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Evaluation of Tricuspid Valve Morphology and Function by Transthoracic Three-Dimensional Echocardiography. Curr Cardiol Rep 2011; 13:242-9. [DOI: 10.1007/s11886-011-0176-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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52
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Gonçalves A, Zamorano JL. Valve anatomy and function with transthoracic three-dimensional echocardiography: advantages and limitations of instantaneous full-volume color Doppler imaging. Ther Adv Cardiovasc Dis 2010; 4:385-94. [PMID: 20965949 DOI: 10.1177/1753944710384771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Three-dimensional echocardiography (3DE) is becoming part of everyday clinical practice worldwide. However, 3DE requires adequate electrocardiographic and respiratory gating and it complements instead of replacing bidimensional echocardiography (2D). The instantaneous full-volume echocardiography technique is trying to overcome some of these limitations and to present an effective alternative to 2D echocardiography. In this article we aim to review the contribution of 3DE to our knowledge of anatomic and functional valvular anatomy and the potential advantages of instantaneous full-volume color Doppler echocardiography.
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53
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Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Hagendorff A, Monin JL, Badano L, Zamorano JL. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:307-32. [PMID: 20435783 DOI: 10.1093/ejechocard/jeq031] [Citation(s) in RCA: 941] [Impact Index Per Article: 67.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Mitral and tricuspid are increasingly prevalent. Doppler echocardiography not only detects the presence of regurgitation but also permits to understand mechanisms of regurgitation, quantification of its severity and repercussions. The present document aims to provide standards for the assessment of mitral and tricuspid regurgitation.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, Valvular Disease Clinic, University Hospital, Université de Liège, CHU du Sart Tilman, 4000 Liège, Belgium.
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54
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Takahashi K, Mackie AS, Rebeyka IM, Ross DB, Robertson M, Dyck JD, Inage A, Smallhorn JF. Two-Dimensional Versus Transthoracic Real-Time Three-Dimensional Echocardiography in the Evaluation of the Mechanisms and Sites of Atrioventricular Valve Regurgitation in a Congenital Heart Disease Population. J Am Soc Echocardiogr 2010; 23:726-34. [DOI: 10.1016/j.echo.2010.04.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Indexed: 11/24/2022]
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55
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Singh P, Inamdar V, Hage FG, Kodali V, Karakus G, Suwanjutah T, Hsiung MC, Nanda NC. Usefulness of live/real time three-dimensional transthoracic echocardiography in evaluation of prosthetic valve function. Echocardiography 2010; 26:1236-49. [PMID: 19929870 DOI: 10.1111/j.1540-8175.2009.01079.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We studied 31 patients with prosthetic valves (PVs) using two-dimensional and three-dimensional transthorathic echocardiography (2DTTE and 3DTTE, respectively) in order to determine whether 3DTTE provides an incremental value on top of 2DTTE in the evaluation of these patients. With 3DTTE both leaflets of the St. Jude mechanical PV can be visualized simultaneously, thereby increasing the diagnostic confidence in excluding valvular abnormalities and overcoming the well-known limitations of 2DTTE in the examination of PVs, which heavily relies on Doppler. Three-dimensional transthorathic echocardiography provides a more comprehensive evaluation of PV regurgitation than 2DTTE with its ability to more precisely quantify PV regurgitation, in determining the mechanism causing regurgitation, and in localizing the regurgitant defect. Furthermore, 3DTTE is superior in identifying, quantifying, and localizing PV thrombi and vegetations, in addition to the unique feature of providing a look inside mass lesions by serial sectioning. These preliminary results suggest the superiority of 3DTTE over 2DTTE in the evaluation of PVs and that it provides incremental knowledge to the echocardiographer.
