{"79101":{"#nid":"79101","#data":{"type":"news","title":"Non-Invasive Measurements of Tricuspid Valve Anatomy Can Predict Severity of Valve Leakage","body":[{"value":"\u003Cp\u003EAn estimated 1.6 million Americans suffer moderate to severe\nleakage through their tricuspid valves, which are complex structures that allow\nblood to flow from the heart\u2019s upper right chamber to the ventricle. If left\nuntreated, severe leakage can affect an individual\u2019s quality of life and can even\nlead to death.\u003C\/p\u003E\n\n\u003Cp\u003EA new study finds that the anatomy of the heart\u2019s tricuspid\nvalve can be used to predict the severity of leakage in the valve, which is a\ncondition called tricuspid regurgitation. The study, conducted by researchers\nfrom the Georgia Institute of Technology and Emory University, found that pulmonary\narterial pressure, the size of the valve opening and papillary muscle position measurements\ncould be used to predict the severity of an individual\u2019s tricuspid\nregurgitation.\u003C\/p\u003E\n\n\u003Cp\u003E\u201cBy being able to identify and measure an individual\u2019s\nparticular tricuspid valve anatomical features that we have shown are\ncorrelated with increased leakage, clinicians should be able to better target their repair efforts and create more\ndurable repairs,\u201d said \u003Ca href=\u0022http:\/\/www.bme.gatech.edu\/facultystaff\/faculty_record.php?id=5\u0022 target=\u0022_blank\u0022\u003EAjit Yoganathan\u003C\/a\u003E, Regents\u2019 professor in the\n\u003Ca href=\u0022http:\/\/www.bme.gatech.edu\u0022 target=\u0022_blank\u0022\u003EWallace H. Coulter Department of Biomedical Engineering at Georgia Tech and\nEmory University\u003C\/a\u003E.\u003C\/p\u003E\n\n\u003Cp\u003EThe study was published in the January issue of the journal \u003Ca href=\u0022http:\/\/dx.doi.org\/10.1161\/CIRCIMAGING.111.965707\u0022 target=\u0022_blank\u0022\u003E\u003Cem\u003ECirculation: Cardiovascular\u003C\/em\u003E \u003Cem\u003EImaging\u003C\/em\u003E\u003C\/a\u003E. Funding for this work was\nprovided by the American Heart Association and a donation from Tom and Shirley\nGurley.\u003C\/p\u003E\n\n\u003Cp\u003EYoganathan and recent Coulter Department doctoral graduate Erin\nSpinner teamed with Stamatios Lerakis, a professor of medicine (cardiology), radiology\nand imaging sciences at Emory University, to non-invasively collect 3-D\nechocardiograms from 64 individuals who exhibited assorted grades of tricuspid leakage.\nSubjects included 20 individuals with \u201ctrace,\u201d 13 with \u201cmild,\u201d 17 with \u201cmoderate\u201d\nand 14 with \u201csevere\u201d tricuspid regurgitation. The subjects with \u201cmild\u201d to\n\u201csevere\u201d leakage exhibited a mix of isolated right, isolated left, and both\nright and left ventricle dilation.\u003C\/p\u003E\n\n\u003Cp\u003EFrom the 3-D echocardiography images of the heart they\ncollected, the researchers measured (1) the area of the annulus, which is the\nfibrous ring that surrounds the tricuspid valve opening; (2) the distance\nbetween the annulus and the three right ventricle papillary muscles, which keep\nthe valve shut when the ventricle contracts; and (3) the position of the papillary\nmuscles with respect to the center of the annulus. The clinicians also measured\npulmonary arterial pressure using standard clinical methods and assessed the\ngrade of tricuspid regurgitation from \u201ctrace\u201d to \u201csevere\u201d with color Doppler\nimaging.