Semi-automated quantification of tricuspid valve dynamics and structure in tetralogy of Fallot and hypoplastic left heart syndrome using three-dimensional echocardiography

Vivek Jani; Ling Li; Mary Craft; Federico Veronesi; Nee Khoo; David Danford; Denisa Muraru; Shelby Kutty

doi:10.1186/s44156-023-00023-y

Semi-automated quantification of tricuspid valve dynamics and structure in tetralogy of Fallot and hypoplastic left heart syndrome using three-dimensional echocardiography

Echo Res Pract. 2023 Jul 6;10(1):10. doi: 10.1186/s44156-023-00023-y.

Authors

Vivek Jani¹, Ling Li², Mary Craft², Federico Veronesi³, Nee Khoo⁴, David Danford², Denisa Muraru^{5

6}, Shelby Kutty⁷

Affiliations

¹ Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA.
² University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, USA.
³ Department of Electrical, Electronic and Information Engineering, University of Bologna, Bologna, Italy.
⁴ Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
⁵ Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
⁶ Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
⁷ Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA. skutty1@jhmi.edu.

Abstract

Anomalies of the tricuspid valve (TV) are associated with worsened prognosis in congenital heart disease (CHD). Here, we present a descriptive study examining changes in TV morphology in two CHD conditions-repaired tetralogy of Fallot (rTOF) and hypoplastic left heart syndrome (HLSH), using three-dimensional echocardiography. Full volume acquisitions of the TV and right ventricle (RV) were performed from an RV-focused apical view using ECG gating over 2-5 consecutive cardiac cycles using 3D echocardiography, from which TV annulus and leaflet parameters were quantified. A total of 40 rTOF patients (age 14 ± 9.8 years), 40 HLHS patients (age1.0 ± 1.5 years) and 80 age and gender matched controls were included. Among leaflet parameters, antero-posterior and posterior-septal TV coaptation heights were smaller in rTOF (p < 0.001) vs. control. Conversely, only the short-axis TV height was different in HLHS vs. controls (HLHS 1.6 ± 0.4 cm vs. control 1.4 ± 0.3 cm). TV leaflet parameters tended to be larger in HLHS, while leaflet coaptation distances were similar between groups. We demonstrate that 3D echocardiography for assessment of the TV is feasible in rTOF and HLHS patients and identifies unique differences in TV morphology. Future studies should clarify the clinical significance of TV morphology in these patient populations.

Keywords: 3D echocardiography; Hypoplastic left heart syndrome; Repaired tetralogy of Fallot; Tricuspid valve.