Tricuspid valve anatomy of massive to torrential tricuspid regurgitation: Computed tomography analysis

Background: 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). Methods: 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. Results: 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 degrees vs. 32 +/- 13 degrees, p < 0.001; posterior leaflet: 22 +/- 11 degrees vs. 30 +/- 11 degrees, 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, a greater angle of the leaflets and a more elliptical annulus were associated with non-central/non-anteroseptal TR jets.Conclusions: 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.