Alex V Nguyen1, Andras Lasso2, Hannah H Nam1, Jennifer Faerber3, Ahmed H Aly4, Alison M Pouch5, Adam B Scanlan1, Francis X McGowan1, Laura Mercer-Rosa6, Meryl S Cohen6, John Simpson7, Gabor Fichtinger2, Matthew A Jolley8. 1. Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 2. Laboratory for Percutaneous Surgery, Queen's University, Goodwin Hall, Kingston, Ontario, Canada. 3. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 4. Department of Bioengineering, University of Pennsylvania, Richards Medical Research Laboratories, Philadelphia, Pennsylvania. 5. Department of Radiology, University of Pennsylvania, Richards Medical Research Laboratories, University of Pennsylvania, Philadelphia, Pennsylvania. 6. Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 7. Department of Congenital Heart Disease, Evelina London Children's Hospital, Lambeth, London, United Kingdom. 8. Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: jolleym@email.chop.edu.
Abstract
BACKGROUND: Tricuspid regurgitation (TR) is a significant contributor to morbidity and mortality in patients with hypoplastic left heart syndrome. The goal of this study was to characterize the dynamic annular motion of the tricuspid valve in patients with HLHS with a Fontan circulation and assess the relation to tricuspid valve function. METHODS: Tricuspid annuli of 48 patients with HLHS with a Fontan circulation were modeled at end-diastole, mid-systole, end-systole, and mid-diastole using transthoracic three-dimensional echocardiography and custom code in 3D Slicer. The angle of the anterior papillary muscle (APM) relative to the annular plane in each systolic phase was also measured. RESULTS: Imaging was performed 5.0 years (interquartile range, 2-11 years) after Fontan operation. The tricuspid annulus varies in shape significantly throughout the cardiac cycle, changing in sphericity (P < .001) but not in annular height or bending angle. In univariate modeling, patients with significant TR had larger changes in septolateral diameter, lateral quadrant area, and posterior quadrant area (P < .05 for all) as well as lower (more laterally directed) APM angles (P < .001) than patients with mild or less TR. In multivariate modeling, a 1 mm/(body surface area)0.5 increase in the maximum change in septolateral diameter was associated with a 1.7-fold increase in having moderate or greater TR, while a 10° decrease in APM angle at mid-systole was associated with an almost 2.5-fold increase in moderate or greater TR (P ≤ .01 for all). CONCLUSIONS: The tricuspid annulus in patients with HLHS with a Fontan circulation changes in shape significantly throughout the cardiac cycle but remains relatively planar. Increased change in septolateral diameter and decreased APM angle are strongly associated with the presence of TR. These findings may inform annuloplasty methods and subvalvular interventions in these complex patients.
BACKGROUND:Tricuspid regurgitation (TR) is a significant contributor to morbidity and mortality in patients with hypoplastic left heart syndrome. The goal of this study was to characterize the dynamic annular motion of the tricuspid valve in patients with HLHS with a Fontan circulation and assess the relation to tricuspid valve function. METHODS: Tricuspid annuli of 48 patients with HLHS with a Fontan circulation were modeled at end-diastole, mid-systole, end-systole, and mid-diastole using transthoracic three-dimensional echocardiography and custom code in 3D Slicer. The angle of the anterior papillary muscle (APM) relative to the annular plane in each systolic phase was also measured. RESULTS: Imaging was performed 5.0 years (interquartile range, 2-11 years) after Fontan operation. The tricuspid annulus varies in shape significantly throughout the cardiac cycle, changing in sphericity (P < .001) but not in annular height or bending angle. In univariate modeling, patients with significant TR had larger changes in septolateral diameter, lateral quadrant area, and posterior quadrant area (P < .05 for all) as well as lower (more laterally directed) APM angles (P < .001) than patients with mild or less TR. In multivariate modeling, a 1 mm/(body surface area)0.5 increase in the maximum change in septolateral diameter was associated with a 1.7-fold increase in having moderate or greater TR, while a 10° decrease in APM angle at mid-systole was associated with an almost 2.5-fold increase in moderate or greater TR (P ≤ .01 for all). CONCLUSIONS: The tricuspid annulus in patients with HLHS with a Fontan circulation changes in shape significantly throughout the cardiac cycle but remains relatively planar. Increased change in septolateral diameter and decreased APM angle are strongly associated with the presence of TR. These findings may inform annuloplasty methods and subvalvular interventions in these complex patients.
