Tricuspid annular motion

Triscupid annular motion is related to right ventricular systolic function in the same way mitral annulus motion is related to left ventricular function. Tricuspid annular excursion reflects the longitudinal motion of the right ventricle, and the systolic descent of the anulus correlates with systolic venous inflow to the right atrium. However, it has not been shown clearly how to reproducibly quantify this motion. Therefore we describe a method to measure triscuspid annular motion using two-dimensional oriented M-mode echocardiography from the apical view. We studied a group of 10 normal subjects (mean age, 28.7 years; range, 25 to 38 years) and a group of 29 patients (mean age, 57.2 years; range, 20 to 84 years) with disease of the left side of the heart but no evidence of involvement of the right side of the heart. In each subject, tricuspid and mitral annular motion were measured respectively at their lateral, septal or medial, anterior, and posterior margin points. The total tricuspid annular motion for normal subjects was, as follows: lateral, 24.9 +/- 3.5 mm; medial, 20.1 +/- 2.5 mm; anterior, 21.6 +/- 3.8 mm; and posterior, 22.3 +/- 2.3 mm. Interobserver and intraobserver variability was low, with a coefficient of variance for the different annular points ranging from 6.19% to 11.56% between observers and from 4.10% to 7.26% within observer. We conclude that it is possible to measure tricuspid annular motion with this method in a reproducible way and to use it as a diagnostic tool in evaluating function of the right side of the heart.     

三尖瓣闭锁的影象诊断

总结１０例三尖瓣闭锁，分析Ｘ线平片，超声心动图及心血管造影表现。着重对三尖瓣闭锁理分型，各种影像学检查的诊断价值进行讨论。提出一些较有特异性的征象。认为平片结合临床可对少血型三在瓣闭锁作出初步诊断；二维超声可提供较多诊断信息；ＭＲＩ尚待开发应用；最后确诊有赖心血管造影，强调右房及左室造影的重要性。     

Congenitally Closed Tricuspid Annulus Functions as Arrhythmogenic Substrate of Atrial Arrhythmia in Patient with Tricuspid Atresia

An intraatrial reentrant circuit was identified using an electroanatomical mapping system and evaluation of postpacing intervals in a patient with tricuspid annulus. Intraatrial reentrant tachycardia was successfully eliminated on the basis of the interpretation that the reentry circuit depends on a congenitally closed tricuspid annulus. We report that a congenitally closed tricuspid annulus is one of the anatomical obstacles when we consider atrial tachyarrhythmia. (PACE 2010; e1–e3)     

Ratio between Vena Contracta Width and Tricuspid Annular Diameter: Prognostic Value in Secondary Tricuspid Regurgitation

STR = secondary tricuspid regurgitation; TA = tricuspid annulus; VC = vena contracta

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Prenatal Diagnosis of Isolated Tricuspid Valve Atresia

Objective. To describe the prenatal features of fetal tricuspid atresia. Methods. Four cases of fetal tricuspid atresia were prenatally diagnosed, sonographically described, and followed. Results. On the basis of this small series, the key findings for diagnosis included the demonstration of no patent tricuspid valve on the 4‐chamber view, no flow across the tricuspid valve on pulsed or color Doppler flow mapping, small right ventricles, and associated interventricular septal defects. Increased nuchal translucency thickness may give the first clue leading to follow‐up scans, resulting in a definite diagnosis. Conclusions. Tricuspid atresia can be readily diagnosed prenatally. The key findings and differential diagnoses are provided.     

超声心动图对三尖瓣闭锁的诊断价值

本文分析7例先天性三尖瓣闭锁患者的超声心动图表现，均示三尖瓣位置呈较粗的带状强回声，无瓣叶启闭活动，彩色多普勒血流显像示右房室间无血流通过，此为三尖瓣闭锁的直接特征性表现。7例均经心血管造影和／或手术证实。     

Tricuspid Incompetence Following Permanent Pacemaker Implantation

Aim: Severe tricuspid insufficiency (TI) after permanent pacemaker implantation (PPI) has been described in small series of patients, though its incidence is not known.
Methods: We retrospectively analyzed the data of 545 patients who underwent PPI and had Doppler echocardiograms performed before and after the procedure. We excluded 135 patients who had ≥moderate TI on the 1st Doppler echocardiogram.
Results: Group 1 included 75 patients (18.3%) who had a >2 grades worsening of TI, and group 2 included 335 patients (82%) with <2 grade increase in TI after PPI. Patients in group 1 were 77 ± 7 years of age, versus 72 ± 10 years in group 2 (P < 0.001). There was no difference in left ventricular size and function. The TI gradient before PPI was higher in group 2 (25 ± 13 mmHg versus 19 ± 12 mmHg [P < 0.001]), though within the normal range in both groups. The mitral E/A ratio was 0.98 in group 1 versus 1.42 in group 2 (P < 0.001). The systolic TI gradient after implantation was 42 ± 12 mmHg in group 1, versus 33 ± 8 mmHg in group 2 (P < 0.001).
Conclusion: Worsening of TI after PPI was not rare and was observed more often in older patients, with abnormal LV relaxation and who developed pulmonary hypertension after the procedure.     

三尖瓣病变外科手术的疗效评估

目的:探讨三尖瓣病变的不同手术方法和术后长期疗效。方法:1979年7月至1998年6月施行三尖瓣病变外科手术51例中,三尖瓣病变中有三尖瓣下移畸形33例,三尖瓣发育不全10例,感染性三尖瓣内膜炎3例,外伤性三尖瓣关闭不全、人工瓣膜功能异常各2例和Uhl’s病1例。51例中,瓣膜替换术37例,瓣膜成形术14例。附加手术有房缺修补术、室缺修补术、房化心室折叠术和缝补术。结果:住院死亡5例,死亡率为9.8％。死亡病例中3例为低心排综合征,2例气管套管并发症。长期随访生物瓣膜死亡4例,为心力衰竭、心律失常;机械瓣死亡1例,为瓣膜栓塞;瓣膜成形术14例无死亡,心功能明显改善。讨论:超声多普勒可明确诊断三尖瓣病变,三维超声可了解瓣叶、瓣下结构和瓣叶下移程度。病变中—重度、瓣叶发育较好、前瓣叶足够大小可施行瓣膜成形术。瓣膜发育不全、严重关闭不全可施行瓣膜替换术。成形手术疗效好,无瓣膜替换术潜在并发症。瓣膜成形术尽可能作为首选手术方案。