3D TEE imaging in a patient with severe tricuspid regurgitation with
dextrocardia and tricuspid commussural prolapse
Abstract
Dextrocardia is a cardiac positional anomaly in which the heart is
located in right hemithorax with base-to-apex axis directed to the right
and caudad. A number of congenital heart defects have been reported with
dextrocardia, including VSD, PDA, ASD, TOF, pentalogy of Fallot,
infundubular PS, transposition and pseudotruncus and total anomalous
pulmonary venous return. We will share a patient with severe TR due to
tricuspid valve commissural prolapse. A 42-year-old female patient was
admitted to our clinic with the complaint of dyspnea. Transthoracic
echocardiography revealed dextrocardia and severe TR consisting of two
separate regurgitation jets. Contrast echocardiography performed due to
dilatation of the coronary sinüs, did not show persistent left superior
vena cava, and no right-to-left shunt was observed. Transesophageal
echocardiography showed a prolapse in the commissure where the tricuspid
anterior and septal leaflets meet, and a severe eccentric regurgitation
jet with an area of vena contracta 0.75cm2 in the 3D MPR was observed. A
moderate regurgitation jet was also seen from the coaptation line of all
three leaflets. Commussural prolapse and regurgitation jet revealed in
detail by 3D imaging. No significant pathology was detected in the other
valves except mild insufficiency. Right heart catheterization and
tricuspid valve surgery were planned for the patient with normal right
heart functions. Although it is known that there are many congenital
pathologies accompanying dextrocardia, we are happy to share our
experience with you as the first case to report the coexistence of
primary tricuspid valve disease and commusural prolapse with 3D detailed
imaging.