Three‐dimensional transthoracic echocardiographic identification of individual cusps of the pulmonary valve: Potential misidentification by the two‐dimensional technique

Elsayed, Mahmoud; Hsiung, Ming C.; Nanda, Navin C.; Alratroot, Ahmad; Turaga, Naga Sai Shravan

doi:10.1111/echo.14032

Cited by 3 publications

(6 citation statements)

References 10 publications

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“…Two‐dimensional TTE is the conventional first step and is well known as a cost‐effective diagnostic tool for heart valve evaluation. However, PV morphology is challenging for conventional 2D echo because of the anatomic localization of the PV under the sternum, and the basic physics of ultrasound penetration through the chest wall and pulmonary parenchyma 3,13,18,21,25,28,29 . Typically, only two cusps of the PV can be visualized simultaneously by 2D TTE even while utilizing short‐axis views.…”

Section: D Transthoracic Echocardiography In Pv Imagingmentioning

confidence: 99%

“…The 3D TTE en face view allows concurrent visualization of all three PV leaflets, as well as assessments of the RVOT and main pulmonary artery, with additional improved quantitative assessment of pulmonary valve stenosis and regurgitation. 2,5,14,21,24,26–28,30,31 One recent study showed that 3D TTE was capable of visualization of all three leaflets image in all study subjects successfully, while 2D TTE only can image one or two leaflets partially 25 . Kelly et al showed PV morphological features are discerned accurately in 60% of patients, and this percentage can increase to 77% when patients with poor image quality on 2D TTE are excluded 17 .…”

Section: D Transthoracic Echocardiography In Pv Imagingmentioning

confidence: 99%

“…17,24 3D echocardiographic data acquisition techniques of full vol- and the basic physics of ultrasound penetration through the chest wall and pulmonary parenchyma. 3,13,18,21,25,28,29 Typically, only two cusps of the PV can be visualized simultaneously by 2D TTE even while utilizing short-axis views. The 3D TTE en face view allows concurrent visualization of all three PV leaflets, as well as assessments of the RVOT and main pulmonary artery, with additional improved quantitative assessment of pulmonary valve stenosis and regurgitation.…”

Section: Focused Wide-angle Zoom and Full Volume With Color Dopplermentioning

confidence: 99%

“…2,5,14,21,24,[26][27][28]30,31 One recent study showed that 3D TTE was capable of visualization of all three leaflets image in all study subjects successfully, while 2D TTE only can image one or two leaflets partially. 25 Kelly et al showed PV morphological features are discerned accurately in 60% of patients, and this percentage can increase to 77% when patients with poor image quality on 2D TTE are excluded. 17 Another investigation of 3D TTE showed that the PV was visualized sufficiently in 92% of cases with "excellent" quality in 70% and excellent RVOT imaging in 40% of study subjects.…”

Section: Focused Wide-angle Zoom and Full Volume With Color Dopplermentioning

confidence: 99%

“…This is because 3D echocardiography acquires a volumetric dataset for cropping and reorientation in order to assess the zone of interest from multiple perspectives. For the pulmonary valve, this means viewing the valve en face from the superior side, the inferior side as well the valve from the side in a longitudinal view 2,24,25 . 2D datasets are very unlikely to visualize all three of the PV leaflets in cross‐sectional views whereas with the volumetric data sets of 3D echocardiography, this is theoretically possible in most cases.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary valve assessment by three‐dimensional echocardiography

Taşkesen

Gill

2021

Echocardiography

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The pulmonary valve (PV) has historically been ignored by imaging studies. Disorders of the PV encountered in adult cardiac patients are increasingly encountered due to advanced care of patients with congenital heart disease and associated PV diseases. Despite advances in PV imaging, multiple challenges remain when it comes to obtaining high quality PV images. While 2D TTE is the usual initial imaging tool for PV, excellent views of the PV annulus and its one or two leaflets are obtained in less than half of patients. The 3D echocardiography en face view allows all three leaflets to be evaluated concurrently, as well as assessments of the RV outflow tract and main pulmonary artery, which has improved quantitative assessment of PV diseases. Increasing image quality and experience with live/real time 3D TEE amplifies its utility in accurate evaluation and helps guide and monitor successful percutaneous PV interventions. 2D TTE remains the first line diagnostic tool; however, 3D TTE and 3D TEE provide better image quality which increases diagnostic accuracy and guidance to therapy. In this review article, we stress improvement in 3D echocardiography and its role in diagnostic and therapeutic options for PV diseases.

