Assessment of the Tricuspid Valve Morphology by Transthoracic Real‐Time‐3D‐Echocardiography

Schnabel, Renate B.; Khaw, Alexander V.; Bardeleben, Ralph Stephan von; Strasser, Christina; Kramm, Thorsten; Meyer, Jürgen; Mohr-Kahaly, Susanne

doi:10.1111/j.0742-2822.2005.03142.x

Cited by 38 publications

(27 citation statements)

References 18 publications

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“…Schnabel et al have shown that transthoracic real-time 3D echo enabled better assessment of the whole tricuspid valve, with a satisfactory inter-rater agreement. 10 In the present study, the morphology of the whole tricuspid valve could not be depicted well on 2D echo. Although we attempted to trace the entire path of the PPM lead from various views, the relationship between the lead and the tricuspid apparatus remained unidentifiable.…”

Section: Discussioncontrasting

confidence: 71%

Entrapment of Permanent Pacemaker Lead as the Cause of Tricuspid Regurgitation Role of 3-Dimensional Echocardiography

Chen

Wang

Chern

et al. 2007

Circ J

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ight heart failure because of tricuspid regurgitation (TR) after permanent pacemaker (PPM) has been reported. [1][2][3][4][5][6] Conventional 2-dimensional (D) echocardiography (echo), though very important for detecting TR, is quite limited in depicting the precise anatomical relationship between the tricuspid leaflets and PPM lead shaft. 2 This relationship may determine the pathogenesis of TR and realization of it may help determine the policy of management. In this report, with the assistance of 3D echo, the structure of the tricuspid valve, its incompetence and the entrapment of the PPM lead shaft in the valve were precisely delineated. Case ReportA 58-year-old man underwent implantation of a transvenous VVIR PPM for atrial fibrillation and complete heart block 9 years ago. Prior to PPM, echocardiography showed moderate TR, with a TR area of 16.6 cm 2 and a right atrial (RA) area of 28.8 cm 2 , and normal systolic function of both ventricles. Three years after PPM implantation, 2D echo showed aggravation of TR with a TR area of 19.4 cm 2 and a RA area of 37.4 cm 2 . Since then, he had abdominal fullness and edema of both legs. These symptoms gradually became aggravated. Follow-up transthoracic echocardiography was performed by using a Philips SONOS 7500 (Philips Medical Systems, Eindhoven, Netherlands) and pyramid-shaped full-volume 3D images of the right ventricle (RV) were acquired from between the left parasternal border and the apical window with a 4 MHz and 4× matrix transducer under ECG gating while the patient gently held his breath. The 2D echo revealed slightly impaired systolic function of the left ventricle with abnormal septal wall motion and mild Circulation Journal Vol.71, July 2007 mitral regurgitation. The RV, RA and inferior vena cava were dilated, and RV function was normal (Fig 1A). Tethering of the septal leaflet of tricuspid valve was observed, together with no coaptation of thes leaflets, thus causing severe TR (Fig 1B). The maximal area of TR was 42.1 cm 2 and that of RA 64.6 cm 2 . The transtricuspid systolic pressure gradient was 12 mmHg. However, the relationship between the tricuspid valve and the PPM lead could not be observed on the multiple views of 2D echo (Figs 1C,D).After being cropped in from the apex toward the base, the full-volume 3D echo showed that the shaft of the PPM lead was entrapped in the thickened, fibrotic and fused posterior and septal leaflets (Fig 2A), which could not coapt during systole, and the vena contracta was well seen (Fig 2A, arrowhead). During diastole, the anterior tricuspid leaflet opened freely. The anterior two-thirds of the septal leaflet was tethered, but not fixed, and could be pushed open slightly. The remaining one-third of the septal leaflet and the entire posterior leaflet was thickened, tethered and frozen (Fig 2B). When the full-volume 3D pyramid was cropped in from the RV free wall, the entrapment of the PPM shaft in the fused septal and posterior leaflets and the free movements of anterior tricuspid leaflet were noted clearly during ...

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Section: Discussioncontrasting

confidence: 71%

Entrapment of Permanent Pacemaker Lead as the Cause of Tricuspid Regurgitation Role of 3-Dimensional Echocardiography

Chen

Wang

Chern

et al. 2007

Circ J

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“…Schnabel et al also reported a high ability (96%) of 3-DE to assess the completeness of the tricuspid valve structure. 8 In the present study 2-DE showed poor assessment ability; Lin et al reported that PPM-induced tricuspid malfunction could be diagnosed preoperatively in only 5 of 41 patients (12%) who underwent surgery for PPM-related TR. 7 The present study confirmed the ability of 3-DE to identify PPM lead positions at the tricuspid valve.…”

Section: -Decontrasting

confidence: 58%

“…Schnabel et al also reported that image quality was less adequate in healthy subjects than in patients with RV dysfunction, 8 which may be related to the fact that the a dilated RV facilitates viewing of the tricuspid valve.…”

Section: -Dementioning

confidence: 99%

“…6,7 However, in the clinical setting, the diagnosis of lead-induced TR can be challenging because conventional 2-dimensional echocardiography (2-DE) has limitations in identifying the anatomical relationship between the lead and the tricuspid leaflets. 7 The 3-dimensional echocardiography (3-DE) has been recently developed for assessing tricuspid valve morphology and pathology, including TR, [8][9][10][11] and case reports on its utility in the diagnosis of PPM-and ICD-lead-related TR have been published. 12,13 However, the ability of 3-DE to identify both the anatomical lead route through the tricuspid valve and lead-induced valve malfunction has not been studied systematically.…”

