It allows the simultaneous visualization of all the three leaflets moving during the cardiac cycle, Brefeldin A leaflet coaptation and separation of the commissures from both the atrial and ventricular perspective (Fig. 15). Furthermore, tricuspid annulus has been shown to have a complex

3D shape: 3DE is the unique method to provide a reliable assessment of actual annulus size and morphology,94) pivotal to plan surgical management in functional regurgitation.95) Tricuspidal stenosis Leaflet thickness, extent of commissural fusion and area planimetry can be readly obtained in rheumatic disease.96-98) Tricuspidal regurgitation When a “pathologic” tricuspid regurgitation is Inhibitors,research,lifescience,medical detected at color Doppler, a complete understanding of leaflet morphology

and of the pathophysiological mechanisms underlying tricuspid regurgitation is mandatory to properly address management. In these cases, a comprehensive assessment Inhibitors,research,lifescience,medical of the morphology of tricuspid valve apparatus using transthoracic 3DE provides important clues on the underlying aetiology and mechanisms of valve dysfunction.94),98-100) Vena contracta and regurgitant orifice area measurements by color Inhibitors,research,lifescience,medical 3DE have been reported to provide a reliable quantification of the severity of tricuspid regurgitation.101) Tricuspid valve Advantages of 3DE: 3DE offers direct visualization of the valve apparatus Inhibitors,research,lifescience,medical and of all 3 leaflets in a single view, which is pivotal to understanding the underlying aetiology and mechanisms of valve dysfunction 3DE provides new opportunities

for improving the quantitative assessment of valve disease severity (tricuspid valve stenosis and regurgitation, isolated or associated) Reliable quantitative assessment of tricuspid annuls size and morphology is possible by semi-automated 3DE softwares 3DE is the most accurate ultrasound method for the quantitation of volumes and function of right heart chambers Limitations Inhibitors,research,lifescience,medical of 3DE: Suboptimal acoustic window renders transthoracic acquisitions of tricuspid valve difficult or at times impossible to interpret Pulmonary valve disease Despite its potential utility, there is no current evidence supporting the routine use of 3DE for pulmonary valve disease assessment.102),103) Prosthetic valves Transoesophageal 3DE is the method of choice for an accurate diagnosis of and prosthetic valve function. Transoesophageal 3DE enhanced the assessment of prosthetic valves and related complications, such as leaking, dehiscence and endocarditis complications. 3D color Doppler flow mapping is able to qualitatively visualize the size and shape of valvular and paravalvular regurgitations, as well as the underlying pathology, enabling exact definition of jet origin and size which are useful to plan management.