BACKGROUND Tricuspid regurgitation (TR) in hypoplastic left heart syndrome (HLHS) is associated with morbidity and mortality. TR mechanisms and the impact of tricuspid valve repair (TVR) are unclear. We examined HLHS TR mechanisms, TVR's impact on tricuspid valve (TV), and features of poor TVR durability. METHODS We retrospectively compared 35 HLHS TVR cases and 35 age/stage-matched HLHS controls who do not undergo TVR. Pre-operative 3-dimensional echocardiography (3DE) assessed overall TV morphology (prolapse, normal, tethered), leaflet morphology, vena contracta area, and TR location. Two-dimensional echocardiography measured TV annulus diameter, RV fractional area change (RVFAC), sphericity, and TR grade at three time points (pre-op, early post-op, and latest follow-up). RESULTS Pre-op, TVR group, and controls had no difference in age, RV function or shape, or TV dimension. TVR group most commonly had anterior leaflet prolapse followed by septal leaflet prolapse or tethering. TR jet arises centrally (63%) and anterior septally (26%). Posterior annuloplasty (69%), commissuroplasty (37%), and leaflet repair (37%) were surgical techniques commonly performed. At early post-op, TR grade and TV annulus decreased. At latest follow-up, TV annulus remained reduced; however, 50% had significant TR. 25% required TV reoperation. Larger vena contracta at TVR was associated with significant TR. CONCLUSION HLHS patients undergoing TVR had more anterior leaflet prolapse and central TR. While TVR initially reduces annular size and TR grade, 50% redevelop significant TR despite maintained annular reduction. The association of greater TR severity prior to repair with post-op recurrence raises the consideration for earlier repair of TR in HLHS patients.

中文翻译：

---

接受电视修复的左心发育不全综合征患者的 3D 超声心动图的见解。

背景技术左心发育不全综合征 (HLHS) 中的三尖瓣反流 (TR) 与发病率和死亡率相关。TR 机制和三尖瓣修复 (TVR) 的影响尚不清楚。我们检查了 HLHS TR 机制、TVR 对三尖瓣 (TV) 的影响以及 TVR 耐久性差的特征。方法 我们回顾性比较了 35 名 HLHS TVR 病例和 35 名年龄/阶段匹配的未接受 TVR 的 HLHS 对照。术前 3 维超声心动图 (3DE) 评估了整体 TV 形态（脱垂、正常、栓系）、瓣叶形态、缩静脉面积和 TR 位置。二维超声心动图测量了三个时间点（术前、术后早期和最新随访）的 TV 瓣环直径、RV 分数面积变化 (RVFAC)、球形度和 TR 等级。结果 Pre-op、TVR 组和对照组在年龄上没有差异，RV 功能或形状，或电视尺寸。TVR 组最常见的是前叶脱垂，其次是间隔叶脱垂或栓系。TR 射流位于中央 (63%) 和前隔 (26%)。后瓣环成形术 (69%)、连合成形术 (37%) 和瓣叶修复 (37%) 是常用的手术技术。在术后早期，TR 等级和 TV 环减少。在最近的随访中，TV 环仍然减少；然而，50% 的人有显着的 TR。25% 需要电视重新手术。TVR 处较大的缩静脉与显着的 TR 相关。结论 接受TVR的HLHS患者有更多的前叶脱垂和中央TR。尽管 TVR 最初减小了环空尺寸和 TR 等级，但 50% 的人重新开发了显着的 TR，尽管环空减小了。