Tricuspid Annular Geometry: A Three-Dimensional Transesophageal Echocardiographic Study

Abstract

Objective To demonstrate the clinical feasibility of accurately measuring tricuspid annular area by 3-dimensional (3D) transesophageal echocardiography (TEE) and to assess the geometric differences based on the presence of tricuspid regurgitation (TR). Also, the shape of the tricuspid annulus was compared with previous descriptions in the literature. Design Prospective. Setting Tertiary care university hospital. Interventions Three-dimensional TEE. Participants Patients undergoing cardiac surgery. Measurements and Main Results Volumetric data sets from 20 patients were acquired by 3D TEE and prospectively analyzed. Comparisons in annular geometry were made between groups based on the presence of TR. The QLab (Philips Medical Systems, Andover, MA) software package was used to calculate tricuspid annular area by both linear elliptical dimensions and planimetry. Further analyses were performed in the 4D Cardio-View (TomTec Corporation GmBH, Munich, Germany) and MATLAB (Natick, MA) software environments to accurately assess annular shape. It was found that patients with greater TR had an eccentrically dilated annulus with a larger annular area. Also, the area as measured by the linear ellipse method was overestimated as compared to the planimetry method. Furthermore, the irregular saddle-shaped geometry of the tricuspid annulus was confirmed through the mathematic model developed by the authors. Conclusions Three-dimensional TEE can be used to measure the tricuspid annular area in a clinically feasible fashion, with an eccentric dilation seen in patients with TR. The tricuspid annulus shape is complex, with annular high and low points, and annular area calculation based on linear measurements significantly overestimates 3D planimetered area.

Tricuspid Annulus: A Three-Dimensional Deconstruction and Reconstruction

“…Current literature is based on analyses derived from invasive animal studies or low-resolution transthoracic echocardiographic data. Recently, intraoperative three-dimensional (3D) transesophageal echocardiography (TEE) and magnetic resonance data have been used to demonstrate the complex shape of the tricuspid annulus [13,14]. However, there remains a need to describe TA geometry and structure routinely with a degree of precision in a clinically feasible manner.…”

Cardiac Imaging—3-Dimensional Echocardiography

“…6,7 The volumetric nature of 3D data facilitates accurate linear and volumetric calculations without any geometric assumptions. Specifically, 3D imaging has demonstrated value in quantitative analyses of structural heart diseases 6,7,14,15 and hemodynamic calculations as well. 16,17 Recently, 3D echocardiographic data have been used for 3D printing of intracardiac structures.…”

“…[6][7][8] Any of the 3D imaging modes can be used to visualize the tricuspid valve from the right atrial and right ventricular (RV) perspective (Fig. 15).…”

Echocardiography of the tricuspid valve

“…This modality requires specialized probes and advanced image processing. 3D imaging has been particularly helpful in delineating the complex, non-planar, structure of the TV annulus and is offering new insights into the pathophysiology and disease of the TV (15,29,30).…”