The Normal Tricuspid Valve
The interest of both cardiologists (echocardiographers and interventional cardiologists) and cardiac surgeons about the tricuspid valve has been fueled by the association of better understanding of the role of tricuspid regurgitation as an independent determinant of patients’ morbidity and mortality, and the advent of novel transcatheter devices to treat severe tricuspid regurgitation in high surgical risk patients. However, conventional two-dimensional echocardiography is unsuitable to study the anatomy and the pathophysiological mechanisms of the regurgitant tricuspid valve because of the complex three-dimensional geometry of the valve and its anterior position in the mediastinum (just behind the sternum). Three-dimensional echocardiography has emerged as a very cost-effective imaging modality to: (1) Assess the anatomy of the tricuspid valve; (2) Measure the size/geometry of the tricuspid annulus; (3) Identify the mechanism of tricuspid regurgitation; (4) analyze the anatomic relationships between the tricuspid valve apparatus and the surrounding cardiac structures; (5) Measure the volumes and function of the right atrium and right ventricle.
This chapter will describe the normal anatomy of the tricuspid valve apparatus and how to use three-dimensional echocardiography to acquire, display and perform quantitative analyses of the tricuspid valve using both transthoracic and transesophageal approaches.
KeywordsTricuspid valve Tricuspid leaflets Tricuspid annulus Transthoracic three-dimensional echocardiography Transesophageal three-dimensional echocardiography
We would like to acknowledge Dr. Stephen P. Sanders, Professor of Pediatrics (Cardiology), Harvard Medical School, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children’s Hospital for providing Fig. 18.2 for this chapter. We would also acknowledge Dr Rebecca T Hahn, Director of Interventional Echocardiography NewYork-Presbyterian/ Columbia University Medical Center and professor of medicine at Columbia University Medical Center for providing Figs. 18.8 and 18.9.
Left Two-dimensional echocardiography imaging of the normal tricuspid valve (MP4 750 kb)
Right transthoracic three-dimensional echocardiography imaging of the normal tricuspid valve from the ventricular perspective (AVI 10352 kb)
Volume rendered display of the normal tricuspid valve acquired using transthoracic three-dimensional echocardiography valve seen from the atrial perspective Tricuspid valve display atrial perspective (AVI 13071 kb)
Upper Bicuspid tricuspid valve seen from the ventricular perspective (AVI 6182 kb)
Lower Quadricuspid tricuspid valve seen from the ventricular perspective Tricuspid valve display ventricular perspective (AVI 4482 kb)
Transthoracic three-dimensional echocardiography. Volume rendering of the tricuspid valve complex (AVI 6573 kb)
Initialization of a transthoracic 3DE data set to measure tricuspid annulus size and geometry (MOV 4945 kb)
Editing of the tricuspid annulus before its quantitation (MOV 9687 kb)
Three-dimensional reconstruction of the geometry of the tricuspid annulus from a transthoracic 3DE data set (MOV 4986 kb)
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