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

Abstract

Background

The tricuspid annulus (TA) in children with congenital heart diseases (CHD) may undergo significant changes in size, shape, and function due to hemodynamic overload.

Objectives

This study aimed to compare TA remodeling in children with CHD, based on the type of right ventricle (RV) overload, using three-dimensional transthoracic echocardiography (3D-TTE).

Methods

We enrolled 30 patients with pre-tricuspid overload (atrial septal defect and partial anomalous pulmonary venous connection), 33 with post-tricuspid overload (pulmonary regurgitation after right ventricular outflow tract surgery), and 27 healthy controls. Using 3D-TTE, we assessed the dimensions of the right chambers, the surface area, and the tenting volume of the TA and analyzed the correlation between these measurements.

Results

3D TA surface was larger in the pre-tricuspid group than in the post-tricuspid group (median 6.60 cm²/m² versus 5.16 cm²/m², P = 0.01) and was correlated to right atrial (RA) volume (P = 0.0001, r = 0.66) and RA surface (P < 0.0001, r = 0.74) in the pre-tricuspid group. The tenting volume was greater in the post-tricuspid group than the control group but did not differ significantly between the pre-tricuspid and the post-tricuspid groups and between the post-tricuspid group and the control group. 3D TA surface and tenting volume were not correlated to RVEDV in none of the groups (Figs. 1–3).

Conclusion

3D modeling of the TA using 3D-TTE is feasible and provides insights into TA remodeling in different RV overload conditions. RA volume and surface area are key determinants of TA size, which could have an impact on the therapeutic strategies in patients with tricuspid regurgitation.