Usefulness of 3D echocardiographic parameters of tricuspid valve morphology to predict residual tricuspid regurgitation after tricuspid annuloplasty

Hiroto Utsunomiya, Yuji Itabashi, Hirotsugu Mihara, Sayuki Kobayashi, Michele A. De Robertis, Alfredo Trento, Takahiro Shiota

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)


Aims Tricuspid valve (TV) annuloplasty is an effective treatment for tricuspid regurgitation (TR). However, the impact of TV morphology on outcome of TV annuloplasty remains unknown. We sought to investigate the relationship between preoperative TV morphology and residual TR after annuloplasty. Methods and results Two-dimensional transthoracic and three-dimensional (3D) transesophageal echocardiography were performed in 97 patients with functional TR before and after surgery. 3D quantitative assessment including annular dimension, tenting height and volume, and lengths and tethering angles of the 3 leaflets was performed. The TV morphological score was derived from the preoperative 3D echocardiography to score a leaflet mobility, leaflet thickening, subvalvular thickening, and calcification. TR severity was determined by the averaged vena contracta measured from the apical and parasternal inflow views. Multivariable analysis revealed that a shorter total leaflet length (P = 0.007), larger tenting volume (P < 0.001), and higher TV morphological score (P < 0.001) were independently associated with residual TR. A TV-Echo score was determined as a sum of points based on receiver operator characteristics analysis: Total leaflet length >61.0 mm, 61.0 to 53.5 mm, and <53.5 mm; tenting volume <2.3 mL, 2.3 to 3.5 mL, and >3.5 mL; and TV morphological score <7, 7 to 18, and >18; each variable was associated with 0 and 1 point and 2 points, respectively. The TV-Echo score ≥2 was associated with significant residual TR with a sensitivity of 85.7% and a specificity of 71.0%. Conclusion In addition to tethering and short length of the leaflets, TV morphological abnormality predicted residual TR after TV annuloplasty.

Original languageEnglish
Pages (from-to)809-817
Number of pages9
JournalEuropean heart journal cardiovascular Imaging
Issue number7
Publication statusPublished - 2017 Jul 1
Externally publishedYes


  • 3D transesophageal echocardiography
  • annuloplasty
  • tricuspid regurgitation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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