title: Tricuspid annular geometry: a three-dimensional transesophageal echocardiographic study.
abstract: OBJECTIVE
  To demonstrate the clinical feasibility of accurately measuring tricuspid annular area by 3-dimensional (3D) transesophageal echocardiography (TEE) and to assess the geometric differences based on the presence of tricuspid regurgitation (TR). Also, the shape of the tricuspid annulus was compared with previous descriptions in the literature.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  Tertiary care university hospital.
  
  
  METHODS
  Three-dimensional TEE.
  
  
  METHODS
  Patients undergoing cardiac surgery.
  
  
  RESULTS
  Volumetric data sets from 20 patients were acquired by 3D TEE and prospectively analyzed. Comparisons in annular geometry were made between groups based on the presence of TR. The QLab (Philips Medical Systems, Andover, MA) software package was used to calculate tricuspid annular area by both linear elliptical dimensions and planimetry. Further analyses were performed in the 4D Cardio-View (TomTec Corporation GmBH, Munich, Germany) and MATLAB (Natick, MA) software environments to accurately assess annular shape. It was found that patients with greater TR had an eccentrically dilated annulus with a larger annular area. Also, the area as measured by the linear ellipse method was overestimated as compared to the planimetry method. Furthermore, the irregular saddle-shaped geometry of the tricuspid annulus was confirmed through the mathematic model developed by the authors.
  
  
  CONCLUSIONS
  Three-dimensional TEE can be used to measure the tricuspid annular area in a clinically feasible fashion, with an eccentric dilation seen in patients with TR. The tricuspid annulus shape is complex, with annular high and low points, and annular area calculation based on linear measurements significantly overestimates 3D planimetered area.
authors.affiliation: Department of Anesthesia & Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. fmahmood@bidmc.harvard.edu
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
authors.forename: Han
authors.initials: H
authors.lastname: Kim
authors.forename: Bilal
authors.initials: B
authors.lastname: Chaudary
authors.forename: Remco
authors.initials: R
authors.lastname: Bergman
authors.forename: Robina
authors.initials: R
authors.lastname: Matyal
authors.forename: Jeniffer
authors.initials: J
authors.lastname: Gerstle
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.forename: Kamal R
authors.initials: KR
authors.lastname: Khabbaz
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D006348:Cardiac Surgical Procedures; D019561:Echocardiography, Four-Dimensional; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011446:Prospective Studies; D012984:Software; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: 3-dimensional transesophageal echocardiography; cardiac surgery; right ventricle; tricuspid annuloplasty; tricuspid regurgitation; tricuspidvalve