\u003C\/p\u003E\n\n\u003Cp\u003EIn collaboration with Emir Veledar, an assistant professor\nand statistician in the Rollins School of Public Health at Emory University, the\nresearchers found statistical differences between individuals with ventricular dilation\nand the control subjects in the parameters of pulmonary arterial pressure,\nannulus area and papillary muscle displacement. They also found that all three factors were correlated with the grade\nof tricuspid regurgitation.\u003C\/p\u003E\n\n\u003Cp\u003E\u201cThis study\u2019s use of\nadvanced cardiovascular imaging, and more specifically 3-D echocardiography, provided\nnew insight into the pathophysiology of tricuspid regurgitation and a good\nunderstanding as to why current surgical treatments for tricuspid regurgitation\nare not good enough,\u201d explained Lerakis. \u201cI believe this study will change the\nfocus and direction of future surgical therapies for tricuspid regurgitation\nonly to make them better and more durable.\u201d\u003C\/p\u003E\u003Cp\u003EBased on the findings of this study, said Lerakis, future surgical therapies\nshould not only be focused on the tricuspid annulus, but on the entire\ntricuspid valve apparatus, including the tricuspid valve papillary muscles and\ntheir three-dimensional location within the apparatus.\u003C\/p\u003E\u003Cp\u003EIndividuals in the study with left ventricle dilation exhibited\nsignificant displacement of one of the papillary muscles and patients with both ventricles dilated had\nsignificant displacement of two papillary muscles. Subjects with right\nventricle dilation showed significant displacement of all three papillary\nmuscles. \u0026nbsp;\u003C\/p\u003E\n\n\u003Cp\u003EThe researchers also found that patients with a dilated right\nventricle were more likely to have a dilated annulus and exhibited the highest\npulmonary arterial pressures and highest levels of tricuspid regurgitation. However,\nnot all patients with a dilated right ventricle had significant increases in\nannulus area, providing evidence that the right ventricle may become dilated\nwithout the annulus being affected.\u003C\/p\u003E\n\n\u003Cp\u003E\u201cWe think an increase in pulmonary arterial pressure caused\ngeometric changes in the ventricle, which resulted in alterations to the\nannulus and papillary muscles,\u201d explained\nYoganathan. \u201cThe combination of displacement of all three papillary\nmuscles and annular dilatation may account for the patients with isolated right\nventricle dilatation having the largest percentage of severe tricuspid regurgitation.\u201d\u003C\/p\u003E\n\n\u003Cp\u003EKnowing which parameters are responsible for significant tricuspid\nregurgitation and having a non-invasive imaging technique to measure these\nparameters should help clinicians target repairs to the specific cause of an individual\u2019s\ntricuspid leakage, according to Yoganathan.\u003C\/p\u003E\n\n\u003Cp\u003EIn future studies, the researchers plan to study papillary\nmuscle displacements in individuals with specific diseases to see if different\ndisease manifestations exhibit different characteristics.\u003C\/p\u003E\n\n\u003Cp\u003E\u201cAlthough it has long been accepted that pulmonary\nhypertension may result in tricuspid regurgitation, this study is one of the\nfirst to provide a clinical correlation between the two,\u201d said Yoganathan, who\nis also the Wallace H. Coulter Distinguished Faculty Chair in Biomedical\nEngineering. \u201cWe want to know whether treating an individual\u2019s pulmonary hypertension,\nand thus decreasing one\u2019s pulmonary arterial pressure, can reverse the\ngeometric changes that are causing tricuspid regurgitation and return the annulus\nand papillary muscles to their original positions.\u201d\u003C\/p\u003E\n\n\u003Cp\u003EEmory University sonographers Jason Higginson, Maria Pernetz\nand Sharon Howell also contributed to the study.