Introduction

Tricuspid regurgitation (TR) affects approximately 1.6 million Americans and is associated with just a 63.9% 1-year survival rate in its moderate to severe forms due to its asymptomatic nature and late diagnosis and surgical referral. As a result, industrial fervor has begun to broach this topic, with several percutaneous treatment devices currently under development. As much remains unknown about the tricuspid apparatus, the mechanics of these procedures remain unquantified. In this study, a testing apparatus and technique for the evaluation of percutaneous tricuspid valve (TV) bicuspidization were developed for the evaluation of these parameters in twelve porcine hearts.

Methods

The passive relaxed myocardial state and the active contracted state were each induced in six porcine hearts and the bicuspidization experiment was run twice, the second time after induction of TR. TV annular area, cinching force, static leakage through the TV annulus, and annular ellipticity were quantified and compared among the groups.

Results

The use of phenol was effective to induce functional TR by increased annular area. Cinching force was not found to differ between any of the testing states, but the bicuspidization experiment was able to reduce the TR annular area to that of its healthy counterpart in addition to reducing static leakage through the TV annulus. Despite appropriately reducing the area, bicuspidization was found to induce a more circular TV annular shape.

Conclusion

Taken together, these results provide a first mechanical analysis of the TV bicuspidization mechanism and may serve as a point of reference for future clinical animal studies.

中文翻译：

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猪模型中三尖瓣二尖瓣化的机械和结构评估。

介绍

三尖瓣关闭不全（TR）影响约160万美国人，由于其无症状性，晚期诊断和手术转诊，其中至重度的1年生存率仅为63.9％。结果，工业上的热情已经开始涉及这个话题，目前正在开发几种经皮治疗设备。由于对三尖瓣器械尚不了解，因此这些手术的机制仍未量化。在这项研究中，开发了一种评估经皮三尖瓣（TV）双尖瓣化的测试设备和技术，用于评估十二个猪心脏中的这些参数。

方法

在6只猪的心脏中分别诱发了被动的放松心肌状态和主动的收缩状态，并且在TR诱导后第二次进行了二尖瓣化实验两次。定量并比较各组之间的电视环形区域，束紧力，通过电视环的静态泄漏和环形椭圆率。

结果

苯酚的使用可有效地通过增加环形面积来诱导功能性TR。没有发现在任何测试状态之间的拉紧力都不同，但是二尖瓣化实验除了减少了通过TV环的静态泄漏外，还能够将TR环形区域减小到其健康的对应区域。尽管适当地减小了面积，但是发现双尖瓣化可诱发更圆形的TV环形。

结论

综上所述，这些结果提供了电视二尖瓣化机制的首次力学分析，并且可以作为将来临床动物研究的参考点。