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Organic Tricuspid Regurgitation

  • Denisa MuraruEmail author
  • Karima Addetia
  • Fabiana Jarjour
  • Roberto M. Lang
  • Luigi P. Badano
Chapter

Abstract

It is usually reported that only 10–15% of patients with tricuspid regurgitation have an organic (primary) etiology of the valve disease. However, it is likely that the actual prevalence of organic etiology of tricuspid regurgitation has been underestimated because of the technical limitations of conventional two-dimensional echocardiography to visualize the anatomy and assess the function of the tricuspid valve. However, the correct diagnosis of tricuspid regurgitation etiology and the assessment of valve anatomy are pivotal either to plan surgery or to select the most appropriate device and approach in interventional cardiology in patients who need tricuspid valve repair.

In this chapter we will review the added value of three-dimensional echocardiography to assess the anatomy and the severity of the various forms of organic (primary) tricuspid regurgitations.

Keywords

Three-dimensional echocardiography Tricuspid valve Tricuspid valve disease Tricuspid regurgitation Tricuspid valve repair Rheumatic tricuspid stenosis Carcinoid disease Pacemaker interference Infective endocarditis Traumatic tricuspid regurgitation Degenerative tricuspid regurgitation 

Supplementary material

Video 20.1a

Left Two-dimensional echocardiography imaging of an Ebstein’s anomaly (AVI 19160 kb)

Video 20.1b

Right Transthoracic three-dimensional echocardiography imaging of an Ebstein’s anomaly. AML anterior mitral leaflet, aRV atrialized right ventricle, RA right atrium, STL septal tricuspid leaflet (AVI 6499 kb)

Video 20.2a

Left Ebstein’s anomaly. All three leaflets are well visualized with a large coaptation gap (AVI 10796 kb)

Video 20.2b

Center Ebstein’s anomaly. Three leaflets with malformation of the posterior one and very large coaptation gap (AVI 13027 kb)

Video 20.2c

Right Ebstein’s anomaly. Large and grossly malformed anterior leaflet with large fenestrations. ATL anterior tricuspid leaflet, LV left ventricle, PTL posterior tricuspid leaflet, STL septal tricuspid leaflet (AVI 10805 kb)

Video 20.3a

Left En face view form the atrial perspective Tricuspid valve display en-face of a grossly deformed tricuspid valve in a patients with Ebstein’s anomaly (AVI 7000 kb)

Video 20.3b

Right En face view form the ventriuclar perspective of a grossly deformed tricuspid valve in a patient with Ebstein’s anomaly. ATL anterior tricuspid leaflet, LV left ventricle, PTL posterior tricuspid leaflet, STL septal tricuspid leaflet (AVI 7756 kb)

Video 20.4a

Two-dimensional 4-chamber view showing the thickened and retracted leaflets of the tricuspid valve, fixed in open position in systole and in diastole, in a patient with carcinoid disease (AVI 5185 kb)

Video 20.4b

Two-dimensional parasternal long-axis view showing the thickened and retracted leaflets of the tricuspid valve, fixed in open position in systole and in diastole, in a patient with carcinoid disease (AVI 4672 kb)

Video 20.4c

Two-dimensional color Doppler in parasternal long-axis view showing the cohesistence of both stenosis and massive tricuspid regurgitation in a patient with carcinoid disease (AVI 1937 kb)

Video 20.4d

3DE volume rendering of the tricuspid valve in a patient with carcinoid disease. The vave is seen en face from the ventricular perspective, depicting the thickened and retracted tricuspid leaflets with a large central orifice which shows little variation in size from systole to diastole. AML anterior mitral leaflet, RA right atrium, RV right ventricle, ATL anterior tricuspid leaflet, LV left ventricle, PTL posterior tricuspid leaflet, STL septal tricuspid leaflet (AVI 5393 kb)

Video 20.5a

Volume rendering of the tricuspid valve seen from the ventricular perspective in a patient with carcinoid disease (MOV 565 kb)

Video 20.5b

Volume rendering of the tricuspid valve seen from the atrial perspective in a patient with carcinoid disease (MOV 1144 kb)

Video 20.5c

Longitudinal cut of the data set of the right ventricle acquired in a patient with carcinoid disease showing thickening and retraction of the chordae with fibrous plaques (MOV 1184 kb)

Video 20.5d

Involvement of the pulmonary valve in a patient with carcinoid disease showing the same anatomo-pathological features of the tricuspid valve leading to steno-insufficiency. Ao aortic valve, PV pulmonary valve, ATL anterior tricuspid leaflet, LV left ventricle, PTL posterior tricuspid leaflet, STL septal tricuspid leaflet (MOV 551 kb)

Video 20.6a

Two-dimensional right ventricular focused view. Tricuspid annulus was mildly dilated (22 mm/m2) and there was no apparent abnormality of the tricuspid valve leaflets. The pacemaker lead is clearly visible, but presence/absence of interference with anterior leaflet motion was difficult to assess (MOV 1667 kb)

Video 20.6b

Two-dimensional color Doppler echocardiography showing significant tricuspid regurgitation in a patient with pace-maker and dilated atria (MOV 1537 kb)

Video 20.6c

Two-dimensional color Doppler echocardiography showing vena contracta and PISA radius (at 30 cm/s) in a in a patient with pace-maker and dilated atria (MOV 1426 kb)

