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Insights from 3D Echocardiography in Hypoplastic Left Heart Syndrome Patients Undergoing TV Repair

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Abstract

Background

Tricuspid regurgitation (TR) in hypoplastic left heart syndrome (HLHS) is associated with morbidity and mortality. TR mechanisms and the impact of tricuspid valve repair (TVR) are unclear. We examined HLHS TR mechanisms, TVR’s impact on tricuspid valve (TV), and features of poor TVR durability.

Methods

We retrospectively compared 35 HLHS TVR cases and 35 age/stage-matched HLHS controls who do not undergo TVR. Pre-operative 3-dimensional echocardiography (3DE) assessed overall TV morphology (prolapse, normal, tethered), leaflet morphology, vena contracta area, and TR location. Two-dimensional echocardiography measured TV annulus diameter, RV fractional area change (RVFAC), sphericity, and TR grade at three time points (pre-op, early post-op, and latest follow-up).

Results

Pre-op, TVR group, and controls had no difference in age, RV function or shape, or TV dimension. TVR group most commonly had anterior leaflet prolapse followed by septal leaflet prolapse or tethering. TR jet arises centrally (63%) and anterior septally (26%). Posterior annuloplasty (69%), commissuroplasty (37%), and leaflet repair (37%) were surgical techniques commonly performed. At early post-op, TR grade and TV annulus decreased. At latest follow-up, TV annulus remained reduced; however, 50% had significant TR. 25% required TV reoperation. Larger vena contracta at TVR was associated with significant TR.

Conclusion

HLHS patients undergoing TVR had more anterior leaflet prolapse and central TR. While TVR initially reduces annular size and TR grade, 50% redevelop significant TR despite maintained annular reduction. The association of greater TR severity prior to repair with post-op recurrence raises the consideration for earlier repair of TR in HLHS patients.

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Funding

This study was generously sponsored by Women and Children’s Health Research Institute.

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Authors and Affiliations

  1. Division of Cardiology, Stollery Children’s Hospital, University of Alberta, 8440-112 St NW, Unit 4C2.25, Edmonton, AB, T6G 2B7, Canada

    Kandice Mah, Nee Scze Khoo, Silvia Alvarez, Jeffrey Smallhorn & Timothy Colen

  2. Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, USA

    Billie-Jean Martin

  3. Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Michiko Maruyama & Ivan M. Rebeyka

Authors
  1. Kandice Mah
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  2. Nee Scze Khoo
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  3. Billie-Jean Martin
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  4. Michiko Maruyama
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  5. Silvia Alvarez
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  6. Ivan M. Rebeyka
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  7. Jeffrey Smallhorn
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  8. Timothy Colen
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Corresponding author

Correspondence to Timothy Colen.

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All authors declare that they have no conflict of interest to disclose.

Ethical Approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The research ethics board at the University of Alberta approved this study.

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This study is retrospective and was approved by both institutions research ethics boards.

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Mah, K., Khoo, N.S., Martin, BJ. et al. Insights from 3D Echocardiography in Hypoplastic Left Heart Syndrome Patients Undergoing TV Repair. Pediatr Cardiol 43, 735–743 (2022). https://doi.org/10.1007/s00246-021-02780-1

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  • DOI: https://doi.org/10.1007/s00246-021-02780-1

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