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The Effect of Downsizing on the Normal Tricuspid Annulus

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Abstract

Tricuspid annuloplasty is a surgical procedure that cinches the valve’s annulus in order to reduce regurgitant blood flow. One of its critical parameters is the degree of downsizing. To provide insight into the effect of downsizing, we studied the annulus of healthy sheep during suture annuloplasty. To this end, we implanted fiduciary markers along the annulus of sheep and subsequently performed a DeVega suture annuloplasty. We performed five downsizing steps in each animal while recording hemodynamic and sonomicrometry data in beating hearts. Subsequently, we used splines to approximate the annulus at baseline and at each downsizing step. Based on these approximations we computed clinical metrics of annular shape and dynamics, and the continuous field metrics height, strain, and curvature. With these data, we demonstrated that annular area reduction during downsizing was primarily driven by compression of the anterior annulus. Similarly, reduction in annular dynamics was driven by reduced contractility in the anterior annulus. Finally, changes in global height and eccentricity of the annulus could be explained by focal changes in the continuous height profile and changes in annular curvature. Our findings are important as they provide insight into a regularly performed surgical procedure and may inform the design of transcatheter devices that mimic suture annuloplasty.

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Acknowledgments

We appreciate the support by the internal grant from Meijer Heart and Vascular Institute at Spectrum Health and by the American Heart Association (18CDA34120028). The authors also acknowledge Jeanette Binkowski for the preparation of Fig. 1.

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None of the authors have conflicts of interest to report.

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Authors and Affiliations

  1. Department of Mechanical Engineering, University of Texas at Austin, 204 E Dean Keeton Street, Austin, TX, 78712, USA

    Mrudang Mathur

  2. Department of Biomedical Engineering, University of Texas at Austin, 107 W Dean Keeton Street, Austin, TX, 78712, USA

    William D. Meador

  3. Silesian Centre for Heart Diseases, Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland

    Tomasz Jazwiec

  4. Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland

    Marcin Malinowski

  5. Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, 49503, USA

    Tomasz A. Timek

  6. Departments of Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, University of Texas at Austin, 2617, Wichita Street, Austin, TX, 78712, USA

    Manuel K. Rausch

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  1. Mrudang Mathur
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  2. William D. Meador
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  3. Tomasz Jazwiec
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  6. Manuel K. Rausch
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Correspondence to Manuel K. Rausch.

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Mathur, M., Meador, W.D., Jazwiec, T. et al. The Effect of Downsizing on the Normal Tricuspid Annulus. Ann Biomed Eng 48, 655–668 (2020). https://doi.org/10.1007/s10439-019-02387-x

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