\u003C\/p\u003E\n\n\u003Cp\u003E\u003Cstrong\u003EResearch News \u0026amp; Publications Office\u003Cbr \/\u003E\nGeorgia Institute of Technology\u003Cbr \/\u003E\n75 Fifth Street, N.W., Suite 314\u003Cbr \/\u003E\nAtlanta, Georgia  30308  USA\u003C\/strong\u003E\n\u003C\/p\u003E\n\n\u003Cp\u003E\u003Cstrong\u003EMedia Relations\nContacts:\u003C\/strong\u003E Abby Robinson (abby@innovate.gatech.edu; 404-385-3364) or John\nToon (jtoon@gatech.edu; 404-894-6986)\u003C\/p\u003E\n\n\u003Cp\u003E\u003Cstrong\u003EWriter: \u003C\/strong\u003EAbby\nRobinson\u003C\/p\u003E","summary":null,"format":"limited_html"}],"field_subtitle":"","field_summary":[{"value":"\u003Cp\u003EA new study finds that the anatomy of the heart\u2019s tricuspid valve can be used to predict the severity of leakage in the valve, which is a condition called tricuspid regurgitation.\u003C\/p\u003E","format":"limited_html"}],"field_summary_sentence":[{"value":"A new study finds that the anatomy of the heart\u2019s tricuspid valve can be used to predict the severity of leakage in the valve."}],"uid":"27206","created_gmt":"2012-01-18 09:53:57","changed_gmt":"2016-10-08 03:10:57","author":"Abby Vogel Robinson","boilerplate_text":"","field_publication":"","field_article_url":"","dateline":{"date":"2012-01-18T00:00:00-05:00","iso_date":"2012-01-18T00:00:00-05:00","tz":"America\/New_York"},"extras":[],"hg_media":{"79081":{"id":"79081","type":"image","title":"Tricuspid valve2","body":null,"created":"1449178063","gmt_created":"2015-12-03 21:27:43","changed":"1475894693","gmt_changed":"2016-10-08 02:44:53","alt":"Tricuspid valve2","file":{"fid":"193883","name":"tricuspid_valve_hires.jpg","image_path":"\/sites\/default\/files\/images\/tricuspid_valve_hires_1.jpg","image_full_path":"http:\/\/www.tlwarc.hg.gatech.edu\/\/sites\/default\/files\/images\/tricuspid_valve_hires_1.jpg","mime":"image\/jpeg","size":308309,"path_740":"http:\/\/www.tlwarc.hg.gatech.edu\/sites\/default\/files\/styles\/740xx_scale\/public\/images\/tricuspid_valve_hires_1.jpg?itok=TUrhX-Do"}},"79071":{"id":"79071","type":"image","title":"Ajit Yoganathan","body":null,"created":"1449178063","gmt_created":"2015-12-03 21:27:43","changed":"1475894693","gmt_changed":"2016-10-08 02:44:53","alt":"Ajit Yoganathan","file":{"fid":"193882","name":"yoganathan_nicole_cappello.jpg","image_path":"\/sites\/default\/files\/images\/yoganathan_nicole_cappello_0.jpg","image_full_path":"http:\/\/www.tlwarc.hg.gatech.edu\/\/sites\/default\/files\/images\/yoganathan_nicole_cappello_0.jpg","mime":"image\/jpeg","size":1897466,"path_740":"http:\/\/www.tlwarc.hg.gatech.edu\/sites\/default\/files\/styles\/740xx_scale\/public\/images\/yoganathan_nicole_cappello_0.jpg?itok=SsCGR_rW"}}},"media_ids":["79081","79071"],"groups":[{"id":"1188","name":"Research Horizons"}],"categories":[{"id":"145","name":"Engineering"},{"id":"135","name":"Research"}],"keywords":[{"id":"2582","name":"Ajit Yoganathan"},{"id":"7521","name":"circulatory"},{"id":"594","name":"college of engineering"},{"id":"14219","name":"Coulter Department of Biomedical Engineering"},{"id":"2583","name":"heart"},{"id":"13949","name":"tricuspid regurgitation"},{"id":"13947","name":"tricuspid valve"}],"core_research_areas":[],"news_room_topics":[],"event_categories":[],"invited_audience":[],"affiliations":[],"classification":[],"areas_of_expertise":[],"news_and_recent_appearances":[],"phone":[],"contact":[{"value":"\u003Cp\u003EAbby Robinson\u003Cbr \/\u003E\nResearch News and Publications\u003Cbr \/\u003E\n\u003Ca href=\u0022mailto:abby@innovate.gatech.edu\u0022\u003Eabby@innovate.gatech.edu\u003C\/a\u003E\u003Cbr \/\u003E\n404-385-3364\u003C\/p\u003E","format":"limited_html"}],"email":[],"slides":[],"orientation":[],"userdata":""}}}