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Affiliation(s)
- Preeti Singh
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
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56
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Singh P, Mehta A, Nanda NC. Live/Real Time Three-Dimensional Transthoracic Echocardiographic Findings in an Adult with Complete Atrioventricular Septal Defect. Echocardiography 2010; 27:87-90. [DOI: 10.1111/j.1540-8175.2009.01129.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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57
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Enar S, Singh P, Douglas C, Panwar SR, Manda J, Kesanolla SK, Nanda NC. Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of Transposition of the Great Arteries in the Adult. Echocardiography 2009; 26:1095-104. [DOI: 10.1111/j.1540-8175.2009.01023.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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58
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Real-Time 3-Dimensional Echocardiography Provides New Insight Into Mechanisms of Tricuspid Valve Regurgitation in Patients With Hypoplastic Left Heart Syndrome. Circulation 2009; 120:1091-8. [DOI: 10.1161/circulationaha.108.809566] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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59
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Badano LP, Agricola E, Perez de Isla L, Gianfagna P, Zamorano JL. Evaluation of the tricuspid valve morphology and function by transthoracic real-time three-dimensional echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:477-84. [PMID: 19482963 DOI: 10.1093/ejechocard/jep044] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Assessment of tricuspid valve (TV) function plays an important role in a number of clinical disease states, including left-sided valve disease and heart failure. However, the TV is a complex structure that, unlike the aortic and mitral valve, it is not possible to visualize in one cross-sectional view using either transthoracic or transoesophageal two-dimensional echocardiography (i.e. imaging all three TV leaflets and their attachment in the annulus simultaneously). Conversely, three-dimensional echocardiography allows users to visualize the whole TV apparatus from any perspective. This may significantly improve our understanding of the pathophysiological mechanisms underlying the various TV diseases and functional tricuspid regurgitation, and potentially suggest ways to improve surgical treatment. This review details the current status of real-time three-dimensional echocardiography evaluation of TV morphology and function with its clinical applications and limitations.
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Affiliation(s)
- Luigi P Badano
- Echo-Lab, Department of Cardiopulmonary Sciences, University Hospital S Maria della Misericordia, P.le S Maria della Misericordia 15, 33100 Udine, Italy.
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60
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Hansalia S, Manda J, Pothineni KR, Nanda NC. Usefulness of live/real time three-dimensional transthoracic echocardiography in diagnosing acquired left ventricular-right atrial communication misdiagnosed as severe pulmonary hypertension by two-dimensional transthoracic echocardiography. Echocardiography 2009; 26:224-7. [PMID: 19207997 DOI: 10.1111/j.1540-8175.2008.00861.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We describe an adult patient with an acquired left ventricular-right atrial communication that was misdiagnosed as severe pulmonary hypertension (PH) by two-dimensional (2D) transthoracic echocardiography, but accurately detected on three-dimensional (3D) transthoracic echocardiography. Open heart surgery confirmed the defect.
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Affiliation(s)
- Sachin Hansalia
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Hergum T, Skaug TR, Matre K, Torp H. Quantification of valvular regurgitation area and geometry using HPRF 3-D Doppler. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2009; 56:975-982. [PMID: 19473915 DOI: 10.1109/tuffc.2009.1129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
It is important to determine the severity of valvular regurgitation accurately because surgery is indicated only in severe regurgitations. The evaluation of, for example, mitral regurgitation is complex, and the current methods have limitations. We have developed a 3-D Doppler method to estimate the cross-sectional area and the geometry of a regurgitant jet at the vena contracta just downstream from the actual orifice. The back-scattered Doppler signal from multiple beams distributed over the area of interest was measured. The received power from these beams was then calibrated using both a priori knowledge of the lateral extent of the beams and a reference beam that was completely enclosed by the vena contracta. To isolate the Doppler signal received from the core of a regurgitant jet, a high pulse repetition frequency and a steep clutter filter are required. The method has been implemented and verified by computer simulations and by in vitro experiments using a pulsatile flow phantom and prosthetic valves with a range of holes. We were able to distinguish between mild, moderate, and severe valvular regurgitation. We were also able to quantify the regurgitational area as well as show the geometry of the regurgitation.
