Comprehensive Two-Dimensional Interrogation of the Tricuspid Valve Using Knowledge Derived from Three-Dimensional Echocardiography

Abstract

Background Accurate identification of tricuspid valve (TV) leaflets by two-dimensional (2D) transthoracic echocardiography is difficult because of variability in the intersection between the imaging plane and leaflets. Using information obtained from multiplanar reconstruction (MPR) of three-dimensional (3D) data sets, the investigators sought to define “novel” 2D views that would allow targeted interrogation of TV leaflets using 2D transthoracic echocardiography. Methods Images of the TV in the standard 2D views (apical four chamber, right ventricular focused, right ventricular inflow, and parasternal short axis) and 3D data sets were acquired from the same probe position in 106 adults. Three-dimensional MPR was used to determine which leaflet combination was seen in the 2D image: anterior and septal, anterior and posterior, anterior alone, or posterior and septal. Using this analysis, 2D landmarks were identified to define nonstandard TV views tailored to depict specific leaflets. Two-dimensional images in these views and 3D data sets were then prospectively collected in 54 additional patients. Three independent readers analyzed these 2D views to determine TV leaflet combinations, and their interpretation was compared with 3D MPR–derived reference. Results Three-dimensional MPR views made it possible to define six nonstandard 2D views on the basis of anatomic clues and landmarks, which consistently depicted all the aforementioned leaflet combinations. When these six views were prospectively tested, the agreement of TV leaflet identification against 3D MPR was excellent (κ = 0.88, κ = 0.93, and κ = 0.98). Conclusion The nonstandard 2D views defined in this study allow accurate TV leaflet identification and may thus be useful when localization of TV leaflet pathology is clinically important. (J Am Soc Echocardiogr 2016;29:74–82.)

Assessment of pulmonary artery pressure by echocardiography—A comprehensive review

“… The best TR signal is often “off-axis,” in-between parasternal and apical windows. An RV-focussed or fore shortened 4-chamber view might give the best signal [12] . Sometimes, subcostal long and short axis windows provide the optimal signal and incident angle.…”

Novelties in 3D Transthoracic Echocardiography

“…Since then, transducers, software and hardware have improved dramatically in terms of acquisition, temporal and spatial resolution and image rendering. Several studies have confirmed the superiority of 3DTTE in the evaluation of the MV apparatus as well as of the aortic (AV) and tricuspid valve (TV) [ 6 , 7 , 8 , 9 ].…”

Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions

“…Indeed, the RCA is at risk for injury during the procedure, especially if located in close proximity to the site of implantation. An "en face" view of the TV is typically obtained on an LAO fluoroscopic projection and allows for antero-posterior orientation alongside the RCA (Figures 5B,D) and corresponds to the TEE transgastric short axis view (103,104). In this view, the ostium and proximal part of the RCA surrounds the anterior valve leaflet while the periphery is close to the posterior leaflet.…”