Transesophageal echocardiography (TEE) indicated tricuspid valve vegetation in the midesophageal four-chamber view, which resulted in a change in treatment and led to a new antibiotic regimen

Background: The coaptation length (CL) of the mitral valve leaflet decreases with increasing mitral regurgitation. Visualization of the CL of the tricuspid valve (TV) is challenging using conventional 2D echocardiography. The aims of this study were: (1) to test the feasibility of visualizing and quantifying the CL of the TV using three-dimensional (3D) transesophageal echocardiography (TEE), and (2) to study it relationship with the severity of tricuspid regurgitation (TR). Methods: Full-volume 3D TEE datasets of the TV were obtained in 24 patients from the transgastric approach. Using multiplanar reconstruction, short-axis plane depicting an en-face view of the TV was used to mark the central coaptation point (Fig. A). Three planes cutting through this point were then selected to view the 3 coaptation lines between: (1) anterior and posterior, (2) septal and anterior, and (3) septal and posterior TV leaflets (Figs. B-D). The CL was measured in each of these planes to obtain mean CL. The severity of tricuspid regurgitation was graded qualitatively as “none”, “trace”, “mild” and “moderate”. Results: Visualization of leaflet coaptation was feasible in 17/24 patients (71%). The mean CL was 0.89±0.03 cm in patients with no TR (N=4), 0.64±0.13 with trace TR (N=6), 0.50±0.07 with mild TR (N=3) and 0.13±0.11 with moderate TR (N=4). Since there was no overlap between the “moderate” group and the other 3 groups, the threshold of average CL for moderate TR was estimated to be between 0.25 (highest value in the “moderate” group) and 0.39 cm (lowest value in the other groups) (Fig. E). Conclusion: Visualization of the TV leaflet coaptation length from transgastric 3D TEE images is feasible in the majority of patients. TV coaptation length is inversely related to the severity of TR. The ability to visualize and quantify the CL of the TV may be useful when planning tricuspid valve repair surgery. Our findings suggest that CL below the threshold may indicate clinically significant TR.

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Abstract 16289: Deformation of Tricuspid Annulus After Tricuspid Ring Annuloplasty: A Three-dimensional Transesophageal Echocardiography Study

Circulation ◽

10.1161/circ.142.suppl_3.16289 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Atsushi Hayashi ◽

Jun Akashi ◽

Yosuke Nabeshima ◽

Mai Iwataki ◽

Yutaka Otsuji

Keyword(s):

Transesophageal Echocardiography ◽

Tricuspid Valve ◽

Heart Surgery ◽

Three Dimensional ◽

Tricuspid Annulus ◽

Annuloplasty Ring ◽

Functional Tricuspid Regurgitation ◽

Ring Annuloplasty ◽

Percent Area ◽

The Impact

Background: Tricuspid ring annuloplasty (TAP) is usually performed for patients with mild or greater functional tricuspid regurgitation (TR) at the time of left-sided valve surgery. However, there were limited data regarding the shape of tricuspid annulus after TAP. The aim of this study was using three-dimensional (3D) transesophageal echocardiography to investigate the impact of the ring annuloplasty on the tricuspid annulus after TAP. Methods: 3D tricuspid valve was retrospectively analyzed in 20 patients who underwent concomitant left-sided heart surgery and TAP for functional TR. 3D data of tricuspid valve were acquired before TAP, immediate after surgery (intraoperative), and before discharge (15±5 days after TAP). TAP was performed by one surgeon using a Carpentier-Edwards Physio Tricuspid annuloplasty ring. The ring size was determined by measuring the distance from anteroseptal to posteroseptal commissures. 3D tricuspid annular area was measured. The area protruded outside the annuloplasty ring was obtained by subtracting the ring area from the annular area (Figure). Results: All 20 patients underwent successfully TAP with less than mild residual TR. Annuloplasty rings size 28mm, 30mm, 32mm, and 34mm were used in 6 (30%), 4 (20%), 5 (25%), and 5 (25%) patients, respectively. Median annular area decreased from 1074 (interquartile rage 893-1276) mm 2 before TAP to 591 (519-706) mm 2 immediate after TAP, but showed significant increase to 645 (501-766) mm 2 at the time of discharge (P<0.001). Percent area protruded outside the annuloplasty ring was 14% immediate after TAP and increased to 24% before discharge (P<0.001). Before discharge, there were 9 patients with more than mild residual TR (2 had moderate TR). Percent area protruded outside the annuloplasty ring was associated with mild or more residual TR at the discharge. Conclusion: Tricuspid annular shape after TAP was not always round. Deformation of tricuspid annulus may be associated with residual TR.

