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Echocardiographic Assessment of Tricuspid Valve Disease

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Tricuspid Valve Disease

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Tricuspid valve structure and function are clinically relevant in a wide range of conditions. An accurate appreciation of the tricuspid valve by 2D and 3D echocardiography is critical to understanding pathologies that underlie these conditions. There can be significant variation in leaflet anatomy and one view alone may be limited or suboptimal, so it is important to assess leaflet anatomy in multiple views or consider additional imaging modalities when assessing the tricuspid valve. Echocardiography should be the first step in determining whether tricuspid regurgitation is primary, a condition due to abnormal leaflets, or secondary, a result of structural changes to the right ventricle or the tricuspid annulus or valve apparatus. The ability to grade tricuspid regurgitation severity relies not just on color Doppler but also on the use of hemodynamics, which can be obtained from a variety of echocardiographic indices. A new gradation scheme for assessing the severity of tricuspid regurgitation has been recently proposed using these indices. Finally, echocardiography allows for decision-making for percutaneous or surgical interventions and allows for both pre-procedural planning and intra-procedural guidance.

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Author information

Authors and Affiliations

  1. Department of Cardiology, University of California, San Francisco, San Francisco, CA, USA

    Thuy D. Nguyen, Jonathan M. Wong & Christiane Abouzeid

  2. Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Atif N. Qasim

Authors
  1. Thuy D. Nguyen
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  2. Jonathan M. Wong
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  3. Christiane Abouzeid
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  4. Atif N. Qasim
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Corresponding author

Correspondence to Atif N. Qasim .

Editor information

Editors and Affiliations

  1. Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA

    Hansie Mathelier

  2. Richard M. Ross Heart Hospital, The Ohio State University, Columbus, OH, USA

    Scott M. Lilly

  3. Cincinnati, OH, USA

    Satya Shreenivas

Electronic Supplementary Material

Video 5.1a

Tricuspid valve prolapse. Left: Right ventricular parasternal inflow view showing prolapse and billowing of the septal leaflet. Right: Zoomed right ventricular parasternal inflow view with Color Doppler showing eccentric jet away from the prolapsed leaflet (MP4 981 kb)

Video 5.1b

Rheumatic heart disease. Apical four-chamber view showing thickening and restriction of the tricuspid leaflets as well as annular dilation and an enlarged large RA. There is also significant RV dilation and tethering of the tricuspid leaflets in the setting of pulmonary hypertension leading to a large coaptation gap between tricuspid leaflets. This patient also has severe mitral and aortic stenosis in the setting of rheumatic heart disease (AVI 29086 kb)

Video 5.1c

Carcinoid. Left: Right ventricular parasternal inflow view showing reduced mobility of the tricuspid valve in a patient with carcinoid tricuspid valve disease. Right: Diastolic color flow acceleration through the tricuspid valve (MP4 265 kb)

Video 5.1d

Ebstein’s anomaly. Apical four-chamber view showing severe apical displacement of the septal leaflet of the tricuspid valve and right-sided chamber dilation (MP4 1029 kb)

Video 5.2

Tricuspid regurgitation from cardiac electronic device lead impingement. Orthogonal transgastric views of the tricuspid valve. A cardiac electronic device lead is seen tethering the posterior leaflet and contributing to severe tricuspid regurgitation (MP4 502 kb)

Video 5.3a

Secondary tricuspid regurgitation examples. Tricuspid regurgitation due to pulmonary hypertension. Note the tethering of the tricuspid leaflets and lack of significant annular dilation leading to severe tricuspid regurgitation, with the origin of the color jet well below the annular plane (MP4 380 kb)

Video 5.3b

Secondary tricuspid regurgitation examples. Tricuspid regurgitation due to arrhythmogenic right ventricular cardiomyopathy. Left: Transgastric view of the tricuspid valve during early systole. Right: Orthogonal view across the posterior and anterior leaflets. This patient has severe RV dysfunction and torrential tricuspid regurgitation, with a significant tenting area and flail gap (MP4 922 kb)

Video 5.3c

Secondary tricuspid regurgitation examples. Idiopathic tricuspid regurgitation. Right ventricular focused apical four-chamber view in early systole showing severe RV enlargement, tricuspid annular dilation, and tricuspid leaflet malcoaptation. This patient has idiopathic tricuspid regurgitation from atrial fibrillation (MP4 511 kb)

Video 5.4

Features of severe TR. Apical four-chamber view with color Doppler showing severe tricuspid regurgitation (MP4 733 kb)

Video 5.5

Prosthetic tricuspid stenosis. Zoomed apical four-chamber TTE view showing color flow acceleration across a 31-mm St. Jude tricuspid prosthetic valve during diastole, consistent with tricuspid stenosis (MP4 482 kb)

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Nguyen, T.D., Wong, J.M., Abouzeid, C., Qasim, A.N. (2022). Echocardiographic Assessment of Tricuspid Valve Disease. In: Mathelier, H., Lilly, S.M., Shreenivas, S. (eds) Tricuspid Valve Disease. Contemporary Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-92046-3_5

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  • DOI: https://doi.org/10.1007/978-3-030-92046-3_5

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  • Online ISBN: 978-3-030-92046-3

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