is the tricuspid valve annulus saddle shape?

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Fawzy H. , Errett L.

University of Toronto, Toronto, Canada;

PURPOSE: Many surgeons consider the tricuspid valve annulus (TA) to be a saddle shape similar to that of the mitral valve, whereas the actual tricuspid valve annulus may have a multiplanar 3-dimensional (3D) shape. The purpose of this study was therefore to study the 3D geometry of the tricuspid valve annulus during the cardiac cycle in healthy subjects. METHODS: This study was conducted on 150 healthy volunteers 92 males (61%) with the mean age of 28 ± 9 years. They had real-time 3D echocardiography with a Sonos live-3D Echo (Philips Medical system, Andover, Mass). Using Tomtec transformer software, tricuspid valve annulus delineation was mapped by placing 6 points along the annulus and it was traced during the cardiac cycle. RESULTS: The tricuspid area was greatest at the end of diastole (10.8 ± 2.0 cm2) and decreased in systole (7.3 ± 1.5 cm2). Spherecity index was lower in diastole (120 ± 20 %) and higher in systole (140 ± 30%). The height of each tricuspid valve annulus point was defined as the distance between this point and the tricuspid valve annulus best-fit plane normalized by the tricuspid valve annulus area. The shape of the tricuspid valve annulus was a Multi-planar- 3D shape with its highest point at the anteroseptal commissure and its lowest point at the posteroseptal commissure, and the anteroposterior commissure was in a middle plane in between. CONCLUSIONS: The shape of the tricuspid valve annulusis not a saddle shape. It has a multiplanar 3D shape that is continuously changing during the cardiac cycle. The optimal tricuspid annuloplasty ring should be a multiplanar 3D one that mimics the normal anatomic shape of the tricuspid valve annulus.

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