title: Comparison of 2-Dimensional, 3-Dimensional, and Surgical Measurements of the Tricuspid Annulus Size: Clinical Implications.
abstract: BACKGROUND
  Associated tricuspid annuloplasty is recommended during left-heart valve surgery when the tricuspid annulus (TA) is dilated but methodology for the measurement of TA size and thresholds for TA enlargement are not clearly defined.
  
  
  RESULTS
  Measurement of the TA diameter (TAD) was prospectively performed using 2-dimensional transthoracic echocardiography (2D-TTE) in 282 patients in 4 different views (parasternal long axis, parasternal short axis, apical 4-chamber [A4C], and subcostal). TAD was also measured using 3D-transesophageal echocardiography in 183 patients (long axis), peroperatively in 120 patients who underwent a tricuspid valve surgery and using TTE (A4C) in 66 healthy volunteers. TAD was significantly different between the 4 2D-TTE views (3.85±0.58, 3.87±0.61, 4.02±0.69, and 3.92±0.65 cm, respectively; P<0.0001) but differences were small and the A4C was the most feasible (76%, 65%, 92%, and 73%, respectively; P<0.0001) and offered the highest reproducibility. TAD measured in A4C view was smaller than when measured by 3D-transesophageal echocardiography (3.90±0.63 versus 4.33±0.62 cm; P<0.0001) but correlation was excellent (r=0.84; P<0.0001) with a systematic 4-mm underestimation. In contrast, 2D-TTE measurements were significantly smaller and only modestly correlated to surgical measurements (4.11±0.61 versus 4.37±0.75 cm; P<0.0001; r=0.57; P<0.0001) which were poorly reproducible. In healthy volunteers, we suggested 42 mm or 23 mm/m(2) as pathological values for the TAD in A4C.
  
  
  CONCLUSIONS
  Measurements of the TAD using 2D-TTE in A4C were highly feasible and reproducible and despite being systematically smaller than 3D measurements, accurately reflected the degree of TA enlargement as assessed using 3D transesophageal echocardiography. We proposed the thresholds that may be used in future prospective studies to demonstrate whether a preventive strategy would improve the outcome.
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).
authors.forename: Julien
authors.initials: J
authors.lastname: Dreyfus
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).
authors.forename: Guillaume
authors.initials: G
authors.lastname: Durand-Viel
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).
authors.forename: Richard
authors.initials: R
authors.lastname: Raffoul
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).
authors.forename: Soleiman
authors.initials: S
authors.lastname: Alkhoder
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).
authors.forename: Ulrik
authors.initials: U
authors.lastname: Hvass
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).
authors.forename: Costin
authors.initials: C
authors.lastname: Radu
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).
authors.forename: Nawwar
authors.initials: N
authors.lastname: Al-Attar
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).
authors.forename: Walid
authors.initials: W
authors.lastname: Ghodbhane
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).
authors.forename: David
authors.initials: D
authors.lastname: Attias
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.).
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.affiliation: From the Department of Cardiology (J.D., G.D.-V., D.A., A.V., D.M.-Z.) and Department of Cardiac Surgery (R.R., S.A., U.H., C.R., N.A.-A., W.G., P.N.), AP-HP, Bichat Hospital, Paris, France; and INSERM U1148, Bichat Hospital and University Paris 7, Paris, France (P.N., A.V., D.M.-Z.). david.messika-zeitoun@bch.aphp.fr.
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
mesh_terms: D000328:Adult; D000368:Aged; D058385:Cardiac Valve Annuloplasty; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: echocardiography, three-dimensional; mitral valve; tricuspid annulus; tricuspid valve; valve surgery