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Tricuspid annular dilation in patients undergoing early mitral valve surgery: is it an old story?

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Abstract

Patients with mitral valve prolapse (MVP), undergoing early surgery for severe regurgitation, are usually characterized by a low degree of right chambers’ remodeling. In this selected population, the mechanisms leading to tricuspid annular (TA) dilatation (TAD) are not well understood. In this setting, we aimed to evaluate, using three-dimensional echocardiography (3DE), how right chambers affect TA size and might contribute to functional tricuspid regurgitation (FTR) progression. We studied 159 patients treated with early isolated surgery for MVP, characterized by: sinus rhythm; normal biventricular function; normal or elevated pulmonary artery pressure; tricuspid regurgitation (TR) ≤ mild; no concomitant cardiac disease. All patients reached a 3-year echocardiographic follow-up. Based on two-dimensional echocardiography, patients were divided in Group 1 (N = 68, 43%, TAD, TA ≥ 21 mm/m2) and Group 2 (N = 91, 57%, no TAD, TA < 21 mm/m2). By 3DE, Group 1 showed larger TA size, right atrial (RA) volume and right ventricular (RV) conical remodeling compared to Group 2 (p < 0.05). The multivariate analysis revealed that RA volume, RV basal diameter and function were independently correlated to TA size (p < 0.05). At the 3-year follow-up there was a low incidence of FTR, with a trend towards FTR progression in Group 1 (p = 0.07). In patients undergoing early surgery for MVP, TAD seems to result from distinctive early-onset geometrical changes of the right chambers, preceding TR, RV dilatation and pulmonary hypertension at rest. An integrated approach, including right chambers’ assessment by 3DE, might help to better recognized patients at higher risk for TAD and, potentially for FTR.

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All data relevant to the studyare included in the article. Data are available upon resenable request.

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Funding

The authors did not receive founding for this research from any agency in the public, commercial or not-for-profits sectors.

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Authors and Affiliations

  1. Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy

    Valentina Volpato, Valentina Mantegazza, Gloria Tamborini, Paola Gripari, Manuela Muratori, Laura Fusini, Marco Zanobini, Francesco Alamanni & Mauro Pepi

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  1. Valentina Volpato
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  2. Valentina Mantegazza
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  3. Gloria Tamborini
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  4. Paola Gripari
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  5. Manuela Muratori
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  6. Laura Fusini
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  7. Marco Zanobini
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  8. Francesco Alamanni
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  9. Mauro Pepi
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Contributions

VV: conceptualization; data curation; formal analysis; investigation; methodology; project administration; validation; visualization; writing—original draft. VM: data curation; formal analysis; investigation; methodology; validation; visualization; writing—review & editing. GT: conceptualization; methodology; project administration; supervision; validation; visualization; review & editing. PG: data curation; formal analysis; investigation; writing—review & editing. MM: data curation; formal analysis; investigation; writing—review & editing. LF: data curation; formal analysis; investigation; writing—review & editing. MZ: data curation; formal analysis; investigation; writing—review & editing. FA: data curation; formal analysis; investigation; writing—review & editing. MP: conceptualization; methodology; project administration; supervision; validation; visualization; review & editing.

Corresponding author

Correspondence to Valentina Volpato.

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Conflict of interest

Dr Volpato is on speaker bureau for Philips Healthcare.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and approved by the Istitutional Ethics Commetee (R1168/20-CCM 1230). Informed consent was obtained from all subjects.

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Informed consent was obtained from all subjects.

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Volpato, V., Mantegazza, V., Tamborini, G. et al. Tricuspid annular dilation in patients undergoing early mitral valve surgery: is it an old story?. Int J Cardiovasc Imaging 37, 2439–2446 (2021). https://doi.org/10.1007/s10554-021-02223-1

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  • DOI: https://doi.org/10.1007/s10554-021-02223-1

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