1/⚡️How to assess tricuspid valve by TOE #echofirst?
➡️What's the role of X-plane?
➡️How to get the best 3D image?
➡️Tips and tricks about transgastric view
➡️What we need to know about pacemaker lead
Take a look this thread 🧵
@NMerke @iamritu @hahn_rt @denisamuraru @lpbadano
2/
Usually 3 leaflets, but is not rare to find different morphologies (2 or 4 leafleats)
ANTERIOR➡️largest and longest in radial direction, most mobile
SEPTAL➡️shortest in radial directios and less mobile
POSTERIOR➡️often many scallops, shortest circumferentially
3/
Start with ME TOE 4Ch view
Attached to IVS ➡️ SEPTAL
The other one near free wall ➡️ ANTERIOR
⚠️(Sometimes with probe in retroflextion position we can see the posterior one)
4/
Let's move to the RV inflow-outflow view (ME 45°,slightly advancing the probe).
Close to the aorta➡️ANTERIOR
The other one➡️ POSTERIOR
5/
According to previous view (RV outflow-inflow) we should imagine a line which scan the valve from anteroseptal commissure up to posteroseptal commissure
6/
⚠️Pay attention now- The importance of X-plane in the imaging of intercommissural view.
➡️Place the cursor next to the aorta, the orthogonal view shows the ANTEROSEPTAL commissure
➡️Moving the cursor to the posterior leaflet, the orthogonal view will show the POSTEROSEPT comm.
7/
How to get the best 3D TOE TV imaging?
Let's advance the probe to the distal esophagus, near the gastroesophageal junction. In order to help yourself check the coronary sinus ostium. In this position no left atrium in near field and better view of TV
8/
Finally a 3D image of tricuspid valve👇
Now try to orient the valve in the surgical view as the first pic of the thread
9/
Transgastric view should be mandatory to get. Training training and still training.
➡️Advancing the probe into the stomach and rotating approximately 20°–60° - try to anteflex!
10/
Pacemaker lead👇
✅Describe exactly the position (inside which commissure is located)
✅Describe any interference with normal leaflet motion
✅TG view and 3D are mandatory to define the anatomy
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