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GUIDELINES Sources

  • Huttin O, Voilliot D, Mandry D, et al. All you need to know about the tricuspid valve: tricuspid valve imaging and tricuspid regurgitation analysis. Arch Cardiovasc Dis. 2016;109:67–80.

  • Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation. J Am Soc Echocardiogr. 2017;30:303–371.

Table 14 and images show the echocardiographic determination of tricuspid regurgitation severity.

ANATOMY

“The tricuspid valve is septophylic. The mitral valve is septophobic.”

  • Tricuspid chordae can insert directly into the interventricular septum. Mitral chordae do not. This can help distinguish the tricuspid valve from the mitral valve when imaging congenital disorders.

  • The normal tricuspid annulus is saddle shaped.

  • There are anterior, posterior, and septal tricuspid valve leaflets.

  • An estimated 80% of significant tricuspid regurgitation is functional.

  • Functional tricuspid regurgitation is due to distortion of:

    • - Right ventricular size.

    • - Tricuspid annulus geometry.

    • - Tricuspid support apparatus.

  • As functional tricuspid regurgitation gets worse, the tricuspid annulus dilates, becomes flatter, and becomes more circular.

Sources

  • Acar C, Périer P, Fontaliran F, et al. Anatomical study of the tricuspid valve and its variations. Surg Radiol Anat. 1990;12:229–230.

  • Anwar AM, Geleijnse ML, Soliman OI, et al. Assessment of normal tricuspid valve anatomy in adults by real-time three-dimensional echocardiography. Int J Cardiovasc Imaging. 2007;23:717–724.

  • Badano LP, Agricola E, Perez de Isla L, et al. Evaluation of the tricuspid valve morphology and function by transthoracic real-time three-dimensional echocardiography. Eur J Echocardiogr. 2009;10:477–484.

  • Dreyfus GD, Martin RP, Chan KM, et al. Functional tricuspid regurgitation: a need to revise our understanding. J Am Coll Cardiol. 2015;65:2331–2336.

  • Fukuda S, Gillinov AM, Song JM, et al. Echocardiographic insights into atrial and ventricular mechanisms of functional tricuspid regurgitation. Am Heart J. 2006;152:1208–1214.

  • Fukuda S, Saracino G, Matsumura Y, et al. Three-dimensional geometry of the tricuspid annulus in healthy subjects and in patients with functional tricuspid regurgitation: a real-time, 3-dimensional echocardiographic study. Circulation. 2006;114:I492–I498.

A staging system for functional tricuspid valve pathology using three parameters:

  • - Tricuspid regurgitation severity.

  • - Annular dilation.

  • - Mode of leaflet coaptation (extent of tethering).

Source

  • Ton-Nu TT, Levine RA, Handschumacher MD, et al. Geometric determinants of functional tricuspid regurgitation: insights from 3-dimensional echocardiography. Circulation. 2006;114:143–149.

TRICUSPID VALVE TRAUMA AND CHORDAL RUPTURE

  • Tricuspid regurgitation can be caused by blunt chest trauma or by endomyocardial biopsy.

  • Tricuspid valves can be involved in 20% of myxomatous mitral valve disease. There can be prolapse, elongation of chordae, and rare chordal rupture.

  • Significant pacemaker lead–induced tricuspid regurgitation is associated with a poor prognosis.

Sources

  • Al-Mohaissen MA, Chan KL. Prevalence and mechanism of tricuspid regurgitation following implantation of endocardial leads for pacemaker or cardioverter-defibrillator. J Am Soc Echocardiogr. 2012;25:245–252.

  • Braverman AC, Coplen ...

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