title: Comprehensive Two-Dimensional Interrogation of the Tricuspid Valve Using Knowledge Derived from Three-Dimensional Echocardiography.
abstract: BACKGROUND
  Accurate identification of tricuspid valve (TV) leaflets by two-dimensional (2D) transthoracic echocardiography is difficult because of variability in the intersection between the imaging plane and leaflets. Using information obtained from multiplanar reconstruction (MPR) of three-dimensional (3D) data sets, the investigators sought to define "novel" 2D views that would allow targeted interrogation of TV leaflets using 2D transthoracic echocardiography.
  
  
  METHODS
  Images of the TV in the standard 2D views (apical four chamber, right ventricular focused, right ventricular inflow, and parasternal short axis) and 3D data sets were acquired from the same probe position in 106 adults. Three-dimensional MPR was used to determine which leaflet combination was seen in the 2D image: anterior and septal, anterior and posterior, anterior alone, or posterior and septal. Using this analysis, 2D landmarks were identified to define nonstandard TV views tailored to depict specific leaflets. Two-dimensional images in these views and 3D data sets were then prospectively collected in 54 additional patients. Three independent readers analyzed these 2D views to determine TV leaflet combinations, and their interpretation was compared with 3D MPR-derived reference.
  
  
  RESULTS
  Three-dimensional MPR views made it possible to define six nonstandard 2D views on the basis of anatomic clues and landmarks, which consistently depicted all the aforementioned leaflet combinations. When these six views were prospectively tested, the agreement of TV leaflet identification against 3D MPR was excellent (κ = 0.88, κ = 0.93, and κ = 0.98).
  
  
  CONCLUSIONS
  The nonstandard 2D views defined in this study allow accurate TV leaflet identification and may thus be useful when localization of TV leaflet pathology is clinically important.
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois. Electronic address: kaddetia@medicine.bsd.uchicago.edu.
authors.forename: Karima
authors.initials: K
authors.lastname: Addetia
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Megan
authors.initials: M
authors.lastname: Yamat
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Anuj
authors.initials: A
authors.lastname: Mediratta
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Diego
authors.initials: D
authors.lastname: Medvedofsky
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Mita
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Preston
authors.initials: P
authors.lastname: Ferrara
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Victor
authors.initials: V
authors.lastname: Mor-Avi
authors.affiliation: Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
mesh_terms: D004452:Echocardiography / Q000379:methods; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging*
keywords: Echocardiography; Leaflets; Multiplanar reconstruction; Tricuspid valve