Unusual echocardiographic views of bicuspid and tricuspid pulmonic valves

Spectrum of pulmonary valve morphology and its relationship to pulmonary trunk in tetralogy of Fallot

BACKGROUND

Tetralogy of Fallot (TOF) is a complex congenital heart disease with anatomic variations. Although the pulmonary valve in TOF is abnormal, it has not been studied well, especially on newer imaging modalities such as multidetector computed tomography (CT), which gives excellent anatomic detail.

AIMS

The aim of this study was to assess the morphology of pulmonary valve in TOF on CT and evaluate its association with the degree of hypoplasia of infundibulum and pulmonary trunk.

MATERIALS AND METHODS

The cardiac CT scans of 30 patients with TOF were reviewed to evaluate the morphology of the pulmonary valve, infundibulum, and pulmonary arteries. Fisher's exact test was performed to examine the association between pulmonary valve morphology and degree of hypoplasia of the infundibulum and pulmonary trunk.

RESULTS

16.7% of patients with TOF had pulmonary atresia. The prevalence of tricuspid, bicuspid, and absent valves were 10%, 53.3% and 6.7%, respectively. In another 13.3% of patients, although valve tissue was present, exact morphology could not be determined on CT. The commissures of 62.5% of the bicuspid valves were at 12 o'clock and 6 o'clock or slightly off the midline. There was statistically significant association between valve morphology and degree of infundibular hypoplasia (P < 0.001) and calibre of pulmonary trunk (P < 0.001).

CONCLUSION

Morphological abnormality of the pulmonary valve is common in TOF. The most common type of pulmonary valve in TOF patients is bicuspid valve with commissures at 12 o'clock and 6 o'clock or slightly off the midline. Fewer cusps of the pulmonary valve are associated with a more severe degree of pulmonary artery hypoplasia.

Echocardiographic two-dimensional view of the pulmonary valve in infants: the high transsternal view

Neonates and small infants have unique characteristics that make it possible to obtain echocardiographic views that are inaccessible in older patients. A high transsternal approach through the cartilaginous sternum and the thymus gland allows visualisation of a short-axis view of the pulmonary valve. This view should be included as part of routine protocols for echocardiographic examinations performed in this age group.

Dual-Source Computed Tomography Evaluation of Children with Congenital Pulmonary Valve Stenosis

BACKGROUND

Despite dual-source computed tomography (DSCT) technology has been performed well on adults or infants with heart disease, specific knowledge about children with congenital pulmonary valve stenosis (PS) remained to be established.

OBJECTIVES

This original research aimed to establish a professional approach of DSCT performing technology on children and to assess the image quality performed by DSCT to establish a diagnostic evaluation for children with PS.

PATIENTS AND METHODS

Ninety-eight children with congenital PS referred to affiliated hospital of Jining medical college were recruited from October 2013 to March 2015. Participants were divided into four groups according to different ages (0 - 1, 1 - 3, 3 - 7, 7 - 14), or three groups according to different heart rates (< 90, 90 - 110, > 110). Image quality of pulmonary valves was assessed based on a four-point grading scale (1 - 4 points). Those cases achieving a score of ≥ 3 points were selected for further investigation, which played a critical role in our analysis. Correlation analysis was used to identify the effects of age and heart rate on image quality. Additionally, the results evaluated by DSCT were compared with those evaluated from the operation, further confirming the accuracy of DSCT.

RESULTS

Seventy-two cases (73.4%) achieved a score of ≥ 3 points based on pulmonary valve imaging, which were available for further diagnosis. There was a statistically significant difference (P < 0.05) between the four groups except 0 - 1 group and 1 - 3 group, 3 - 7 group and 7 - 14 group, and the image quality of elder group was higher than younger group. Image score was gradually decreased with increased heart rate (F = 19.05, P < 0.01). Heart rate was negatively correlated with pulmonary valve scores (r = -0.391, P < 0.001), while there was no correlation between age and scores (r = 0.185, P = 0.070). The number, shape, commissure, and opening status of pulmonary valves evaluated by DSCT were the same as the results of operation.

CONCLUSION

Heart rate serves a pivotal role in imaging quality of DSCT. DSCT provides a functional evaluation of children with congenital PS and consequently contributes to a theoretical basis for corresponding treatment protocols.

CT and MRI of pulmonary valvular abnormalities

Pulmonary valve disease constitutes a wide spectrum of conditions. Traditionally, echocardiography has been the technique of choice for the evaluation of pulmonary and other valvular disease. However, with advances in technology, computed tomography (CT) and magnetic resonance imaging (MRI) are playing increasingly important roles in the evaluation of these disorders. In this article, we review the normal appearance of the pulmonary valve and then illustrate various variants and pathological entities of the pulmonary valve.

Assessment of pulmonary valve and right ventricular outflow tract with real-time three-dimensional echocardiography

AIM

Assessment of pulmonary valve (PV) and right ventricular outflow tract (RVOT) using real-time 3-dimensional echocardiography (RT3DE).

METHODS

Two-dimensional echocardiography (2DE) and RT3DE were performed in 50 patients with congenital heart disease (mean age 32 +/- 9.5 years, 60% female). Measurements were obtained at parasternal views: short axis (PSAX) at aortic valve level and long axis (PLAX) with superior tilting. RT3DE visualization was evaluated by 4-point score (1: not visualized, 2: inadequate, 3: sufficient, and 4: excellent). Diameters of PV annulus (PVAD), and RVOT (RVOTD) were measured by both 2DE and RT3DE, while areas (PVAA) and (RVOTA) by RT3DE only.

RESULTS

By RT3DE, PV was visualized sufficiently in 68% and RVOT excellently in 40%. PVAD and PVAA were measured in 88%. RVOTD and PVAD by 2DE at PLAX were significantly higher than PSAX (P < 0.0001) and lower than that by RT3DE (P < 0.001).

CONCLUSION

RT3DE helps in RVOT and PV assessment adding more details supplemental to 2DE.

A bicuspid pulmonary valve associated with tetralogy of fallot

Congenitally bicuspid pulmonary valves are uncommon. When they occur, it is usually in association with other congenital cardiac lesions, most often a tetralogy of Fallot. We present a rare case of a patient with a congenitally bicuspid pulmonary valve who had pulmonary valve and RVOT reconstruction. The patient did well for 17 years, but needed further reconstruction when the pulmonary valve started getting stenosed and RV pressures went up significantly. The pulmonary valve showed fibroses, thickening, and focal calcification.