Multimodal imaging of the tricuspid valve: normal appearance and pathological entities

Abstract

The tricuspid valve, which is the atrioventricular valve attached to the morphological right ventricle, is affected by a wide range of pathological processes. Tricuspid valve diseases are now increasingly recognized as a significant cause of morbidity and mortality. Echocardiography is the most widely available and, hence, the first-line imaging modality used in the evaluation of tricuspid valve disorders; however, CT and MRI are also increasingly used for further evaluation and characterization of these entities. In this article, we first review the normal anatomy and embryology of the tricuspid valve, followed by a discussion of the role of multiple imaging modalities in the evaluation of tricuspid valve abnormalities. We then review and illustrate the imaging appearance of several congenital and acquired tricuspid valve abnormalities.Main Messages• Tricuspid valve diseases have a significant impact on morbidity and mortality.• CT and MRI are increasingly used in the evaluation of tricuspid disorders.• CT and MRI help in diagnosis, functional evaluation, pre-surgical planning and post-surgical follow-up.• The most common cause of tricuspid regurgitation is functional.Electronic supplementary materialThe online version of this article (doi:10.1007/s13244-016-0504-7) contains supplementary material, which is available to authorized users.

Mitral Ebstein's Anomaly Modified with a Scarred Rhabdomyoma in Tuberous Sclerosis: An Extremely Rare Cause of Mitral Insufficiency

“…The apical displacement of the hinge point of the plastered tricuspid valve eventually leads to tricuspid regurgitation. At the same time, RV myocardial dysplasia, which occurs due to incomplete generation, results in RV dysfunction ( 7 ).…”

Role of computed tomography in transcatheter replacement of ‘other valves’: a comprehensive review of preprocedural imaging

“…The tricuspidal valve annulus dimensions with regard to the maximal antero-posterior and septal-lateral diameter, the perimeter and the area of the annulus can be measured on a short-axis view, while the distance of the annulus from the right ventricular apex, another important parameter in the preprocedural planning, can be measured using the long-axis four-chamber view 67 . Leaflet thickening and fusion, with or without calcification, can be shown in tricuspidal valve stenosis, whereas the tricuspidal valve regurgitant orifice area can be measured in tricuspidal valve regurgitation 68,69 …”

“…67 Leaflet thickening and fusion, with or without calcification, can be shown in tricuspidal valve stenosis, whereas the tricuspidal valve regurgitant orifice area can be measured in tricuspidal valve regurgitation. 68,69 Furthermore, current developments in 3D printing software can provide an accurate representation of the tricuspidal valve apparatus, which is particularly useful for congenital heart disease. 70 Evaluation of the right heart chambers Evaluation of right ventricular and right atrial volumes can be assessed by CT, using at least 10 phases of the cardiac cycle (5-95% of R-R interval).…”

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“…To prevent this problem, a semi-invasive technique that simultaneously injects contrast agents via both the femoral and antecubital veins has been suggested [ 16 ]. This is an ideal method, but due to its invasiveness, the biphasic or triphasic protocol is generally used [ 17 18 ]. For function analysis with electrocardiography (ECG)-gated cardiac CT, multiphase data with a maximum 1.5-mm slice thickness reconstructed for at least 10 phases of the cardiac cycle (0%–90% of R-R interval) are required.…”

“…5 ). The normal maximum annulus diameter, circumference, and area are 3.1 ± 0.4 cm, 11.9 ± 0.9 cm, and 11.3 ± 1.8 cm 2 , respectively, on the four-chamber view of two-dimensional (2D) echocardiography [ 23 24 ], and 3.0–3.5 cm on the short-axis CT image [ 18 ]. In functional TR, which is characterized by a dilated annulus (> 40 mm) [ 25 ], the annulus dilates along the RV free wall, and the shape becomes more circular and flatter ( Fig.…”