Evaluation of Tricuspid Valve Morphology and Function by Transthoracic Three-Dimensional Echocardiography

Abstract

Tricuspid valve (TV) disease commonly occurs in combination with left-sided heart disease. Despite the growing enthusiasm for developing novel minimally invasive therapies for the mitral or aortic valve, the TV disease formerly received less attention and was frequently left untreated. Strong evidence has increased the awareness of the impact of severe TV regurgitation on patient survival, functional capacity, and surgical risk. Preoperative TV accurate description is challenging because, unlike left-sided valves, a complete visualization of tricuspid annulus and all three leaflets in one view is routinely impossible by two-dimensional transthoracic or transesophageal echocardiography. Three-dimensional echocardiography (3DE) with its unrestricted imaging capabilities has sparked significant research interest for a better understanding and improved treatment of valvular heart disease. This review summarizes the current status of 3DE for the assessment of TV morphology and function, with its clinical applications and current limitations, as well as its potential implications for designing TV repair techniques.

EAE/ASE Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography

“…121,122 In a study of 29 patients with a spectrum of TV pathologies, 3D echocardiography provided incremental diagnostic value over 2D echocardiography with regard to the etiology and location of the abnormal leaflet segments. 123 Three-dimensional echocardiography has demonstrated that the TV annulus has a bimodal or saddle shape with distinct high (superior) points oriented anteriorly and posteriorly and low (inferior) points oriented medially and laterally.…”

Comparison of the offset distance of the tricuspid septal leaflet in neonates with Ebstein’s anomaly and neonates with pulmonary atresia with intact ventricular septum

“…A prominent apical displacement of the septal leaflet of the tricuspid valve from the atrioventricular junction is an intrinsic morphologic feature of Ebstein's anomaly. An indexed offset distance of the tricuspid septal leaflet ⩾8 mm/m 2 has been used or suggested as a diagnostic criterion of Ebstein's anomaly in multiple studies and reviews [10][11][12][13][14][15][16][17] after it was first reported by Shiina et al in 1984, 18 although an overlap of the minimal septal offset distance between the cases with and without Ebstein's anomaly was reported in the same year by other authors. 19 To the best of our knowledge, this criterion has not yet been reviewed comprehensively in neonatal populations.…”

Current Clinical Applications of Transthoracic Three-Dimensional Echocardiography

“…Leaflet thickness, extent of commissural fusion and area planimetry can be readly obtained in rheumatic disease 96-98)…”

“…In these cases, a comprehensive assessment of the morphology of tricuspid valve apparatus using transthoracic 3DE provides important clues on the underlying aetiology and mechanisms of valve dysfunction 94)98-100)…”