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confidence: 99%

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Clinical Utility of 3-Dimensional Echocardiography in the Evaluation of Tricuspid Regurgitation Caused by Pacemaker Leads

Seo

Ishizu

Nakajima

et al. 2008

Circ J

111

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ignificant tricuspid regurgitation (TR) has been reported in patients with a permanent pacemaker (PPM), [1][2][3][4][5] and the leads of such a device or those of an implantable cardioverter defibrillator (ICD) can be the primary cause of symptomatic TR. 6,7 However, in the clinical setting, the diagnosis of lead-induced TR can be challenging because conventional 2-dimensional echocardiography (2-DE) has limitations in identifying the anatomical relationship between the lead and the tricuspid leaflets. 7 The 3-dimensional echocardiography (3-DE) has been recently developed for assessing tricuspid valve morphology and pathology, including TR, [8][9][10][11] and case reports on its utility in the diagnosis of PPM-and ICD-lead-related TR have been published. 12,13 However, the ability of 3-DE to identify both the anatomical lead route through the tricuspid valve and lead-induced valve malfunction has not been studied systematically. Methods Patient PopulationIn 87 patients with PPM, ICD or cardiac resynchroniza- Circulation Journal Vol.72, September 2008tion therapy device, 3-DE studies were performed to evaluate the route of the leads and the presence of lead-related TR (Table 1). The underlying cardiac disease for which PPM implantation was required was complete or advanced atrioventricular block in 28 patients and sick sinus syndrome, including slow atrial fibrillation, in 22 patients, and for ICD implantation it was primary or secondary prevention of fatal cardiac arrhythmias in 17 patients. Cardiac resynchronization therapy devices with or without ICD were implanted in 20 patients with advanced heart failure. The study was approved by the local research ethics committee, and all patients gave written informed consent. Clinical Utility of 3-Dimensional Echocardiography in the Evaluation of Tricuspid Regurgitation Caused by Pacemaker LeadsYoshihiro Seo, MD; Tomoko Ishizu, MD; Hideki Nakajima, RDCS*; Yukio Sekiguchi, MD; Shigeyuki Watanabe, MD; Kazutaka Aonuma, MD Background This study evaluated the usefulness of 3-dimensional echocardiography (3-DE) for identifying permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD) lead-related symptomatic tricuspid regurgitation (TR). Methods and ResultsEighty-seven patients underwent 3-DE examination: 50 patients with PPM, 17 with ICD, and 20 with cardiac resynchronization therapy devices. TR severity was classified as trivial/mild, moderate, or severe according to the ratio of TR area to right atrium area. The 3-DE identified the lead route and position at the tricuspid valve in 82 patients (94.2%). In 5 patients, images without lead-induced artifacts could not be obtained. TR severity was trivial/mild in 50 patients, moderate in 20 patients, and severe in 12 patients. In all patients with trivial/mild TR and all but 1 patient with moderate TR, leads were positioned on the annulus side between leaflets. Lead-induced obstruction to tricuspid valve closing was identified in 1 patient with moderate TR and in 7 of 12 patients with severe TR: 4 patients had...

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“…Recent experimental work has demonstrated that the current RT-3DE technique is also very promising for the assessment of intracardiac anatomy, not in the least because of its potential to present structural abnormalities in novel views (6)(7)(8)(9)(10)(11) . The intracardiac anatomy is especially interesting in structural heart disease, of which congenital heart disease is the main contributor.…”

Section: Introductionmentioning

confidence: 99%

Validation of Real-time Transthoracic 3D echocardiography in Children with Congenital Heart Disease

Bosch

Harkel

McGhie

et al. 2017

SAHJ

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Aims Assessment of feasibility, accuracy and applicability in clinical practice of real-time three-dimensional echocardiography (RT-3DE) in children with congenital heart defects. Methods and resultsFrom September 2004 to June 2005, 100 consecutive children (57 infants, 43 children > 1 year of age), who were scheduled for corrective intracardiac surgery, were enrolled in this study. RT-3DE was performed with Philips Sonos 7500 echo-system and off-line analysis with TomTec Echoview© software. Quantitative and qualitative assessments of the region of interest were performed on the 3D reconstruction, comparing these results with the anatomic fi ndings and measurements performed during intracardiac surgery. Acquisition of RT-3DE datasets was feasible in 92 of the 100 (92%) patients and acquisition time was 6 ± 3 minutes. The overall quantitative analyses showed an excellent correlation (r < 0.90) between RT-3De and surgery. Also the qualitative analyses were accurate compared with surgical fi ndings, in all patients in which RT-3DE was feasible. Conclusion This study shows that RT-3DE can be used in the clinical practice for the assessment of intracardiac anatomy in children with congenital heart disease. The information derived from the 3D reconstructions can be taken into consideration in the preoperative planning and management regarding interventional or surgical therapy.

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Assessment of the Tricuspid Valve Morphology by Transthoracic Real‐Time‐3D‐Echocardiography

Cited by 38 publications

References 18 publications

Entrapment of Permanent Pacemaker Lead as the Cause of Tricuspid Regurgitation Role of 3-Dimensional Echocardiography

Entrapment of Permanent Pacemaker Lead as the Cause of Tricuspid Regurgitation Role of 3-Dimensional Echocardiography

Clinical Utility of 3-Dimensional Echocardiography in the Evaluation of Tricuspid Regurgitation Caused by Pacemaker Leads

Validation of Real-time Transthoracic 3D echocardiography in Children with Congenital Heart Disease

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