Abstract

BACKGROUND: Twenty-five percent of hypoplastic left heart syndrome (HLHS) patients require tricuspid valve (TV) repair. Location of tricuspid regurgitation (TR) is important in determining the type of repair performed. Three-dimensional echocardiography (3DE) studies report a high incidence of error in 2DE identification of TV leaflets. This study compares 3DE and 2DE assessment of TR in HLHS (jet location, TR grade, reproducibility).METHODS: We performed a retrospective, single center review. Fifty-six HLHS patients with available 2DEs and 3DEs, and mild or greater TR, were included. TR location, grade, vena contracta (VC) area, and TV annulus diameter were measured from 2DE and 3DE. Reproducibility was assessed by blinded reviewers.RESULTS: 3DE identified primary jet location as central (57%), followed by antero-septal (36%). There was poor agreement between 3DE and 2DE findings for jet location (kappa 0.05; CI: -0.08 to 0.19). Interobserver reproducibility for 3DE location was excellent (kappa 0.8), whereas 2DE reproducibility was poor (kappa 0.32). The most common jet location pre-Norwood and pre-Glenn is central (70%); whereas pre-Fontan and post-Fontan the location is central (45%) and anterior-septal (48%). 2DE VC area correlated moderately with 3DE VC area (r = 0.60, p<0.0001). 2DE and 3DE TV annulus diameter for lateral (r = 0.85, p<0.0001) and anterior-posterior (r= 0.74, p= 0.001) dimensions were strongly correlated.CONCLUSIONS: In children with HLHS, 2DE assessment of TR location has poor agreement with 3DE and was poorly reproducible. In contrast, 3DE TR jet location was highly reproducible. Pre-Glenn, a central TR jet was the most common, while post-Glenn central and anteroseptal locations were equal, highlighting the importance of pre-operative identification of TR jet location in HLHS patients.

View details for DOI 10.1016/j.echo.2020.12.010

View details for PubMedID 33373699