EUROECHO and other imaging modalities 2012 location:Athens, Greece date:05-08 December 2012
Background: Conflicting data from existing guidelines and the most influential textbooks made identification of tricuspid valve leaflets (TVL) in standard two-dimensional echocardiographic (2DE) views a matter of great controversy. Advanced post-processing of three-dimensional echo (3DE) data sets may help to clarify this issue.
Methods: Standard 2DE and 3DE data were acquired in 65 consecutive patients. Using a dedicated, in-house developed research software, at first, all three TVLs were visualized in a ventricular en-face view and manually coloured. Secondly, image planes from the standard apical four chamber (A4C), parasternal short-axis (SAX) and right ventricular inflow (RVI) views were reconstructed from the colourized 3DE data set. Colours allowed to reliably identify TVLs in any view and the frequency of occurrence of a certain TVL was counted.
Results: See figure for numeric results. Visible TVLs can vary in any standard echo view due to variability in leaflet morphology and image planes. The large anterior leaflet was visualized in the majority of A4C views, but posterior TVLs may be found as well. In parasternal SAX views, the leaflet adjacent to the aortic valve was either anterior or septal. In RVI views, septal TVLs were found in two thirds of patients while on third showed posterior TVLs.
Conclusions: High variability in tricuspid valve leaflet anatomy and the dependence on the transducer position do not allow schematic leaflet identification. All existing TV leaflet identification schemes are therefore only partially correct and should be used with caution. If correct leaflet identification is needed, the use of three-dimensional echocardiography is recommended.