Unusual echocardiographic views of bicuspid and tricuspid pulmonic valves

McAleer, Eileen; Kort, Smadar; Rosenzweig, Barry P.; Katz, Edward S.; Tunick, Paul A.; Phoon, Colin K.L.; Kronzon, Itzhak

doi:10.1067/mje.2001.114007

Cited by 21 publications

(18 citation statements)

References 6 publications

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“…On transthoracic echocardiography, assessment of the pulmonary valve anatomy is suboptimal as short axis views of the pulmonary artery are not clearly obtained. [6] Hence, most studies of pulmonary valve anatomy have been performed on surgical heart specimens from autopsies. With the advent of cardiac CT with its multiphasic images, it is possible to perform a detailed assessment of the cardiovascular structures including the pulmonary valve.…”

Section: Discussionmentioning

confidence: 99%

Spectrum of pulmonary valve morphology and its relationship to pulmonary trunk in tetralogy of Fallot

Chacko

Chiramel

Vimala

et al. 2017

Indian Journal of Radiology and Imaging

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Background:Tetralogy of Fallot (TOF) is a complex congenital heart disease with anatomic variations. Although the pulmonary valve in TOF is abnormal, it has not been studied well, especially on newer imaging modalities such as multidetector computed tomography (CT), which gives excellent anatomic detail.Aims:The aim of this study was to assess the morphology of pulmonary valve in TOF on CT and evaluate its association with the degree of hypoplasia of infundibulum and pulmonary trunk.Materials and Methods:The cardiac CT scans of 30 patients with TOF were reviewed to evaluate the morphology of the pulmonary valve, infundibulum, and pulmonary arteries. Fisher's exact test was performed to examine the association between pulmonary valve morphology and degree of hypoplasia of the infundibulum and pulmonary trunk.Results:16.7% of patients with TOF had pulmonary atresia. The prevalence of tricuspid, bicuspid, and absent valves were 10%, 53.3% and 6.7%, respectively. In another 13.3% of patients, although valve tissue was present, exact morphology could not be determined on CT. The commissures of 62.5% of the bicuspid valves were at 12 o’clock and 6 o’clock or slightly off the midline. There was statistically significant association between valve morphology and degree of infundibular hypoplasia (P < 0.001) and calibre of pulmonary trunk (P < 0.001).Conclusion:Morphological abnormality of the pulmonary valve is common in TOF. The most common type of pulmonary valve in TOF patients is bicuspid valve with commissures at 12 o’clock and 6 o’clock or slightly off the midline. Fewer cusps of the pulmonary valve are associated with a more severe degree of pulmonary artery hypoplasia.

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Section: Discussionmentioning

confidence: 99%

Spectrum of pulmonary valve morphology and its relationship to pulmonary trunk in tetralogy of Fallot

Chacko

Chiramel

Vimala

et al. 2017

Indian Journal of Radiology and Imaging

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“…TTE shows pulmonary artery in its longitudinal axis. Since short axis views of the pulmonic valve are not generally obtained, and therefore the distinction between tricuspid and bicuspid pulmonic valves is difficult if not impossible 6 . As increasing numbers of patients with moderate to severe pulmonary regurgitation develop right ventricular dysfunction after surgical repair of tetralogy of Fallot, careful, critical longitudinal follow‐up of these patients is needed with assessment by clinical and laboratory studies of right ventricular size, function, and exercise capability.…”

Section: Discussionmentioning

confidence: 99%

A Bicuspid Pulmonary Valve Associated with Tetralogy of Fallot

Nair¹,

Thangaroopan

Cunningham

et al. 2006

J Cardiac Surgery

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Congenitally bicuspid pulmonary valves are uncommon. When they occur, it is usually in association with other congenital cardiac lesions, most often a tetralogy of Fallot. We present a rare case of a patient with a congenitally bicuspid pulmonary valve who had pulmonary valve and RVOT reconstruction. The patient did well for 17 years, but needed further reconstruction when the pulmonary valve started getting stenosed and RV pressures went up significantly. The pulmonary valve showed fibroses, thickening, and focal calcification.

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“…Previous studies have documented that BPV were common in TOF patients [Nair, Thangaroopan, Cunningham et al (2006);McAleer, Kort, Rosenzweig et al (2001); Chacko, Chiramel, Vimala et al 2017]. Their data reported that 81% of bicuspid valves did not have a median raphe [Chacko, Chiramel, Vimala et al (2017)].…”

Section: The Leaflets Of Pvmentioning

confidence: 98%

Computational Modeling of Human Bicuspid Pulmonary Valve Dynamic Deformation in Patients with Tetralogy of Fallot

Li¹,

Baird²,

Yao³

et al. 2019

Computer Modeling in Engineering &Amp; Sciences

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Pulmonary valve stenosis (PVS) is one common right ventricular outflow tract obstruction problem in patients with tetralogy of Fallot (TOF). Congenital bicuspid pulmonary valve (BPV) is a condition of valvular stenosis, and the occurrence of congenital BPV is often associated with TOF. Dynamic computational models of normal pulmonary root (PR) with tri-leaflet and PR with BPV in patients with TOF were developed to investigate the effect of geometric structure of BPV on valve stress and strain distributions. The pulmonary root geometry included valvular leaflets, sinuses, interleaflet triangles and annulus. Mechanical properties of pulmonary valve leaflet were obtained from biaxial testing of human PV leaflet, and characterized by an anisotropic Mooney-Rivlin model. The complete cardiac cycle was simulated to observe valve leaflet dynamic stress/strain behaviors. Our results indicated that stress/strain distribution patterns of normal tri-leaflet pulmonary valve (TPV) and the BPV were different on valve leaflets when the valve was fully open, but they were similar when valves were completely closed. When the valve was fully open, the BPV maximum stress value on the leaflets was 197.2 kPa, which was 94.3% higher than of the normal TPV value (101.5 kPa). During the valve was fully open, the stress distribution in the interleaflet triangles region of the PR was asymmetric in the BPV model compared with that in the TPV model. The geometric orifice area value in the completely opened position of BPV model was reduced 55.6 % from that of the normal PV. Our initial results demonstrated that valve geometrical variations with BPV may be a potential risk factor linked to occurrence of PVS in patients with TOF. Computational models could be a useful tool in identifying possible linkage between valve disease development and biomechanical factors. Large-scale clinical studies are needed to validate these preliminary findings.

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Unusual echocardiographic views of bicuspid and tricuspid pulmonic valves

Cited by 21 publications

References 6 publications

Spectrum of pulmonary valve morphology and its relationship to pulmonary trunk in tetralogy of Fallot

Spectrum of pulmonary valve morphology and its relationship to pulmonary trunk in tetralogy of Fallot

A Bicuspid Pulmonary Valve Associated with Tetralogy of Fallot

Computational Modeling of Human Bicuspid Pulmonary Valve Dynamic Deformation in Patients with Tetralogy of Fallot

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