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Tricuspid Valve
Introduction
The tricuspid valve is the largest of the four heart valves and ranges from 4 to 6 cm 2 in area. The tricuspid valve has anterior, septal, and posterior leaflets. The anterior leaflet usually is the largest, with a width of 2.2 cm. The septal and posterior leaflets are notably smaller and measure roughly 1.5 and 2.0 cm, respectively, based on autopsy series. Our experience shows that the posterior leaflet often is the smallest. In many cases, the posterior leaflet is not only the smallest, it is also quite rudimentary. Disease processes of the tricuspid valve are relatively uncommon. The tricuspid valve can frequently be incompetent because of factors separate from the valve itself. Specific examples of such incompetence include right ventricular annular dilation, tricuspid annular dilation, or both as well as pulmonary hypertension. In the presence of pathology that directly involves the valve, such as bacterial endocarditis or tricuspid valve prolapse, identification of specific leaflet involvement often is critical for addressing surgical management, particularly to determine whether tricuspid valve replacement would be indicated compared with tricuspid annuloplasty.
Advantages of Real-Time Three-Dimensional Echocardiography
Real-time three-dimensional echocardiography (RT3DE) has a major advantage for imaging the tricuspid valve because of its ability to display the valve en face, which results in the visualization of all three tricuspid leaflets simultaneously; this rarely is possible with standard two-dimensional (2D) imaging. Furthermore, even on the rare occasion when imaging of the tricuspid valve en face is possible, it is possible from only one view. RT3DE allows several approaches to en face imaging of the tricuspid valve by the transthoracic approach, including RV inflow, the parasternal short-axis, apical four-chamber, and subcostal views. Dilation of the right ventricle provides a particularly satisfactory window for the visualization of the tricuspid valve with RT3DE.
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