Assessment of tricuspid annulus geometry in children with CHD using 3D echocardiography

Introduction

Modeling of tricuspid annuli (TA) is recently available from three-dimensional transthoracic echocardiography (3D-TTE).

Objective

We aimed to compare remodeling of TA geometry in children with CHD according to the type of right ventricle (RV) overload.

Methods

Patients were divided in 3 groups: control groups (healthy children), pre-tricuspid overload group (atrial septal defect and anomaly of pulmonary venous return) and post- tricuspid overload group (pulmonary regurgitation after RVOT surgery). Patients with tricuspid valve anomaly were excluded. TA were modeled using 3D-TTE (Vivid E95, GE) and integrated semi-automatic tricuspid valve analysis algorithm. RV end-diastolic (RVEDV) and end- systolic volumes were calculated from 3D-TTE using integrated RV analysis algorithm. Measurements were indexed to body surface area (BSA).

Results/Expected results

In total, 103 patients were included (27 control, 30 pre-tricuspid and 34 post-tricuspid overload), mean age 10.5 ± 4.3 years old and mean weight 36.7 ± 17.1 kg. The 3 groups were matched for age and BSA. RV was dilated in pre- and post-tricuspid groups (89.1 ± 26.0 and 102.4 ± 21.6 ml/m² respectively vs. 57.5 ± 12.2 ml/m² in control group). TA surface were significantly larger in pre-tricuspid group compared to control and post-tricuspid group (6.6 ± 1.6, 4.9 ± 0.9 and 5.5 ± 1.2 mm/cm² respectively, P < 0.0001 and P = 0.009 respectively) but did not differ significantly between the control and post-tricuspid group (P = 0.32). Same results were found for TA short and long axis diameters. However, the tenting volume was greater in post-tricuspid group compared to control and pre-tricuspid group (1.3 ± 0.5, versus 0.9 ± 0.4 and 1.0 ± 0.3 ml/m² respectively, P < 0.0001 and P = 0.03 respectively) but didn’t differ significantly between pre-tricuspid and control group (P = 0.15). Tenting volume was not correlated to RVEDV (Figure 1).

Conclusion/Perspectives

3D modeling of TA is feasible from 3D-TTE and allow understanding remodeling of TA geometry in different situation of RV overload. This could have an impact on the therapeutic strategies in patients with tricuspid regurgitation.