Author + information
- Received February 15, 2017
- Revision received August 7, 2017
- Accepted August 14, 2017
- Published online March 4, 2019.
- Karima Addetia, MDa,
- Denisa Muraru, MD, PhDb,∗ (, )
- Federico Veronesi, PhDc,
- Csaba Jenei, MDb,
- Giacomo Cavalli, MDb,
- Stephanie A. Besser, MSAS, MSAa,
- Victor Mor-Avi, PhDa,
- Roberto M. Lang, MDa,∗ and
- Luigi P. Badano, MD, PhDb,∗
- aSection of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
- bDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
- cDepartment of Electrical, Electronic and Information Engineering, University of Bologna, Bologna, Italy
- ↵∗Address for correspondence:
Dr. Denisa Muraru, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
Objectives The authors used transthoracic 3-dimensional transthoracic echocardiography (3DE) to characterize tricuspid annulus (TA) geometry and dynamics in healthy volunteers.
Background Accurate sizing of the TA is essential for planning tricuspid annuloplasty and for implantation of new percutaneous tricuspid devices.
Methods 3DE of the TA from 209 healthy volunteers was analyzed using custom software to measure TA area, perimeter, circularity, and dimensions at end diastole (equals tricuspid valve closure), mid-systole, end systole, and late diastole. TA intercommissural distances were measured at mid-systole. For comparison, TA diameters were measured at the same time points on multiplanar reconstruction of the 3DE datasets and on 2-dimensional transthoracic echocardiography (2DE) apical 4-chamber and right ventricular focused views. In 13 subjects with both 3DE and computed tomography, TA parameters were compared.
Results 3DE TA area, perimeter, and dimensions were largest in late diastole and smallest at mid-systole/end systole. Normal tricuspid valve parameters in end diastole were 8.6 ± 2.0 cm2 for area; 10.5 ± 1.2 cm for perimeter; 36 ± 4 mm and 30 ± 4 mm for longest and shortest dimensions, respectively; and 0.83 ± 0.10 for circularity. There were no age-related changes in TA parameters. Women had larger indexed TA perimeter and longer long-axis dimensions compared with men. The longest 3DE TA dimension was significantly longer than diameters measured from both 2DE and 3D multiplanar reconstruction. 3DE TA area, perimeter, and dimensions correlated with both right atrial and right ventricular volumes, suggesting that both chambers may be determinants of TA size. TA fractional area change was 35 ± 10%. Fractional changes in both perimeter and dimensions were ≥20%. When compared with computed tomography, 3DE systematically underestimated TA parameters.
Conclusions Gender and body size should be taken into account to identify the reference values of TA dimensions. 2DE underestimates TA dimensions.
↵∗ Drs. Lang and Badano contributed equally to this work.
Dr. Muraru has served as a consultant, has received research support, and has served on the Speakers Bureau for GE Healthcare and TomTec Imaging. Dr. Veronesi has served as a consultant for GE Healthcare. Dr. Lang has served on the Speakers Bureau and Advisory Board and has received research grants from Philips Medical Imaging. Dr. Badano has received equipment grants from GE Vingmed and TomTec Imaging Systems; and has received speaker honoraria from GE Vingmed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 15, 2017.
- Revision received August 7, 2017.
- Accepted August 14, 2017.
- 2019 American College of Cardiology Foundation