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Images in Cardiovascular Ultrasound
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Double-orifice tricuspid valve visualized by three dimensional transthoracic echocardiography
Kikuko Obase1*, Karima Addetia2, Kazue Takahashi3, Katsunori Yamamoto3, Ai Kawamura4, Tomoko Tamada4, Koichiro Imai4, Shiro Uemura4
1Nagasaki University Cardiovascular Surgery
2Unversity of Chicago, Section of Cardiology
3Kawasaki Medical School Hospital, Central Clinical Laboratory
4Kawasaki Medical School Hospital, Department of Cardiology
Corresponding Author: Kikuko Obase ,Email: kobase@nagasaki-u.ac.jp
ABSTRACT
A 75 year-old man with atrial fibrillation was hospitalized because of shortness of breath triggered by upper respiratory infection and tachycardia. His symptoms were improved by bed rest and administration of diuretics. Pretreatment echocardiogram reported dilatation of the right ventricle (RV). Follow-up study was performed before discharge. Apical four-chamber view still demonstrated remarkable dilatation of RV (Figure1A). In one of the apical four chamber views, the tricuspid valve showed a bridge-like appearance in systole without valve opening (Figure1B, arrows, Video 1). The RV inflow view (Figure 1D-F, Video 2) revealed localized small leaflet defect at posterior septum (Figure 1D, white arrow) with the opposing leaflet tip coapting against the RV wall (yellow arrow). At the anterior side of the “bridge”, another valve orifice was observed in RV inflow view as well as parasternal short axis views (Figure 1G-I, Video 3). Color Doppler images in these views showed flow from the RV to right atrium across two orifices (Figure 1F, I), suggesting double-orifice tricuspid valve. There was no pressure gradient across both orifices in diastole. Tricuspid regurgitation jet velocity of less than 3m/s was observed from both orifices in systole. 3D transthoracic echocardiography clearly visualized double orifices (Figure 2, asterisks, Video 4) and confirmed the diagnosis.
Keywords: Double-orifice tricuspid vavle, Echocardiography, 3D
Volume 25, No 3
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