Tricuspid valve: Once disregarded, now acknowledged

Figures

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  Fig. 1. Showing overall increase in published interest and study of both the Tricuspid Valve and Tricuspid Regurgitation over time (Data acquired using PubMed Online Database).

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  Fig. 2. The RA anterior wall has been dissected and lifted along the atrioventricular groove (Top) to show posterior and anterior wall structures (Bottom). IVC – Inferior Vena Cava, SVC – Superior Vena Cava.

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  Fig. 3. Schematic representation of the non-planar, elliptical shape and position of the Tricuspid Annulus. The normal distance between the most superior ‘points’ and the inferior ‘points’ is shown by the caliper measuring 7 mm. Arrows showing the RA – Right Atrium, RV – Right Ventricle, IVC – Inferior Vena Cava, SVC – Superior Vena Cava.

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  Fig. 4. Schematic illustration of the TV open up and flattened (Bottom) when dissected along the acute margin of the RV (Top). PPM – Posterior Papillary Muscle, SPM – Septal Papillary Muscle, APM – Anterior Papillary Muscle, C1 – Posteroseptal Commissure, C2 – Anteroseptal Commissure, C3 – Anteroposterior Commissure. Key: Basal zone – peach colour, Clear zone – white colour, Rough Zone – Peach colour with horizontal wave strokes, Muscle – Pink colour, Chordae – Yellow.

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  Fig. 5. Illustrations showing intracardiac structures in typical transthoracic echocardiography views. Parasternal Long Axis (RV Inflow view) shows Septal and Anterior leaflets; Parasternal Short Axis (AV level) shows Posterior and Septal leaflets; Apical 5 Chamber (Superior Angulation) shows Anterior and Septal leaflets; Apical 4 chamber (inferior Angulation) shows Posterior and Septal leaflets. RA – Right Atrium, RV – Right Ventricule, LA – Left Atrium, LV – Left Ventricle, AV – Aortic Valve, IVC – Inferior Vena Cava, SVC – Superior Vena Cava.

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  Fig. 6. Illustration showing Carpentier classification of TR, type I shows ‘Functional TR’, Type II, IIIa and IIIb show examples of ‘Primary TR’ using RV focused Apical 4 Chamber View in TTE.

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  Fig. 7. Illustration showing proposed novel classification of TR. Primary TR resulting from acquired or congenital pathology of the leaflet tissue. Secondary TR resulting from annular dilatation and RV remodelling. Iatrogenic TR resulting from endocardial device leads impinging leaflet mobility.

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  Fig. 8. Depicting the Tricuspid Annulus, leaflets, diaphragm and interatrial septum. The arrows show functional changes to annulus diameter in development of functional TR. Leaflets most affected are anterior and posterior. A – Anterior portion of annulus, P – Posterior portion of annulus, AL – Anterior leaflet, PL – Posterior leaflet, SL – Septal Leaflet, RA – Right Atrium, RV – Right Ventricle.