Tricuspid Valve Disease: Imaging Using Transthoracic Echocardiography

Tricuspid valve disease is common but often has less attention than in the left side of the heart. Functional tricuspid regurgitation if left untreated is associated with unfavorable outcome. Moreover, tricuspid valve surgery is often associated with higher complications than for any other surgical valve intervention. Transthoracic echocardiography (TTE) is the gold standard imaging of choice in the assessment of tricuspid valve disease. TTE has many sub modalities such as the M-mode, 2D and 3D modes, the bi-plane mode and the recently introduced iRotate mode. Furthermore, Doppler interrogation of the tricuspid valve as well as blood flow over other cardiac valves, pulmonary, aortic, hepatic venous flow is the mainstay in hemodynamic assessment of patients with tricuspid valve disease. TTE role begins with screening for the presence or absence and type of tricuspid valve disease. Moreover, determination of the etiology, severity of the tricuspid lesion, associated other valvular problems and chamber quantification are part of an imaging protocol/approach, which required for full diagnosis of tricuspid valve disease. Pre-operative and pre-catheter interventional planning can be performed by TTE. Finally, post interventional outcome as well as follow-up is often determined via TTE. In this chapter, we will provide a comprehensive and state-of-the art overview of the use of TTE for the assessment of TV disease. Advantages as well as limitations of each TTE sub modality will be outlined. A perspective on the value of TTE in the era of percutaneous transcatheter TV interventions will also be highlighted.