Authors: Richard G Ohye; Carlen A Gomez; Caren S Goldberg; Holly L Graves; Eric J Devaney; Edward L Bove Journal: Cardiol Young Date: 2006-09 Impact factor: 1.093
Authors: Jorge H Jimenez; Shasan W Liou; Muralidhar Padala; Zhaoming He; Michael Sacks; Robert C Gorman; Joseph H Gorman; Ajit P Yoganathan Journal: J Thorac Cardiovasc Surg Date: 2007-12 Impact factor: 5.209
Authors: Feroze Mahmood; Joseph H Gorman; Balachundhar Subramaniam; Robert C Gorman; Peter J Panzica; Robert C Hagberg; Adam B Lerner; Philip E Hess; Andrew Maslow; Kamal R Khabbaz Journal: Ann Thorac Surg Date: 2010-10 Impact factor: 4.330
Authors: Ivan S Salgo; Joseph H Gorman; Robert C Gorman; Benjamin M Jackson; Frank W Bowen; Theodore Plappert; Martin G St John Sutton; L Henry Edmunds Journal: Circulation Date: 2002-08-06 Impact factor: 29.690
Authors: Masaki Nii; Vitor Guerra; Kevin S Roman; Christopher K Macgowan; Jeffrey F Smallhorn Journal: J Am Soc Echocardiogr Date: 2006-04 Impact factor: 5.251
Authors: K Takahashi; A Inage; I M Rebeyka; D B Ross; R B Thompson; A S Mackie; J F Smallhorn Journal: Circulation Date: 2009-09-08 Impact factor: 29.690
Authors: Hannah H Nam; Christian Herz; Andras Lasso; Alana Cianciulli; Maura Flynn; Jing Huang; Zi Wang; Beatriz Paniagua; Jared Vicory; Saleha Kabir; John Simpson; David Harrild; Gerald Marx; Meryl S Cohen; Andrew C Glatz; Matthew A Jolley Journal: J Am Soc Echocardiogr Date: 2022-05-07 Impact factor: 7.722
Authors: Jared Vicory; Christian Herz; David Allemang; Hannah H Nam; Alana Cianciulli; Chad Vigil; Ye Han; Andras Lasso; Matthew A Jolley; Beatriz Paniagua Journal: Stat Atlases Comput Models Heart Date: 2022-01-01
Authors: Wensi Wu; Stephen Ching; Steve A Maas; Andras Lasso; Patricia Sabin; Jeffrey A Weiss; Matthew A Jolley Journal: J Biomech Eng Date: 2022-10-01 Impact factor: 1.899
Authors: Perry S Choi; Hannah H Nam; Andras Lasso; Christian Herz; Simon Drouin; David M Harrild; Michael Quartermain; Gabor Fichtinger; Christopher E Mascio; Sitaram Emani; Matthew A Jolley Journal: Ann Thorac Surg Date: 2020-03-18 Impact factor: 4.330
Authors: Hannah H Nam; Patrick V Dinh; Andras Lasso; Christian Herz; Jing Huang; Adriana Posada; Ahmed H Aly; Alison M Pouch; Saleha Kabir; John Simpson; Andrew C Glatz; David M Harrild; Gerald Marx; Gabor Fichtinger; Meryl S Cohen; Matthew A Jolley Journal: Ann Thorac Surg Date: 2020-12-24 Impact factor: 4.330
Authors: Alana Cianciulli; Andras Lasso; Csaba Pinter; Stephen Ching; Reena M Ghosh; Tiffany Chen; Christian Herz; Chad Vigil; Simon Drouin; Lindsay S Rogers; Michael D Quartermain; David M Biko; Kevin K Whitehead; Gabor Fichtinger; Matthew J Gillespie; Matthew A Jolley Journal: J Am Soc Echocardiogr Date: 2021-07-15 Impact factor: 7.722
Authors: Christian Herz; Alana Cianciulli; Stephen Ching; Chad Vigil; Andras Lasso; Hannah H Nam; Simon Drouin; David M Biko; Matthew Gillespie; Gabor Fichtinger; Matthew A Jolley Journal: J Am Soc Echocardiogr Date: 2021-04-02 Impact factor: 7.722
Authors: Stephanie Y Tseng; Saira Siddiqui; Michael V Di Maria; Garick D Hill; Adam M Lubert; Shelby Kutty; Alexander R Opotowsky; Mathias Possner; David L S Morales; James A Quintessenza; Tarek Alsaied Journal: J Am Heart Assoc Date: 2020-05-16 Impact factor: 5.501
Authors: Christian Herz; Danielle F Pace; Hannah H Nam; Andras Lasso; Patrick Dinh; Maura Flynn; Alana Cianciulli; Polina Golland; Matthew A Jolley Journal: Front Cardiovasc Med Date: 2021-12-09