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A systematic method for using 3D echocardiography to evaluate tricuspid valve insufficiency in hypoplastic left heart syndrome


1 Department of Pediatrics, University of Utah School of Medicine; Primary Children's Hospital, Provo, Utah, USA
2 Department of Surgery, Univeristy of Utah School of Medicine; Primary Children's Hospital, Provo, Utah, USA
3 Brigham Young Univeristy, Provo, Utah, USA

Correspondence Address:
Christopher Robin Mart
University of Utah - Primary Children's Medical Center, 100 North Mario Capecchi Drive,
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.140842

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Year : 2014  |  Volume : 7  |  Issue : 3  |  Page : 193-200

 

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With surgical palliation of hypoplastic left heart syndrome (HLHS), the tricuspid valve (TV) becomes the systemic atrioventricular valve and moderate/severe TV insufficiency (TVI), an adverse risk factor for survival to Fontan, has been reported in up to 35% of patients prior to stage I palliation. Precise echocardiographic identification of the mechanism of TVI cannot be determined by two-dimensional echocardiography. Three-dimensional echocardiography (3DE) can provide significant insight into the mechanisms of TVI. It is the intent of this report to propose a systematic method on how to evaluate and display 3DE images of the TV in HLHS which has not been done previously. TV anatomy, function, and the known mechanisms of insufficiency are reviewed. We defined three regions of the TV (anterior, posterior, septal) that can help define valve "leaflets" that incorporates the many variations of TV anatomy. To determine how the surgeon views the TV, a picture of a pathologic specimen of the TV was placed on a computer screen and rotated until it was oriented as it appears during surgery, the "surgeons view." We have proposed a systematic method for evaluating and displaying the TV using 3DE which can provide significant insight into the mechanisms causing TVI in HLHS. This has the potential to improve both the surgical approach to repairing the valve and, ultimately, patient outcomes.






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1 Department of Pediatrics, University of Utah School of Medicine; Primary Children's Hospital, Provo, Utah, USA
2 Department of Surgery, Univeristy of Utah School of Medicine; Primary Children's Hospital, Provo, Utah, USA
3 Brigham Young Univeristy, Provo, Utah, USA

Correspondence Address:
Christopher Robin Mart
University of Utah - Primary Children's Medical Center, 100 North Mario Capecchi Drive,
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.140842

Rights and Permissions

With surgical palliation of hypoplastic left heart syndrome (HLHS), the tricuspid valve (TV) becomes the systemic atrioventricular valve and moderate/severe TV insufficiency (TVI), an adverse risk factor for survival to Fontan, has been reported in up to 35% of patients prior to stage I palliation. Precise echocardiographic identification of the mechanism of TVI cannot be determined by two-dimensional echocardiography. Three-dimensional echocardiography (3DE) can provide significant insight into the mechanisms of TVI. It is the intent of this report to propose a systematic method on how to evaluate and display 3DE images of the TV in HLHS which has not been done previously. TV anatomy, function, and the known mechanisms of insufficiency are reviewed. We defined three regions of the TV (anterior, posterior, septal) that can help define valve "leaflets" that incorporates the many variations of TV anatomy. To determine how the surgeon views the TV, a picture of a pathologic specimen of the TV was placed on a computer screen and rotated until it was oriented as it appears during surgery, the "surgeons view." We have proposed a systematic method for evaluating and displaying the TV using 3DE which can provide significant insight into the mechanisms causing TVI in HLHS. This has the potential to improve both the surgical approach to repairing the valve and, ultimately, patient outcomes.






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