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Impact of Pulmonary Hypertension on Tricuspid Valve Function

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Abstract

Pulmonary arterial hypertension (PAH) results in increased right ventricle (RV) afterload leading to RV remodeling, tricuspid regurgitation (TR), and RV failure. Though characterizing the mechanisms of TR in PAH may suggest new treatment strategies, the mechanisms leading to TR in PAH have not been characterized. In the present study, eleven porcine tricuspid valves were studied in an in vitro right heart simulator. Annular dilatations of 1.2 and 1.4 times normal area, papillary muscle (PM) displacement simulating concentric RV dilatation and eccentric RV dilatation due to concomitant left ventricle dysfunction, and two levels of PAH hemodynamics were simulated independently and in combination. Relative TR, tenting area (TA) along each coaptation line, and coaptation area (CA) of each leaflet were quantified. Results showed a significant increase (p ≤ 0.05) in TR with both increased mean pulmonary artery pressure (mPAP) and annular dilatation of 1.4 times normal. Increased mPAP significantly decreased TA but tended to increase CA, while PM displacement significantly increased TA but did not affect CA, suggesting competing effects of transvalvular pressure and leaflet tethering. Annular dilatation significantly decreased anterior and posterior CA but did not affect TA. These results may inform future TV repairs in PAH to reduce TR and improve RV hemodynamics.

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Abbreviations

A, P, S:

Anterior, posterior, septal

CA:

Coaptation area

LV:

Left ventricle

mPAP:

Mean pulmonary artery pressure

PAH, PH:

Pulmonary arterial hypertension, pulmonary hypertension

PM:

Papillary muscle

RV:

Right ventricle

TA:

Tenting area

TR:

Tricuspid regurgitation

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Acknowledgments

The authors thank Holifield Farms for the donation of porcine hearts. LDCC was funded with Government support under and awarded by DoD, Air Force Office of Scientific Research, National Defense Science and Engineering Graduate (NDSEG) Fellowship, 32 CFR 168a. JRD was funded by the Georgia Institute of Technology Petit Undergraduate Research Scholarship, and EMS was funded by the American Heart Association Predoctoral Fellowship (09PRE2380090). Funds were also provided by the Wallace H. Coulter Distinguished Faculty Chair Endowment.

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None.

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Authors and Affiliations

  1. George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA

    Lauren D. C. Casa & Ajit P. Yoganathan

  2. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University – Parker H. Petit Biotechnology Building, 315 Ferst Drive Suite 2116, Atlanta, GA, 30332-0363, USA

    Joseph R. Dolensky, Erin M. Spinner & Ajit P. Yoganathan

  3. Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Emir Veledar & Stamatios Lerakis

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  1. Lauren D. C. Casa
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  2. Joseph R. Dolensky
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Correspondence to Ajit P. Yoganathan.

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Associate Editor Jane Grande-Allen oversaw the review of this article.

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Casa, L.D.C., Dolensky, J.R., Spinner, E.M. et al. Impact of Pulmonary Hypertension on Tricuspid Valve Function. Ann Biomed Eng 41, 709–724 (2013). https://doi.org/10.1007/s10439-012-0713-2

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  • DOI: https://doi.org/10.1007/s10439-012-0713-2

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