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Affiliation(s)
- Torbjørn Hergum
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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62
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Jungwirth B, Mackensen GB. Real-time 3-dimensional echocardiography in the operating room. Semin Cardiothorac Vasc Anesth 2008; 12:248-64. [PMID: 19033269 DOI: 10.1177/1089253208328669] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Real-time 3-dimensional transesophageal echocardiography (RT-3D-TEE) represents a novel clinical and intuitively educational perioperative cardiovascular imaging modality. The development of RT-3D-TEE allows for live 3D imaging as it circumvents most of the disadvantages of reconstructive 3D methods. RT-3D-TEE will likely revolutionize perioperative assessment of complex 3D structures, such as the mitral valve (MV), as it provides important mechanistic insights into functional and ischemic mitral regurgitation. The MV is particularly suited to live RT-3D-TEE assessment because of the complex interrelationships among the valve, chordae, papillary muscles, and myocardial walls. The 3D en face view of the MV is in accordance with the surgical view and allows to illustrate the unique saddle shape of the MV annulus and to define and localize mitral leaflet lesions in MV prolapse, endocarditis, or congenital MV abnormalities, all potentially important in guiding surgical repair. RT-3D-TEE will soon be integrated into routine perioperative practice. Its unique ability of real-time acquisition, online rendering and cropping capabilities, accurate identification of the precise pathology and location of cardiac disease, together with its ability to promptly quantify 3D data sets using built-in software, will likely help in transitioning this modality into standard of care.
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Affiliation(s)
- Bettina Jungwirth
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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63
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Little SH, Pirat B, Kumar R, Igo SR, McCulloch M, Hartley CJ, Xu J, Zoghbi WA. Three-dimensional color Doppler echocardiography for direct measurement of vena contracta area in mitral regurgitation: in vitro validation and clinical experience. JACC Cardiovasc Imaging 2008; 1:695-704. [PMID: 19356505 DOI: 10.1016/j.jcmg.2008.05.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 05/22/2008] [Accepted: 05/23/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Our goal was to prospectively compare the accuracy of real-time three-dimensional (3D) color Doppler vena contracta (VC) area and two-dimensional (2D) VC diameter in an in vitro model and in the clinical assessment of mitral regurgitation (MR) severity. BACKGROUND Real-time 3D color Doppler allows direct measurement of VC area and may be more accurate for assessment of MR than the conventional VC diameter measurement by 2D color Doppler. METHODS Using a circulatory loop with an incorporated imaging chamber, various pulsatile flow rates of MR were driven through 4 differently sized orifices. In a clinical study of patients with at least mild MR, regurgitation severity was assessed quantitatively using Doppler-derived effective regurgitant orifice area (EROA), and semiquantitatively as recommended by the American Society of Echocardiography. We describe a step-by-step process to accurately identify the 3D-VC area and compare that measure against known orifice areas (in vitro study) and EROA (clinical study). RESULTS In vitro, 3D-VC area demonstrated the strongest correlation with known orifice area (r = 0.92, p < 0.001), whereas 2D-VC diameter had a weak correlation with orifice area (r = 0.56, p = 0.01). In a clinical study of 61 patients, 3D-VC area correlated with Doppler-derived EROA (r = 0.85, p < 0.001); the relation was stronger than for 2D-VC diameter (r = 0.67, p < 0.001). The advantage of 3D-VC area over 2D-VC diameter was more pronounced in eccentric jets (r = 0.87, p < 0.001 vs. r = 0.6, p < 0.001, respectively) and in moderate-to-severe or severe MR (r = 0.80, p < 0.001 vs. r = 0.18, p = 0.4, respectively). CONCLUSIONS Measurement of VC area is feasible with real-time 3D color Doppler and provides a simple parameter that accurately reflects MR severity, particularly in eccentric and clinically significant MR where geometric assumptions may be challenging.
