We aimed to comprehensively assess tricuspid valve anatomy and to determine factors associated with the more advanced stages beyond severe TR (i.e., massive to torrential).
We retrospectively analyzed the pre-procedural cardiac CT images in patients with ≥severe TR using 3mensio software. The tricuspid valve annulus size, right-atrial and right-ventricular dimensions, tenting height, and leaflet angles were measured.
A total of 103 patients were analyzed. The mean effective regurgitant orifice area was 61.7 ± 31.5 mm2, vena contracta was 13.1 ± 4.6 mm, and massive/torrential TR was observed in 62 patients. Compared to patients with severe TR, patients with massive/torrential TR had a larger tricuspid annulus area (18.6 ± 3.4 cm2 vs. 20.6 ± 5.3 cm2, p = 0.037), right atrial short-axis diameter (66.1 ± 9.1 mm vs. 70.6 ± 9.9 mm, p = 0.022), increased tenting height (8.8 ± 3.6 mm vs. 10.7 ± 3.7 mm, p = 0.014), and greater leaflet angles (anterior leaflet: 22 ± 9° vs. 32 ± 13°, p < 0.001; posterior leaflet: 22 ± 11° vs. 30 ± 11°, p = 0.003). In the multivariable logistic regression model, the angle of anterior leaflet (OR 1.08, 95%CI 1.03–1.14, p = 0.004) and posterior leaflet (OR 1.07, 95%CI 1.02–1.13, p = 0.007) were associated with massive/torrential TR. Additionally, patients with massive/torrential TR more often had TR jets from non-central/non-anteroseptal commissure (34% vs. 76%, p < 0.001). In the multivariable model, the greater angle of the leaflets and more elliptical annulus were associated with non-central/non-anteroseptal TR jets.
Anterior and posterior leaflet angles are significant factors associated with massive/torrential TR. Furthermore, leaflet angles and ellipticity of the tricuspid valve are associated with the location of TR jets.
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Published online: January 25, 2023
Accepted: January 24, 2023
Received in revised form: January 8, 2023
Received: July 4, 2022
Publication stageIn Press Journal Pre-Proof
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