title: Assessment of the tricuspid valve morphology by transthoracic real-time-3D-echocardiography.
abstract: OBJECTIVE
  To demonstrate the feasibility of transthoracic three-dimensional real-time echocardiography (3D-TTE) supplemental to routine assessments of the tricuspid valve and to analyze interrater agreement.
  
  
  METHODS
  Twenty healthy subjects and 74 patients with right ventricular failure were examined with conventional 2D and additionally 3D-TTE (SONOS 7500, Philips, Netherlands). The 3D exams were performed and recorded by one of two raters. The recordings were evaluated offline and independently by both raters for visualization of morphological and functional features of the tricuspid valve according to a subjective 3-point scale. Statistical analyses were performed for interrater agreement and for comparison of imaging quality between the two study groups. In addition, we present an illustrative case report.
  
  
  RESULTS
  Visualization of the spatial relationship between the tricuspid valve and vicinal structures, of the commissures, the orifice, and entirety of valve depiction were better in the ventricular failure group as compared to the control group. Annular dimensions were equally assessable in both groups, leaflet thickness and mobility were not significantly different. Interrater agreement on assessability was slight for leaflet thickness, fair for leaflet mobility and orifice area, and good for the remaining features. The 3D-TTE exam including offline evaluation took 6.5 minutes on average and maximally 14 minutes.
  
  
  CONCLUSIONS
  3D-TTE of the tricuspid valve can be performed in addition to routine 2D echocardiography within a reasonable time and with high assessability of important features in patients with right ventricular failure. Interrater agreement was fair to good overall. Thus, its feasibility may encourage prospective studies on its potential for more detailed noninvasive diagnosis and preoperative planning.
authors.affiliation: Second Medical Clinic, Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, Germany. Schnabelr@web.de
authors.forename: Renate
authors.initials: R
authors.lastname: Schnabel
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Khaw
authors.forename: Ralph Stephan
authors.initials: RS
authors.lastname: von Bardeleben
authors.forename: Christina
authors.initials: C
authors.lastname: Strasser
authors.forename: Thorsten
authors.initials: T
authors.lastname: Kramm
authors.forename: Jürgen
authors.initials: J
authors.lastname: Meyer
authors.forename: Susanne
authors.initials: S
authors.lastname: Mohr-Kahaly
mesh_terms: D000328:Adult; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D015588:Observer Variation; D013997:Time Factors; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging