BACKGROUND Evaluation of the tricuspid annulus is crucial for the decision making at the time of left heart surgery. Current recommendations for tricuspid valve repair are based on two-dimensional (2D) transthoracic echocardiography (TTE), despite the known underestimation compared with three-dimensional (3D) echocardiography. However, little is known about the differences in 3D tricuspid annular (TA) sizing using TTE versus transesophageal echocardiography (TEE). The aims of this study were to (1) compare 2D and 3D TA measurements performed with both TTE and TEE and (2) compare two 3D methods for TA measurements: multiplanar reconstruction (MPR) and dedicated software (DS) designed to take into account TA nonplanarity. METHODS Seventy patients underwent 2D and 3D TTE and TEE. Two-dimensional images were used to measure TA diameter from apical four-chamber, right ventricular-focused (TTE), and midesophageal four-chamber (TEE) views. Three-dimensional full-volume data sets were analyzed using both MPR and DS, to obtain major and minor axes, perimeter, and area. Intertechnique agreement was assessed using Bland-Altman analysis. RESULTS Measurements on 2D TTE and TEE, which were view dependent, underestimated TA major dimensions in all views compared with 3D values, irrespective of the 3D method. MPR and DS measurements were significantly different, with DS resulting in larger values for all parameters, irrespective of approach. No differences were found between 3D TTE and 3D TEE for both MPR and DS. CONCLUSIONS Our findings highlight the need for methodology that respects the 3D geometry of the tricuspid annulus, including its nonplanarity, which cannot be accurately assessed from 2D images and is not equally taken into account by different 3D measurement methodologies. Accordingly, a 3D cutoff value for TA enlargement needs to be established and is likely to be larger than the guideline-recommended 2D-based 40-mm cutoff. Importantly, noninvasive 3D TTE can be used instead of 3D TEE because TA measurements are not different.

中文翻译：

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三尖瓣环的超声心动图评估：第三维度和测量方法的影响。

背景技术三尖瓣环的评估对于左心脏手术时的决策至关重要。尽管与三维（3D）超声心动图相比，已知的低估了评估，但目前三尖瓣修复的建议是基于二维（2D）经胸超声心动图（TTE）。但是，对于使用TTE与经食管超声心动图（TEE）进行3D三尖瓣环形（TA）尺寸调整的差异知之甚少。这项研究的目的是（1）比较用TTE和TEE进行的2D和3D TA测量，以及（2）比较两种3D TA测量方法：多平面重建（MPR）和专用软件（DS），旨在考虑TA非平面性。方法70例患者接受了2D和3D TTE和TEE。二维图像用于从心尖四腔，右心室聚焦（TTE）和食管中四腔（TEE）的角度测量TA直径。使用MPR和DS对三维全量数据集进行了分析，以获得长轴和短轴，周长和面积。使用Bland-Altman分析评估了技术间的协议。结果对2D TTE和TEE的测量是依赖于视图的，与3D值相比，无论使用3D方法如何，所有视图中的TA主要尺寸都被低估了。MPR和DS的测量值显着不同，而DS导致所有参数的值均较大，而与方法无关。对于MPR和DS，在3D TTE和3D TEE之间没有发现差异。结论我们的研究结果突显了需要尊重三尖瓣环3D几何形状的方法的必要性，包括其非平面性，无法从2D图像中准确评估它，并且不同的3D测量方法也未将其平均考虑在内。因此，需要建立用于TA放大的3D截止值，并且该值可能会大于准则推荐的基于2D的40 mm截止值。重要的是，可以使用无创3D TTE代替3D TEE，因为TA测量没有区别。