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Transesophageal echocardiography (TEE) disclosed Takotsubo syndrome in the midesophageal two-chamber view and inotropic agents initiated because of left ventricular dysfunction

ASVIDE ◽

10.21037/asvide.2020.174 ◽

2020 ◽

Vol 7 ◽

pp. 174-174

Author(s):

Xiang Si ◽

Jie Ma ◽

Dai-Yin Cao ◽

Hai-Lin Xu ◽

Ling-Yun Zuo ◽

...

Keyword(s):

Transesophageal Echocardiography ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Inotropic Agents ◽

Takotsubo Syndrome ◽

Chamber View

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Transesophageal echocardiography (TEE) revealed a left atrial appendage thrombus in the midesophageal two-chamber view, which led to anticoagulation therapy

ASVIDE ◽

10.21037/asvide.2020.172 ◽

2020 ◽

Vol 7 ◽

pp. 172-172

Author(s):

Xiang Si ◽

Jie Ma ◽

Dai-Yin Cao ◽

Hai-Lin Xu ◽

Ling-Yun Zuo ◽

...

Keyword(s):

Transesophageal Echocardiography ◽

Left Atrial ◽

Left Atrial Appendage ◽

Anticoagulation Therapy ◽

Atrial Appendage ◽

Left Atrial Appendage Thrombus ◽

Chamber View

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Tricuspid valve dysplasia in a domestic feline: case report

Semina Ciências Agrárias ◽

10.5433/1679-0359.2017v38n2p1087 ◽

2017 ◽

Vol 38 (2) ◽

pp. 1087

Author(s):

Matheus Matioli Mantovani ◽

André Martins Gimenes ◽

Jacqueline Ribeiro de Castro ◽

Guilherme Teixeira Goldfeder ◽

Maria Helena Matiko Akao Larsson ◽

...

Keyword(s):

Tricuspid Valve ◽

Clinical Manifestations ◽

Domestic Cat ◽

Respiratory Pattern ◽

Chamber View ◽

Anomalous Insertion ◽

Dimensional Echocardiography ◽

The Right ◽

Two Dimensional Echocardiography ◽

Septal Motion

Tricuspid valve dysplasia (TVD) is a congenital heart defect described in dogs and cats; however, in Brazil there are no reports of this condition in cats. Therefore, our goal was to report a case of TVD in a domestic cat. A four-year-old, female, domestic short hair cat that was seen at the Cardiology Service of the Veterinary Teaching Hospital, University of São Paulo, for apathy, appetite loss and dyspnea for five days. During physical examination, dyspnea with a restrictive respiratory pattern due to pleural effusion was observed. Thoracocentesis was performed and 450 mL of serosanguineous fluid was drained. Two-dimensional echocardiography in the right parasternal short-axis plane at the level of the papillary muscles showed right ventricular dilatation and paradoxical septal motion. On the left parasternal apical four-chamber view, significant dilatation of the right chambers, loss of mobility of the septal leaflet of the tricuspid valve and a thickened mural leaflet chordae with anomalous insertion were observed. Based on clinical and echocardiographic aspects, a diagnosis of TVD was given. Treatment was initiated with enalapril 0.5 mg/kg, furosemide 0.5 mg/kg and pimobendan 0.3 mg/kg every 12 hours, all per os. The patient experienced remission of clinical manifestations and survived for 50 days after diagnosis.

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