Video 20.6d

Volume rendering of the tricuspid valve seen en-face from the ventricular perspective showing the position of the pacemaker lead which restricts the motion of the anterior tricuspid leaflet. ATL anterior tricuspid leaflet, LV left ventricle, PTL posterior tricuspid leaflet, STL septal tricuspid leaflet (MOV 643 kb)

Video 20.7a

Left Two-dimensional apical 4-chamber view with color Doppler showing a mild tricuspid regurgitation after pace-maker implantation (AVI 75941 kb)

Video 20.7b

Right Volume rendering of the tricuspid valve seen en face from the ventricular perspective the black arrow shows the pace-maker lead positioned in the commissure between the posterior and the septal tricuspid leaflets with no interference with valve leaflet motion (AVI 67503 kb)

Video 20.8a

Two-dimensional parasternal short-axis view of the tricuspid valve in a patient with previous blunt chest trauma (AVI 23984 kb)

Video 20.8b

Two-dimensional parasternal long-axis view of right ventricular inflow in a patient with previous blunt chest trauma showing two tethered tricuspid leaflets and a large coaptation gap (AVI 16731 kb)

Video 20.8c

Two-dimensional apical 4-chamber view in a patient with previous blunt chest trauma (AVI 12143 kb)

Video 20.8d

Two-dimensional apical 4-chamber view with color Doppler in a patient with previous blunt chest trauma. LA left atrium, LV left ventricle, RA right atrium, RV right ventricle, TV tricuspid valve (AVI 6296 kb)

Video 20.9a

Left En faceview En-face view of the tricuspid valve from the ventricular perspective, in a patient with previous blunt chest trauma, showing that only the septal and posterior tricuspid leaflets are tethered, whereas the anterior leaflet is flailing (AVI 8339 kb)

Video 20.9b

Right Longitudinal cut of a 3D data set of the tricuspid valve at the level of the anterior leaflet, in a patient with previous blunt chest, trauma showing its flail and the ruptured chorda. ATL anterior tricuspid leaflet, LV left ventricle, PTL posterior tricuspid leaflet, STL septal tricuspid leaflet (AVI 5889 kb)

Video 20.10a

Two-dimensional parastenal long axis view of right ventricular inflow in a patient with rheumatic tricuspid valve disease (AVI 18550 kb)

Video 20.10b

Apical 4-chamber view showing the thickened and hypomobile tricuspid valve leaflets in a patient with rheumatic tricuspid valve disease (AVI 17720 kb)

Video 20.10c

Apical 4-chamber view with color Doppler showing the severe tricuspid regurgitation with a large vena contracta width in a patient with rheumatic tricuspid valve disease (AVI 8187 kb)

Video 20.10d

Three-dimensional echocardiography with volume rendering of the tricuspid valve from the ventricular perspective. The en-face view of the valve allows the visualization of the thickened leaflets, the fused commissures and the size of the residual opening orifice. ATL anterior tricuspid leaflet, LV left ventricle, PTL posterior tricuspid leaflet, STL septal tricuspid leaflet (AVI 16660 kb)

Video 20.11

Prolapse of the septal tricuspid leaflet in a patients with degenerative tricuspid regurgitation. Ao aortic valve, MV mitral valve, ATL anterior tricuspid leaflet, LV left ventricle, PTL posterior tricuspid leaflet, STL septal tricuspid leaflet (AVI 13053 kb)

Video 20.12

Volume rendering of the tricuspid valve seen from the atrial perspective in a patient with Barlow disease. Ao aortic valve, MV mitral valve, ATL anterior tricuspid leaflet, LV left ventricle, PTL posterior tricuspid leaflet, STL septal tricuspid leaflet (AVI 14241 kb)

Video 20.13a

Left Transthoracic 3DE and volume rendering of the tricuspid valve displayed from the atrial perspective in a drug abuser with infective endocarditis of the tricuspid valve. Two large vegetation were visualized on the septal and anterior leaflets of the tricuspid valve (AVI 7388 kb)

Video 20.13b

Right Transthoracic 3DE and volume rendering of the tricuspid valve displayed in a drug abuser with infective endocarditis of the tricuspid valve. Longitudinal cut-plane to appreciate the site of attachment and the size of the vegetations as well as their functional interference with the valve function (AVI 7249 kb)

Video 20.14

Transesophageal 3DE with the volume rendering of the right atrium and origin of the superior vena cava in a patient with infective endocarditis localized at the origin of the superior vena cava after removal of infected pace-maker lead. A long and floating vegetation is attached at the origin of the superior vena cava. LA left atrium, RA right atrium, SVC superior vena cava (AVI 11261 kb)

Video 20.15

Transesophageal 3DE and volume rendering display of a large endocarditis mass wrapped around the ventricular portion of the lead of an implantable intracardiac defibrillator. A mobile vegetation attached to the tricuspid valve is also visualized. Ao aortic valve, MV mitral valve, ATL anterior tricuspid leaflet, LV left ventricle, PTL posterior tricuspid leaflet, STL septal tricuspid leaflet (AVI 1789 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Denisa Muraru
    • 1
    Email author
  • Karima Addetia
    • 2
  • Fabiana Jarjour
    • 3
  • Roberto M. Lang
    • 2
  • Luigi P. Badano
    • 1
  1. 1.University of Milano-Bicocca, and Istituto Auxologico Italiano, IRCCS, San Luca HospitalMilanItaly
  2. 2.Noninvasive Cardiac Imaging Laboratories, Department of Medicine/Section of CardiologyUniversity of Chicago Medical CenterChicagoUSA
  3. 3.Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua School of MedicinePaduaItaly

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