Next Steps in Modeling the Tricuspid Valve

In an era where cardiovascular imaging has allowed us to develop robust models of the aortic and mitral valves that guide cardiac interventions, our attention has now been drawn to the tricuspid valve. Tricuspid regurgitation (TR) is a common finding, present in many normal patients. However, moderate or worse TR is associated with a poor prognosis independent of left ventricle systolic function or the presence of pulmonary hypertension.1 See Article by Utsunomiya et al Functional TR is the result of uncoupling the right heart valvulo-ventricular complex. Although the leaflets are normal, the regurgitant orifice develops from annular dilatation (>40 mm) and valvular deformation or leaflet tenting (>8 mm).2 Patients experiencing right ventricular dilatation and dysfunction will have functional TR primarily because of tenting. Those without significant ventricular remodeling from left heart disease or pulmonary hypertension, but significant tricuspid annular dilatation as seen with atrial fibrillation, will have functional TR primarily because of annular dilatation. In this issue of Circulation: Cardiovascular Imaging , Utsunomiya et al3 were able to achieve structural differentiation of atrial fibrillation TR and left heart TR while demonstrating how 3-dimensional (3D) echocardiography can be used to model the tricuspid valve. They were …