Assessment of the tricuspid valve: a comparison of four transesophageal echocardiographic windows.

OBJECTIVE Tricuspid valve annular dilation is associated with persistent tricuspid valve regurgitation (TR) after cardiac surgery. The purpose of this study is to compare assessment of the tricuspid valve annulus from 4 different echocardiographic windows. DESIGN Prospective study. SETTING Single tertiary care hospital. PATIENTS Twenty patients undergoing cardiac surgery, including right atriotomy. METHODS Measurements of the tricuspid valve annular diameter during ventricular diastole (TVADd) and of TR jet dimensions, obtained from 3 different transesophageal and 1 transgastric echocardiographic window, were compared with each other and with that measured by the surgeon during cardiopulmonary bypass. Data were compared using correlation statistics, bias analysis, and analysis of variance for repeated measures. RESULTS TVAD measured by the surgeon both agreed and correlated best with TVADd measured from the transgastric right ventricular inflow/outflow window (r = 0.98; mean bias 0.04 cm). The proximal TR jet widths and TR jet lengths were larger when measured from midesophageal 4-chamber and midesophageal right ventricular inflow/outflow windows compared with other windows (p < 0.01). CONCLUSION TVADd was more accurately measured from transgastric windows, whereas the measurements of the TR jet were greater from esophageal windows. These data support imaging from multiple windows to obtain a more comprehensive assessment of the tricuspid valve anatomy and function.

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