Background

Tricuspid valve regurgitation (TR) is a risk factor for morbidity and mortality in children with hypoplastic left heart syndrome (HLHS). Surgical tricuspid valve (TV) repair is common, but durable repair remains challenging. The aim of this study was to examine mechanisms of TR requiring surgery, features associated with unsuccessful repair, and TV changes after surgical repair.

Methods

Thirty-six patients with HLHS requiring TV repair (TVR) and 36 matched control subjects with HLHS were assessed using two-dimensional and three-dimensional echocardiography. Using three-dimensional echocardiography, TV coordinates from the annulus, leaflet, and ventricle were used to measure annular, leaflet, prolapse, and tethering values and anterior papillary muscle angle. TR grade and ventricular size, function, and shape were assessed using two-dimensional echocardiography.

Results

Patients requiring TVR had greater total leaflet prolapse, larger TV annular and leaflet areas, and flatter annuli, with no difference in tethering, coaptation index, or anterior papillary muscle angle. In patients with HLHS, successful TVR at follow-up (58%) was associated with preoperative total leaflet prolapse (especially posterior). Unsuccessful repair was associated with preoperative tethering of the septal leaflet. TVR in patients with HLHS caused a reduction of total annular and leaflet size and reduced prolapse and tethering of the posterior leaflet but did not affect anterior leaflet prolapse or septal leaflet tethering.

Conclusions

Features associated with TVR include a flattened and dilated TV annulus with leaflet prolapse. The additional presence of a tethered septal leaflet before TVR is associated with significant postoperative TR. Current surgical techniques, predominantly posterior annuloplasty and commissuroplasty, adequately address annular size and posterior leaflet pathology, but not septal leaflet tethering. Individualized and innovative surgical techniques are vital to improve surgical repair success.

中文翻译：

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三尖瓣栓系与左心发育不全综合征瓣膜修复后残余反流相关：三维超声心动图研究

背景

三尖瓣关闭不全 (TR) 是左心发育不良综合征 (HLHS) 儿童发病率和死亡率的危险因素。手术三尖瓣 (TV) 修复很常见，但持久修复仍然具有挑战性。本研究的目的是检查需要手术的 TR 机制、与修复失败相关的特征以及手术修复后的 TV 变化。

方法

使用二维和三维超声心动图评估了 36 名需要 TV 修复 (TVR) 的 HLHS 患者和 36 名匹配的 HLHS 对照受试者。使用三维超声心动图，来自瓣环、瓣叶和心室的 TV 坐标用于测量瓣环、瓣叶、脱垂和栓系值以及前乳头肌角。使用二维超声心动图评估 TR 等级和心室大小、功能和形状。

结果

需要 TVR 的患者有更大的总瓣叶脱垂、更大的 TV 环和瓣叶面积以及更平坦的瓣环，在束缚、接合指数或前乳头肌角方面没有差异。在 HLHS 患者中，随访时成功的 TVR (58%) 与术前总瓣叶脱垂（尤其是后叶脱垂）相关。不成功的修复与术前分隔瓣叶的栓系有关。HLHS 患者的 TVR 导致总瓣环和瓣叶尺寸减小以及后瓣脱垂和束缚减少，但不影响前瓣脱垂或间隔瓣束缚。

结论

与 TVR 相关的特征包括具有瓣叶脱垂的扁平和扩张的 TV 瓣环。在 TVR 之前额外存在的系留隔膜传单与显着的术后 TR 相关。当前的手术技术，主要是后瓣环成形术和连合成形术，可以充分解决瓣环大小和后瓣病变，但不能解决间隔瓣束缚。个性化和创新的手术技术对于提高手术修复成功率至关重要。