@article {NGUYEN2019,
	title = {Dynamic Three-Dimensional Geometry of the Tricuspid Valve Annulus in Hypoplastic Left Heart Syndrome with a Fontan Circulation},
	journal = {Journal of the American Society of Echocardiography},
	year = {2019},
	abstract = {<p>Background Tricuspid regurgitation (TR) is a significant contributor to morbidity and mortality in patients with hypoplastic left heart syndrome. The goal of this study was to characterize the dynamic annular motion of the tricuspid valve in patients with HLHS with a Fontan circulation and assess the relation to tricuspid valve function. Methods Tricuspid annuli of 48 patients with HLHS with a Fontan circulation were modeled at end-diastole, mid-systole, end-systole, and mid-diastole using transthoracic three-dimensional echocardiography and custom code in 3D Slicer. The angle of the anterior papillary muscle (APM) relative to the annular plane in each systolic phase was also measured. Results Imaging was performed 5.0\&nbsp;years (interquartile range, 2{\textendash}11\&nbsp;years) after Fontan operation. The tricuspid annulus varies in shape significantly throughout the cardiac cycle, changing in sphericity (P\&nbsp;\&lt;\&nbsp;.001) but not in annular height or bending angle. In univariate modeling, patients with significant TR had larger changes in septolateral diameter, lateral quadrant area, and posterior quadrant area (P\&nbsp;\&lt;\&nbsp;.05 for all) as well as lower (more laterally directed) APM angles (P\&nbsp;\&lt;\&nbsp;.001) than patients with mild or less TR. In multivariate modeling, a 1\&nbsp;mm/(body surface area)0.5 increase in the maximum change in septolateral diameter was associated with a 1.7-fold increase in having moderate or greater TR, while a 10{\textdegree} decrease in APM angle at mid-systole was associated with an almost 2.5-fold increase in moderate or greater TR (P\&nbsp;<=\&nbsp;.01 for all). Conclusions The tricuspid annulus in patients with HLHS with a Fontan circulation changes in shape significantly throughout the cardiac cycle but remains relatively planar. Increased change in septolateral diameter and decreased APM angle are strongly associated with the presence of TR. These findings may inform annuloplasty methods and subvalvular interventions in these complex patients.</p>
},
	keywords = {Congenital heart disease, Echocardiography, Valvular heart disease},
	issn = {0894-7317},
	doi = {https://doi.org/10.1016/j.echo.2019.01.002},
	url = {http://www.sciencedirect.com/science/article/pii/S0894731719300021},
	author = {Alexander V. Nguyen and Andras Lasso and HannahH Nam and Jennifer Faerber and Ahmed H. Aly and Alison M. Pouch and Adam B. Scanlan and FrancisX McGowan and Laura Mercer-Rosa and Meryl S. Cohen and John Simpson and Gabor Fichtinger and MatthewA Jolley}
}
@conference {DBLP:conf/fimh/PouchALNSMFGGYJ17,
	title = {Image Segmentation and Modeling of the Pediatric Tricuspid Valve in Hypoplastic Left Heart Syndrome},
	booktitle = {Functional Imaging and Modelling of the Heart - 9th International Conference, {FIMH} 2017, Toronto, ON, Canada, June 11-13, 2017, Proceedings},
	year = {2017},
	pages = {95{\textendash}105},
	doi = {10.1007/978-3-319-59448-4_10},
	url = {https://doi.org/10.1007/978-3-319-59448-4_10},
	author = {Alison M. Pouch and Ahmed H. Aly and Andras Lasso and Alexander V. Nguyen and Adam B. Scanlan and FrancisX McGowan and Gabor Fichtinger and Robert C. Gorman and Robert C. Gorman and Paul A. Yushkevich and MatthewA Jolley}
}
