DK2985_C000 1..28 - AlSharqia Echo Club

19Pulmonic and Tricuspid ValvesFRANÇOIS MARCOTTE, DENIS BOUCHARDUniversity of Montreal, Montreal, CanadaI. Normal Tricuspid and PulmonicValve Anatomy 447II. Anatomical Manifestations ofValvular Lesions 450A. Tricuspid Regurgitation 450III. Endocarditis 455A. Vegetations 455B. Abscesses 458IV. Rheumatic Valve Disease 458A. Other Inflammatory Valvulopathies 458V. Myxoid Degeneration 459VI. Pulmonic Valve Disease 459VII. Valve Repair, Tricuspid—Indications andMethods of Repair 460A. Suture Annuloplasty, Complications,Failed Repair 462B. Annuloplasty Rings 463VIII. Valve Replacement 463A. Tricuspid Valvectomy 465B. Types of Valve Prosthesis 465References 467Transesophageal echocardiography (TEE) is onlyoccasionally requested for the primary evaluation of tricuspidand pulmonic valve disease. This is, in part,because isolated tricuspid and pulmonic valve diseasesare relatively uncommon in comparison with left-sidedvalvular heart disease. Furthermore, compared with themitral and aortic valves, these structures are more anteriorand located in the TEE far field, making their assessmentperhaps more difficult. Nevertheless, as transthoracicechocardiography (TTE) does not always allow theoptimal evaluation of the tricuspid and pulmonic valves,particularly during cardiac surgery, TEE may yield veryuseful informations complementary to TTE. IntraoperativeTEE, typically done for the assessment of mitral and aorticvalve (AoV) disease, provides a fairly accurate predictionof disease severity and pathology in .95% of cases inexperienced hands (1). A TEE examination, oblivious tothe presence of right-sided valve disease in the operatingroom, can lead to serious short- and long-term consequencesfor the patient. Right heart failure secondaryto right-sided valvulopathies can be extremely difficultto treat medically and may ultimately lead to a reducedevent-free survival (2,3).I. NORMAL TRICUSPID AND PULMONICVALVE ANATOMYSituated in the crescentic, pyramid-shaped right ventricle(RV) which supports the low-pressure pulmonary circulation,the tricuspid valve (TV) is in the right ventricularinlet chamber or sinus, while the pulmonic valve (PV) isanterior and superior to the TV in the right ventricularoutlet or conus (Fig. 19.1). Unlike the AoVs, the tricuspid447