3D evaluation of tricuspid annulus morphology in patients with pulmonary hypertension

Tricuspid valve (TV) dilatation is associated with tricuspid regurgitation and right ventricular failure. Pulmonary hypertension (PH) secondary to mitral valve disease is a common cause of TV dilatation. Decision regarding when to surgically repair the TV, while operating on the mitral valve, is a topic of debate, and is frequently based solely on 2D echocardiographic measurement of TV diameters. To facilitate decision-making, we sought to develop software for 3D analysis of TV morphology from real-time 3D echocardiographic images. Novel custom software was used to trace and measure TV annulus (TA) in 10 patients with PH and 10 control subjects (CTRL). To trace the TA, 10 rotated planes (18° apart) were displayed and two TA points were selected in each plane. Points were interpolated using smooth splines. The following parameters were automatically computed in 3D: area, perimeter, height, eccentricity, segment lengths, diameters and segmental annulus curvature. Compared to CTRL, in patients with PH, the TA was: (1) bigger and less planar; (2) less elliptical, i.e. more round Interestingly, changes in annular shape were not uniform, as the anterior and posterior segments showed altered segment lengths and curvature, while the septal segment remained unchanged Our new software revealed that PH affects both size and shape of the TA, suggesting that 3D analysis may be useful for pre-surgical evaluation of TV pathology.