Abstract 19399: Failure to Adequately Reduce Tricuspid Valve Size in Hypoplastic Left Heart Syndrome: Tricuspid Valve Repair is an Important Mechanism of Significant Post-Operative Regurgitation
Bibliographic record
Abstract
Background: Tricuspid valve regurgitation (TR) is associated with morbidity and mortality in hypoplastic left heart syndrome (HLHS). Successful tricuspid valve repair (TVR) may improve outcomes, however 30-50% of patients develop significant post-operative TR, often requiring further surgery. We sought to determine pre-operative factors associated with development of TR after TVR in HLHS. Methods: Twenty-six HLHS patients requiring TVR for TR between 2005 and 2015 were assessed. 2D echocardiography (2DE) was used pre-op and late post-op (> 6 months) to assess TR grade, vena contracta (VC) size and annulus size. Patients were divided into those with ≤ mild TR (group A) and those with ≥ moderate TR (group B) at late post-op. Pre-op 3D echocardiography (3DE) was used to assess mechanism and location of TR. Surgical notes were reviewed for repair details. Results: Fourteen patients (54%) had ≤ mild TR (group A) and 12 (46%) had ≥ moderate TR (group B) at late post-op. TVR occurred most commonly with other surgical procedures (2 at Norwood, 8 at Glenn, and 7 at Fontan). On preop 3DE, 13 (52%) had central TR, 7 (28%) had central TR with extension into a commissure, 2 (8%) had anterior-septal TR, and 3 (12%) had mixed commissural TR. The primary mechanism was tethering in 14 (56%) and prolapse in 12 (44%). For surgical repair, 17 (65%) had posterior annuloplasty, 5 (19%) cleft closure, and 4 (16%) other. Types of surgical repair were similar between the 2 groups. Group A had smaller pre-op 2DE TV annulus Z-score (3.4 vs 5.0, P=0.013) but no difference in pre-op 2DE VC diameter, when compared to group B. Group A pre and post op-comparison showed reduced annulus Z-score (3.4 vs 0.8, P=0.01) and VC diameter (p=0.01), while Group B pre and post op annulus size and VC size showed no reduction. There was no difference between group A and B with respect to TR location or primary mechanism involved. Late post-op VC demonstrated moderate correlation with pre-op TV annulus size (P=0.005; R=0.54) but not with pre-op VC. Conclusion: TR after valve repair is common. Larger pre op annulus size is related to post-operative TR. Despite surgical repair aimed at reducing TV annulus size, failure to adequately reduce TV size appears to be a mechanism of persistent significant post-operative regurgitation in HLHS.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".