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Section: D Transthoracic Echocardiography In Pv Imagingmentioning

confidence: 99%

Section: D Transthoracic Echocardiography In Pv Imagingmentioning

confidence: 99%

Section: Focused Wide-angle Zoom and Full Volume With Color Dopplermentioning

confidence: 99%

Section: Focused Wide-angle Zoom and Full Volume With Color Dopplermentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pulmonary valve assessment by three‐dimensional echocardiography

Taşkesen

Gill

2021

Echocardiography

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Feasibility of pulmonary valve imaging using transesophageal echocardiography upper esophageal view

et al. 2019

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Background The present study designed to evaluate feasibility of transesophageal echocardiographic (TEE) imaging of the pulmonary valve (PV) at the transaortic upper esophageal (TAUE) window. We hypothesized that patients with larger aorta would be more likely to have visualization of the PV from this TAUE window. Methods 2D TEE images of the PV were prospectively acquired by one operator at the TAUE window looking through the aortic arch. Patients were divided into four groups based on image quality of PV (group 1, not visualized; group 2, barely visualized; group 3, sufficient visualization; group 4, excellent visualization). Clinical, echocardiographic, and radiologic parameters were collected. Results A total of 212 consecutive patients (54 ± 14 years, 63.7% male) were enrolled. Group distribution was as follows: group 1, n = 60 (28.3%); group 2 n = 39 (18.4%); group 3, n = 27 (12.7%); group 4, n = 86 (40.6%). There were no differences between groups’ baseline clinical characteristics. There was a weak although statistically negative correlation between PV image quality and aortic arch dimension (r = −0.17 P = 0.01). There was a stronger positive correlation between PV thickness (r = 0.38 P < 0.001) and PV image quality. Retrospective subgroup analysis of 76 patients with recent chest CT showed similar, but not significant trends as by TEE. Conclusion The use of 2D TEE TAUE results in diagnostic image quality of the PV in the majority of patients and outstanding image quality in a subset of patients. PV image quality is negatively affected by increasing aorta diameter and positively affected by PV thickness.

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Quadricuspid Pulmonary Valve: Case Report and the Comparison with Quadricuspid Aortic Valve

Miyake

Inoue

Mushiake

2023

CCR

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Background: Quadricuspid pulmonary valve (QPV) is a rare congenital anomaly. Simple QPV had been mainly diagnosed at the time of autopsy before 2000 and the frequency rates of QPV are approximately 0.02%–0.41%. QPV was initially diagnosed using transthoracic echocardiography (TTE) after 2000 and with contrast computed tomography (CT) or cardiac magnetic resonance imaging (CMR) after 2009. Obtaining the cross-sectional view of the pulmonary valve using TTE is difficult. We aimed to review the papers regarding the incidence, embryology, diagnosis, associated congenital heart anomalies, and prognosis in patients with QPV, and furthermore to compare with those in patients with quadricuspid aortic valve (QAV). Case presentation: We diagnosed QPV with mild stenosis in a 12-month-old infant. With a slight angulation of the transducer superiorly from the left high parasternal short-axis view, a short-axis view of QPV was obtained. Results: In QPV cases diagnosed at autopsy, Hurwitz’s type-b with three equal cusps and one smaller cusp is dominant, whereas Hurwitz’s type-a with four equal cusps is dominant in clinically diagnosed cases. Patients with associated congenital heart anomaly and valvular stenosis are more frequent in patients with QPV than in patients with QAV. Coronary artery anomalies and infectious endocarditis are more frequent in patients with QAV than in patients with QPV. The incidence of PR is more common in type-a QPV than in type-b QPV. There is no difference between type-a QAV and type-b QAV with respect to the incidence of aortic regurgitation (AR). It is assumed that QPV is a risk factor for a Ross operation. However, QPVs have been used as autografts in certain patients. Conclusion: Between QPV and QAV, various differences were found about frequency rates, diagnostic methods, valve morphology, valve function, associated congenital heart diseases, and frequencies of infectious endocarditis.

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Three‐dimensional transthoracic echocardiographic identification of individual cusps of the pulmonary valve: Potential misidentification by the two‐dimensional technique

Cited by 3 publications

References 10 publications

Pulmonary valve assessment by three‐dimensional echocardiography

Pulmonary valve assessment by three‐dimensional echocardiography

Feasibility of pulmonary valve imaging using transesophageal echocardiography upper esophageal view

Quadricuspid Pulmonary Valve: Case Report and the Comparison with Quadricuspid Aortic Valve

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