Transcatheter Repair for Patients with Tricuspid Regurgitation.

Background: Severe tricuspid regurgitation is a debilitating condition that is associated with substantial morbidity and often with poor quality of life. Decreasing tricuspid regurgitation may reduce symptoms and improve clinical outcomes in patients with this disease.

Methods: We conducted a prospective randomized trial of percutaneous tricuspid transcatheter edge-to-edge repair (TEER) for severe tricuspid regurgitation.

The right atrium and tricuspid annulus are cardinal structures in tricuspid regurgitation with or without pulmonary hypertension.

Background: Right heart structural abnormalities occur in both tricuspid regurgitation (TR) and pulmonary hypertension (PH). They may occur independently or together, but their joint effects on cardiac structure are incompletely described. This study examined the interactions of TR severity and PH on right heart structural changes.

Impact of pulmonary hypertension on tricuspid valve function.

Pulmonary arterial hypertension (PAH) results in increased right ventricle (RV) afterload leading to RV remodeling, tricuspid regurgitation (TR), and RV failure. Though characterizing the mechanisms of TR in PAH may suggest new treatment strategies, the mechanisms leading to TR in PAH have not been characterized. In the present study, eleven porcine tricuspid valves were studied in an in vitro right heart simulator.

Peak mechanical loads induced in the in vitro edge-to-edge repair of posterior leaflet flail.

Background: Percutaneous edge-to-edge mitral valve (MV) repair is a potential therapeutic option for patients presenting with mitral regurgitation, who may not be suitable for surgery. We characterized the edge-to-edge repair forces in a posterior leaflet flail MV model to identify potential modes of mechanical failure.

Methods: Porcine MVs were evaluated in two different sizes (Physio II 32 and 40) in a left-side heart simulator under physiologic hemodynamic conditions.

Measurement of strut chordal forces of the tricuspid valve using miniature C ring transducers.

Tricuspid valve (TV) leaflets, papillary muscles (PM), and tendinous chords must work together to ensure proper coaptation. Alterations in valvular mechanics, including chordal forces, may lead to improper coaptation resulting in tricuspid regurgitation. Little is known about TV mechanics as right-sided heart diseases have been overlooked.

The effects of a three-dimensional, saddle-shaped annulus on anterior and posterior leaflet stretch and regurgitation of the tricuspid valve.

Tricuspid regurgitation (TR) is present in trace amounts or more in 82-86% of the population and is greater than mild in 14% of the population. In severe cases, it can contribute to right heart failure and adversely affect mitral valve repair durability. One major cause of TR is the dilation of the tricuspid annulus, which alters the geometry of the annulus from a saddle-shape to a more planar profile.

Correlates of tricuspid regurgitation as determined by 3D echocardiography: pulmonary arterial pressure, ventricle geometry, annular dilatation, and papillary muscle displacement.

Background: While it is understood that annular dilatation contributes to tricuspid regurgitation (TR), other factors are less clear. The geometry of the right ventricle (RV) and left ventricle (LV) may alter tricuspid annulus size and papillary muscle (PM) positions leading to TR.

Methods And Results: Three-dimensional echocardiographic images were obtained at Emory University Hospital using a GE Vivid 7 ultrasound system.

In vitro characterization of the mechanisms responsible for functional tricuspid regurgitation.

Background: Functional tricuspid regurgitation (TR) is increasingly recognized as a source of morbidity. Current repair strategies focus on annular remodeling because annular dilatation is common in patients with TR. Although papillary muscle (PM) displacement is recognized in functional mitral regurgitation, its role in TR is less well characterized.

Altered right ventricular papillary muscle position and orientation in patients with a dilated left ventricle.

Objective: To investigate the impact of left ventricular dilatation on right ventricular papillary muscle displacement.

Methods: Thirteen patients underwent high-resolution cardiac magnetic resonance imaging at Emory University Hospital: Seven patients with congestive heart failure and a dilated left ventricle composed the dilated left ventricular group, and 6 normal subjects were used as a control. A total of 120 cardiac magnetic resonance imaging slices were acquired in a short-axis view at end diastole for each subject.