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INTRODUCTION

The tricuspid valve (TV) is affected by a wide variety of pathological entities, ranging from congenital abnormalities to neoplasms. Their impact also varies widely, from the characteristic stenosis and regurgitation to the subtler carcinoid tumors and fibroelastomas. Because of the clinically asymptomatic pattern, TV abnormalities have generally received less attention than the abnormalities on the left side.1 However, various studies have shown that TV diseases have a significant impact on morbidity and mortality. A detailed transesophageal echocardiographic (TEE) examination of the right-sided heart valves can provide accurate diagnosis of valvular diseases; define anatomical, functional, and perivalvular abnormalities; and guide appropriate management. Integration of this information with the evaluation of the cardiac chambers is necessary to assess the degree of the pathology and determine its impact on cardiac function. In a review of 1,918 cases undergoing intraoperative TEE prior to cardiac surgery, discrepant findings at the time of surgical inspection were present in only 48 patients, of which 5 involved the tricuspid and pulmonic valves.2 Therefore, this modality should yield adequate diagnostic accuracy when the exam is conducted appropriately. This chapter discusses the main pathologies involving the tricuspid and pulmonic valves leading to regurgitation and/or stenosis and their assessment by two-dimensional TEE (Table 12-1). Even with the advent of three-dimensional matrix array probes allowing the acquisition of real-time images, optimal visualization of the tricuspid and pulmonary valves is seldom feasible3; therefore, their three-dimensional evaluation will depend on future improvements of this technology.

Table 12–1.Conditions causing tricuspid and pulmonic valve dysfunction

TRICUSPID VALVE

Relevant Anatomical Landmarks

The TV is the most caudally located and has the largest orifice of all four cardiac valves (4 to 6 cm2). The three leaflets of the TV are named anterior, posterior (inferior), and septal (medial) based on their relative positions (Fig. 12-1). The septal leaflet's insertion point at the septum is more apically displaced than that of the anterior mitral leaflet. The two major papillary muscles, the anterior and posterior, are located on the corresponding walls of the right ventricle. These papillary muscles are characterized by being more numerous, smaller, and more widely separated than those on the left side of ...

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