Predictors of Tricuspid Valve Anulus Dilation in a Heart Recipient Population

• Tricuspid valve regurgitation in reported in >20% of heart recipients. It severity has not only clinical impact but it is also associated with increased mortality.
• This study estimated possible early predictors for tricuspid valve regurgitation after orthotopic heart transplantation performed with standard Lower-Shumway technique on MRI studies.
• Echocardiographic evaluation followed by magnetic resonance studies were performed. The mean duration from time of transplantation was 34 ± 12 months and mean tricuspid valve diameter increased from 3.0 ± 0.3 to 3.34 ± 0.30 mm (P < .05).
• The was a positive correlation observed between recipient native right atrium and overall right atrium diameter and tricuspid valve diameter distension.

BackgroundTricuspid valve regurgitation in reported in >20% of heart recipients. It severity has not only clinical impact, but it is also associated with increased mortality. Risk factors for developing tricuspid valve dysfunction include allograft rejection, donor/recipient pericardial cavity mismatch, preoperative transpulmonary gradient and vascular resistance, biatrial anastomosis technique, and biopsy-induced injury. Tricuspid valve annulus distention is reported to causative factor for most common type of tricuspid valve dysfunction after heart transplantation. The aim of the study was to estimate possible early predictors for tricuspid valve regurgitation after orthotopic heart transplantation performed with standard Lower-Shumway technique on magnetic resonance imaging studies.MethodsA total of 20 patients (18 men and 2 women) with a mean age of 45 ± 12 years were enrolled into the study. Echocardiographic evaluation followed by magnetic resonance studies were performed. The mean duration from time of transplantation was 34 ± 12 months. Magnetic resonance and echocardiographic imaging focused on tricuspid valve annulus diameter and atrium dimensions.ResultsThe was a progressive distension of tricuspid valve annulus observed during the follow-up period. Mean tricuspid valve diameter increased from 3.0 ± 0.3 to 3.34 ± 0.3 mm (P < .05). There was a positive correlation observed between recipient native right atrium and overall right atrium diameter and tricuspid valve diameter distension.ConclusionsOverall right atrium diameter and native recipient right atrium diameter were found to be a risk factor for tricuspid valve annulus distension.