ArticleFrontiers in cardiovascular medicine2025
Heart 3D: echocardiographic and anatomical features of the tricuspid valve in a heterogeneous population with severe regurgitation-implications for edge-to-edge procedure suitability.
Article in Frontiers in cardiovascular medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aim: To assess the incremental value of real-time three-dimensional (3D) transesophageal echocardiography (TEE) in visualizing tricuspid valve (TV) anatomy for procedural planning and guidance of transcatheter edge-to-edge repair (TEER) in cases of severe tricuspid regurgitation (TR). Materials and methods: An observational study was conducted on 54 patients with severe TR. The visualization of the TV leaflets during systole was graded semiquantitatively using predefined criteria: 0 points-no visible leaflet border or tissue; 1.25-border only; 2-border and <50% tissue; 3-border and >50% tissue. Each of the three leaflets was evaluated independently in both two-dimensional (2D) and 3D TEE, with a maximum cumulative score of 9. Two thresholds were established: ≥4.5 points as the primary endpoint for adequate visualization for TEER planning and ≥6 points as the secondary endpoint indicating sufficient quality for a detailed morphological assessment. Results: In 3D TEE, 77.8% of patients achieved the primary endpoint, and 68.5% reached the secondary threshold. In comparison, 2D TEE enabled 74.1% and 42.6% of patients to meet these respective thresholds. Although the difference in achieving the primary endpoint was not statistically significant ( Conclusion: In this observational study, real-time 3D TEE proved feasible for assessing tricuspid valve anatomy and visualization quality in patients with severe TR who were considered for TEER. Compared with 2D TEE, 3D TEE offered an improved visualization of the posterior leaflet and provided adequate image quality for procedural planning in most patients. Moreover, a statistically significant advantage was observed for 3D TEE over 2D TEE in providing image quality sufficient for a detailed morphological evaluation.
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