CHAPTER 21: Tricuspid Valve

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...