Author + information
- Received January 24, 1984
- Revision received May 22, 1984
- Accepted May 30, 1984
- Published online November 1, 1984.
- Thomas C. Gibson, MB, FACC*,1,
- Rodney A. Foale, MB, MRCP1,
- David E. Guyer, MD1 and
- Arthur E. Weyman, MD, FACC1
- ↵*Address for reprints: Thomas C. Gibson, MB, Division of Cardiology, Medical Center Hospital of Vermont, Burlington, Vermont 05401.
Incomplete closure of the tricuspid valve without apparent cusp disease was noted on two-dimensional echocardiography in 31 patients. This abnormality was defined as a failure of the tricuspid valve leaflet tips to reach the plane of the tricuspid valve anulus by at least 1 cm in the standard apical four chamber view at the point of maximal systolic closure. This resulted in a final systolic leaflet position deeper within the right ventricular cavity than is normally seen. The finding was present in the following diagnostic subgroups: Group A, pulmonary hypertension (11 patients); Group B, rheumatic heart disease (4 patients); Group C, dilated cardiomyopathy (9 patients) and Group D, previous myocardial infarction (7 patients). Right atrial, right ventricular and tricuspid anulus measurements were made and compared with those from a group of 67 normal subjects. The results were as follows: right atrial endsystolic area = 27.2 ± 8.6 cm2 (normal = 13.4 ± 2.0); right ventricular end-systolic area = 25.6 ± 8.7 cm2 (normal = 10.9 ± 2.9); right ventricular end-diastolic area = 31.5 ± 9.1 cm2 (normal = 20.1 ± 4.9) and tricuspid valve anular end-systolic dimension = 4.0 ± 0.6 cm (normal = 2.2 ± 0.3). The differences from the normal data were all statistically significant (p < 0.001).
Incomplete closure of the tricuspid valve, although a nonspecific diagnostic finding, is primarily associated with right-sided chamber enlargement. Tricuspid regurgitation may be present. The mechanism could be related to geometric changes in valve apparatus dynamics secondary to right-sided cardiac enlargement and tricuspid valve anular dilation. It is also possible that previous right ventricular infarction with wall dyskinesia may impede correct closure.
- Received January 24, 1984.
- Revision received May 22, 1984.
- Accepted May 30, 1984.
- American College of Cardiology Foundation