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Evaluation of rheumatic tricuspid valve stenosis by real-time three-dimensional echocardiography
  1. Ashraf M Anwar1,
  2. Marcel L Geleijnse2,
  3. Osama I I Soliman1,
  4. Jackie S McGhie2,
  5. Attila Nemes2,
  6. Folkert J ten Cate2
  1. 1Department of Cardiology, Al-Husein University Hospital, Al-Azhar University, Cairo, Egypt
  2. 2The Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to:
    Dr F J ten Cate
    Thoraxcenter, Room Ba 302, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; f.j.tencate{at}

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Rheumatic heart disease causes tricuspid valve stenosis in up to 8% of patients.1 Unfortunately, tricuspid valve stenosis is easily missed at clinical examination except in advanced cases when a high degree of clinical suspicion exists.2 Undetected and thus uncorrected tricuspid valve stenosis may lead to postoperative low cardiac output despite successful relief of left-sided valve disease and carries a high mortality and morbidity.3 Two-dimensional echocardiography (2DE) can detect thickened tricuspid valve leaflets and a reduced tricuspid valve orifice diameter, and continuous-wave Doppler allows estimation of the tricuspid transvalvular pressure gradient.4 However, in most patients, it is not possible to visualise all three tricuspid valve leaflets simultaneously with 2DE.5 Transthoracic real-time three-dimensional echocardiography (RT3DE) may be a valuable imaging modality for the examination of stenotic tricuspid valves because all leaflets can be seen simultaneously and studied from both atrial and ventricular aspects. This study aimed to apply RT3DE for tricuspid valve assessment in patients with rheumatic tricuspid valve stenosis.


Five patients (mean (SD) age 33 (7) years, four men) with an established diagnosis of rheumatic tricuspid valve disease were examined by 2DE (Philips Sonos 7500 with S3 probe, Best, The Netherlands) and RT3DE (same system with X4 probe). These patients were compared with eight patients …

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  • Competing interests: None declared.