Imaging-based tricuspid valve anatomy by computed tomography, magnetic resonance imaging, two and three-dimensional echocardiography: correlation with anatomic specimen

Abstract

Interest on tricuspid valve (TV) (and hence in TV anatomy) has increased in the last two decades with the awareness that functional tricuspid regurgitation (FTR) is an insidious disease progressively leading to untreatable right heart failure and eventually to death. Medical therapy may alleviate symptoms, while surgical therapy may improve outcome but it is associated with high mortality and recurrence of significant regurgitation. Nowadays, an increasing number of left valve diseases are successfully treated through a percutaneous transcatheter approach. The negative impact that the untreated FTR may have in these patients has highlighted the necessity of developing transcatheter solutions also for FTR and numerous catheter devices for treating FTR are currently under evaluation. The essential pre-requisite for an effective and safe surgical or transcatheter therapy is a deep knowledge of the normal TV anatomy. In this review, we describe the anatomy of TV and surrounding structures as revealed by computed tomography, cardiac magnetic resonance, 2D/3D transthoracic echocardiography, and 2D/3D transoesophageal echocardiography emphasizing strengths and weaknesses of each of these imaging tools. To confirm the anatomical fidelity of these imaging modalities, where appropriate, the non-invasive images where presented, side-by-side, with corresponding images from anatomic specimens.