence of a morphological variant may accelerate TR severity or HF progression during follow-up.Table1 Figure1.TV morphologies
Fusco et al. (Sat,) reported a other. Transthoracic 3D echo showed 45% of adults with systemic right ventricle had tricuspid valve variants, with 50% having moderate-to-severe regurgitation.