The Journal of thoracic and cardiovascular surgery
June 2, 2026 · via Europe PMC
Rationale of functional tricuspid annular dilatation based on standardized intraoperative measurements.
Kawada N, Naganuma H, Muramatsu K, +5 more, Kunihara T.
AI summary — for doctors, generated from the abstract only
In functional tricuspid regurgitation, annular dilatation is uneven and mostly involves the posterior annulus, with the septal and anterior segments relatively spared.
What was studied
Retrospective analysis of 106 patients who had tricuspid ring annuloplasty during left-sided valve surgery for functional TR, with intraoperative measurement of septal, posterior and anterior annular segments compared against cadaveric controls and stratified by LV diameter, rhythm, TR gradient and leaflet scallops.
Key findings
- Total and posterior annular lengths were significantly longer than in cadaveric controls, while septal and anterior lengths were relatively preserved.
- LV diastolic diameter above 56 mm went with posterior and total annular enlargement; atrial fibrillation went with selective anterior enlargement.
- More posterior leaflet scallops were linked to disproportionate posterior annular elongation, suggesting a leaflet-driven mechanism.
Clinical relevance
The findings give an anatomic rationale for tailoring annuloplasty to the segment that actually dilates rather than assuming uniform annular enlargement, which matters for surgeons repairing the tricuspid valve at the time of left-sided surgery.
Who should care
Limitations
This is a single-cohort retrospective study that relied on cadaveric measurements from a prior study as controls, so differences may partly reflect measurement and population differences rather than true remodeling.
When planning tricuspid annuloplasty, consider the patient's LV size, rhythm and posterior leaflet anatomy as clues to where the annulus is dilated.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objective
Functional tricuspid regurgitation (FTR) is commonly attributed to annular dilatation; however, the segment-specific patterns and mechanisms of annular remodeling remain incompletely defined. This study aimed to characterize the segmental and mechanistic features of functional tricuspid annular dilatation using standardized intraoperative measurements.
Methods
We retrospectively analyzed 106 patients who underwent tricuspid ring annuloplasty concomitant with left-sided valve surgery for FTR between April 2015 and October 2025. Tricuspid annular length was measured intraoperatively using standardized anatomic segmentation into septal, posterior, and anterior components. Patients were stratified by left ventricular diastolic diameter, tricuspid regurgitation pressure gradient, cardiac rhythm, and number of posterior leaflet scallops. Cadaveric annular measurements from a previous anatomic study served as controls.
Results
Compared with cadaveric controls, patients with FTR demonstrated significant elongation of total and posterior annular lengths, whereas septal and anterior lengths were relatively preserved. Left ventricular diastolic diameter >56 mm was associated with enlargement of total and posterior annular lengths with minimal septal involvement. Tricuspid regurgitation pressure gradient was not associated with annular dimensions but correlated with greater severity of tricuspid regurgitation. Atrial fibrillation was associated with selective anterior annular enlargement. A greater number of posterior leaflet scallops was associated with disproportionate posterior annular elongation, indicating a leaflet-driven mechanism of posterior annular remodeling.
Conclusions
Functional tricuspid annular dilatation is nonuniform and predominantly involves the posterior annulus. Ventricular, atrial, and valvular factors exert distinct, segment-specific effects on annular geometry, providing a structural and mechanistic rationale for individualized annuloplasty strategies.
DOI
10.1016/j.jtcvs.2026.05.016
PMID
42235748
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
Want more like this?
Browse more from the feed. A free account unlocks the full feed, saving and communities.
Back to the research feed