Brief Overview of Normal RH Anatomy

Echocardiographic Imaging of the TV and RH

CMR Imaging of the TV and RH

MDCT Imaging of the TV and RH

Fluoroscopic RHAnatomy

Conclusions

References

BRIEF OVERVIEW OF NORMAL RH ANATOMY

The TV apparatus includes the 3 leaflets, the annulus, and the subvalvular apparatus (chordae tendineae, papillary muscles), and is closely linked with the right atrium (RA) and the right ventricle (RV) in the socalled “valve-ventricular complex” (۶). The TV is the largest among the 4 cardiac valves. In relation to the mitral valve (MV), the TV is located more apically (#10 mm), anteriorly, and to the right (Figure 1). The tricuspid leaflets are thinner than the mitral leaflets and therefore are more difficult to image. The TV annular plane is oriented nearly vertically and is rotated w45
from the sagittal plane (7). The TV usually has 3 leaflets assigned anatomically as the septal, anterior, and posterior which close in a trifoliate fashion (Figures 1A and 1B). The tricuspid annulus (TA) is a complex, saddle-shaped, dynamic structure (8). The nonplanar TA has higher points in the anteroseptal and posterolateral portions and lower points in anterolateral and posteroseptal portions (Figures 1 and 2). TA size and shape change significantly during the cardiac cycle. RIGHT VENTRICLE. The RV is triangular in shape and crescent-shaped when viewed in cross-section. The RV chamber is divided into 3 components: inlet, apical trabecular, and outlet. The TV separates the RV inlet from the RA. The apical component of the RV has coarser trabeculations than the left ventricle (LV) apex. The RV outlet presents a “crossover” relationship with the LV outflow tract (Figure 1B). The RV roof is formed by the crista supraventricularis (or supraventricular crest) consisting of the ventriculoinfundibular fold and the trabecula septomarginalis, which contains the right bundle branch and continues as the moderator band (Figures 1B and 1E). Because of the complex shape of the RV, the 3 components are difficult to simultaneously image in a single cross-sectional view by using 2-dimensional (2D) echocardiography (2DE). A complete anatomical overview of the RH can be found in an accompanying publication (9). INTERVENTIONAL CONSIDERATIONS.