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      Assessment of normal tricuspid valve anatomy in adults by real-time three-dimensional echocardiography

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          Abstract

          Background

          The tricuspid valve (TV) is a complex structure. Unlike the aortic and mitral valve it is not possible to visualize all TV leaflets simultaneously in one cross-sectional view by standard two-dimensional echocardiography (2DE) either transthoracic or transesophageal due to the position of TV in the far field.

          Aim

          Quantitative and qualitative assessment of the normal TV using real-time 3-dimensional echocardiography (RT3DE).

          Methods

          RT3DE was performed for 100 normal adults (mean age 30 ± 9 years, 65% males). RT3DE visualization was evaluated by 4-point score (1: not visualized, 2: inadequate, 3: sufficient, and 4: excellent). Measurements included TV annulus diameters (TAD), TV area (TVA), and commissural width.

          Results

          In 90% of patients with good 2DE image quality, it was possible to analyse TV anatomy by RT3DE. A detailed anatomical structure including unique description and measurement of tricuspid annulus shape and size, TV leaflets shape, and mobility, and TV commissural width were obtained in majority of patients. Identification of each TV leaflet as seen in the routine 2DE views was obtained.

          Conclusion

          RT3DE of the TV is feasible in a large number of patients. RT3DE may add to functional 2DE data in description of TV anatomy and providing highly reproducible and actual reality (anatomical and functional) measurements.

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          Most cited references22

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          Statistical methods for assessing agreement between two methods of clinical measurement.

          J Bland, D Altman (1986)
          In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
          Article 0 comments Cited 2559 times – based on 0 reviews     Review now
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            Morphology of the human tricuspid valve.

            Richard M. Silver, E Wigle, Carol Lam … (1971)
            Article 0 comments Cited 41 times – based on 0 reviews     Review now
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              Formation of the tricuspid valve in the human heart.

              Mark Moorman, W Lamers, L. F. A. Wessels … (1995)
              Some of the problems concerning the origin of the inlet component of the definitive right ventricle were resolved in a previous study in which we showed it to be derived exclusively from the embryonic right ventricle. Questions remain, however, concerning the relative contributions of endocardial cushion tissue and myocardium to the definitive valvar apparatus guarding the right atrioventricular orifice and the origin of the valvar leaflets. The formation of the tricuspid valve was studied by scanning electron microscopic and immunohistochemical techniques. Concurrent with the development of the right atrioventricular connection, a myocardial ridge forms at the boundary between the atrioventricular canal and the embryonic right ventricle. It grows to become a myocardial gully that funnels atrial blood beneath the lesser curvature of the initial heart tube toward the middle of the right ventricle. Fenestrations in the floor of the gully create an additional inferior opening in the funnel, transforming its initial anterior rim into the septomarginal trabeculation. The septum formed by the fusion of the endocardial ridges of the outflow tract becomes myocardialized in its inferior portion to form, in part, the outlet septum and, in part, the supraventricular crest. The smooth atrial surface of the tricuspid valvar leaflets develops from endocardial cushion tissue. The leaflets become freely movable, however, only after delamination of the tension apparatus within the myocardium. The inferior and septal leaflets derive from the gully and the ventricular septum, their delamination being a single, continuous process. The antero-superior leaflet forms by delamination from the developing supraventricular crest. The leaflets of the tricuspid valve develop equally from the endocardial cushion tissues and the myocardium. The myocardium contributing to the valve comes from two sources, the tricuspid gully complex and the developing supraventricular crest. These findings facilitate the understanding of several congenital malformations.
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                : +31-10-4633986 , +31-10-4635498 , f.j.tencate@erasmusmc.nl
                Journal
                Journal ID (nlm-ta): Int J Cardiovasc Imaging
                Title: The International Journal of Cardiovascular Imaging
                Publisher: Springer Netherlands (Dordrecht )
                ISSN (Print): 1569-5794
                ISSN (Electronic): 1875-8312
                Publication date (Electronic): 23 February 2007
                Publication date (Print): December 2007
                Volume: 23
                Issue: 6
                Pages: 717-724
                Affiliations
                [1 ]The Thoraxcenter, Erasmus MC, Dr. Molewaterplein 40, Rotterdam, 3015 GD The Netherlands
                [2 ]Department of Cardiology, Al-Husein University Hospital, Al-Azhar University, Cairo, Egypt
                Article
                Publisher ID: 9210
                DOI: 10.1007/s10554-007-9210-3
                PMC ID: 2048827
                PubMed ID: 17318363
                SO-VID: bfad00a5-bf61-4622-8c35-52d8a8716085
                Copyright © © Springer Science+Business Media, Inc. 2007
                History
                Date received : 26 December 2006
                Date accepted : 29 January 2007
                Categories
                Subject: Original Paper
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media B.V. 2007

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: normal tricuspid valve,tricuspid valve anatomical structure,real-time three-dimensional echocardiography
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: normal tricuspid valve, tricuspid valve anatomical structure, real-time three-dimensional echocardiography

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