The Normal Tricuspid Valve

The interest of both cardiologists (echocardiographers and interventional cardiologists) and cardiac surgeons about the tricuspid valve has been fueled by the association of better understanding of the role of tricuspid regurgitation as an independent determinant of patients’ morbidity and mortality, and the advent of novel transcatheter devices to treat severe tricuspid regurgitation in high surgical risk patients. However, conventional two-dimensional echocardiography is unsuitable to study the anatomy and the pathophysiological mechanisms of the regurgitant tricuspid valve because of the complex three-dimensional geometry of the valve and its anterior position in the mediastinum (just behind the sternum). Three-dimensional echocardiography has emerged as a very cost-effective imaging modality to: (1) Assess the anatomy of the tricuspid valve; (2) Measure the size/ geometry of the tricuspid annulus; (3) Identify the mechanism of tricuspid regurgitation; (4) analyze the anatomic relationships between the tricuspid valve apparatus and the surrounding cardiac structures; (5) Measure the volumes and function of the right atrium and right ventricle. This chapter will describe the normal anatomy of the tricuspid valve apparatus and how to use three-dimensional echocardiography to acquire, display and perform quantitative analyses of the tricuspid valve using both transthoracic and transesophageal approaches.