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Affiliation(s)
- Stephen H Little
- The Methodist DeBakey Heart and Vascular Center, Houston, Texas 77030, USA
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64
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Anwar AM, Nosir YFM. Role of Real Time Three-Dimensional Echocardiography in Heart Failure. Echocardiography 2008; 25:983-92. [DOI: 10.1111/j.1540-8175.2008.00746.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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65
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Pothineni KR, Wells BJ, Hsiung MC, Nanda NC, Yelamanchili P, Suwanjutah T, Prasad AR, Hansalia S, Lin CC, Yin WH, Young MS. Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of Pulmonary Regurgitation. Echocardiography 2008; 25:911-7. [DOI: 10.1111/j.1540-8175.2008.00721.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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66
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Miller AP, Nanda NC. Live/real-time three-dimensional transthoracic assessment of mitral regurgitation and mitral valve prolapse. Cardiol Clin 2007; 25:319-25. [PMID: 17765112 DOI: 10.1016/j.ccl.2007.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Evaluation of the mitral valve requires appreciation of its complex geometry. To accurately guide surgical interventions and describe pathology, three-dimensional transthoracic echocardiography (TTE) is an immense improvement over the cumbersome mental reconstruction required by two-dimensional approaches. Here we describe real-time, three-dimensional transthoracic techniques for assessing mitral regurgitation and mitral valve prolapse.
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Affiliation(s)
- Andrew P Miller
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Heart Station SWB/S102, 619 19th Street South, Birmingham, AL 35249, USA
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67
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Schmidt A, Da Silva Júnior T, Pazin-Filho A, Otávio Murta Júnior L, César Almeida-Filho O, Gallo-Júnior L, Antonio Marin-Neto J, Carlos Maciel B. Effects of Changing Blood Viscosity and Heart Rate on Vena Contracta Width as Evaluated by Color Doppler Flow Mapping. An In Vitro Study with a Pulsatile Flow Model. Echocardiography 2007; 25:133-40. [DOI: 10.1111/j.1540-8175.2007.00561.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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68
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Ahlgrim AA, Nanda NC, Berther E, Gill EA. Three-Dimensional Echocardiography: An Alternative Imaging Choice for Evaluation of Tricuspid Valve Disorders. Cardiol Clin 2007; 25:305-9. [PMID: 17765110 DOI: 10.1016/j.ccl.2007.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article presents an approach to real-time three-dimensional imaging of the tricuspid valve from three different views. This is followed by some representative cases that illustrate these views and some unique tricuspid valve abnormalities, including one case of corrected transposition.
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Affiliation(s)
- Alicia A Ahlgrim
- Harborview Medical Center, 325 Ninth Avenue, Box 359748, Seattle, WA 98104, USA
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69
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Pothineni KR, Duncan K, Yelamanchili P, Nanda NC, Patel V, Fan P, Burri MV, Singh A, Panwar SR. Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of Tricuspid Valve Pathology: Incremental Value over the Two-Dimensional Technique. Echocardiography 2007; 24:541-52. [PMID: 17456074 DOI: 10.1111/j.1540-8175.2007.00451.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Twenty-nine patients with different tricuspid valve (TV) pathologies were studied by both two-dimensional transthoracic (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE). A major contribution of 3DTTE over 2DTTE was the en face visualization of all three leaflets of the TV in all patients. This allowed accurate assessment of TV orifice area in patients with TV stenosis and carcinoid disease. Loss of TV leaflet tissue, defects in TV leaflets and size of TV systolic non-coaptation could also be delineated and resulted in identifying the mechanism of tricuspid regurgitation (TR) in patients with Ebstein's anomaly and rheumatic heart disease. Prolapse of TV leaflets could also be well visualized and enabled us to develop a schema for systematic assessment of individual segment prolapse which could help in surgical planning. The exact sites of chordae rupture in patients with flail TV as well as right ventricular papillary muscle rupture could be well seen by 3DTTE. 3DTTE also permitted sectioning of various TV masses for more specific diagnosis of their nature. In addition, color Doppler 3DTTE provided an estimate of quantitative evaluation of TR severity, since the exact shape and size of the vena contracta could be accurately assessed. In conclusion, our preliminary experience with 3DTTE has demonstrated substantial incremental value over 2DTTE in the assessment of various TV pathologies.
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Affiliation(s)
- Koteswara R Pothineni
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA
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