Study of tricuspid valve regurgitation by 2d and 3d echocardiography. Comparison between transthoracic and transesophageal examination for screening interventions

Aim: To compare the accuracy of 2D and 3D tricuspid valve reconstructions of TTE versus TEE for screening patients with TR who are candidates for surgical or transcatheter interventions. Methods: Consecutive 42 patients with diagnosis of symptomatic and significant TR were enrolled. Each patient underwent a 2D/3D TTE and a 2D/3D TEE on the same day. Parameters for RV dimension and function evaluation were acquired on a 2D examination from the RV focused apical window for TTE and 4 mid-esophageal chambers for TEE. 3D reconstructions were made to visualize the structures and parameters to be studied (tricuspid annulus, leaflets, annulus area, annulus perimeter, valve area). The leaflets gap was obtained from the transgastric view (for TEE) and from 3D reconstructions (for TTE). The GLIDE score (Gap, jet Location, Image quality, chordal structure Density, En-Face TR jet morphology), a simple, five-component score that can predict a successful T-TEER, was calculated for TTE and TEE. Results: TR grade, function and dimension of RV, tricuspid annulus parameters, coaptation gap and total GLIDE-score analyzed at TTE and TEE did not show any statistically difference (p > 0.05) except for the number of leaflets that were better determined by TEE instead of TTE (P < 0,001). Conclusions: TTE is an excellent initial screening tool for evaluating patients who are candidates for transcatheter repair or surgical intervention for significant TR. However, TEE provides superior visualization of the valve leaflets and should be performed in patients with favorable anatomical characteristics identified on TTE.