Extract

An 81-year-old hypertensive female was admitted for exertional dyspnoea. An echocardiogram revealed a dilated aorta (40 mm at sinus level, 51 mm at tubular level) and an ‘idiopathic’ moderate–severe tricuspid regurgitation (TR) with normal biventricular size and function and pulmonary pressures (see Supplementary data online, Videos S1 and S2). Transthoracic three-dimensional echocardiography (3DE) revealed a compression of right atrium (RA) by dilated aorta with a marked deformation of tricuspid annulus (TA) and no structural abnormality of tricuspid leaflets (see Supplementary data online, Videos S3 and S4). Quantitative 3DE analysis revealed a small TA area (5.6 cm2) and highly elliptical TA shape (47 × 13 mm). TA maximal diameter by 3DE was 2.5-fold larger than the RV-focused four-chamber diameter (19 mm) by two-dimensional echocardiography (2DE). 3D angio-CT confirmed the ascending aorta aneurysm, and the RA and TA compression by the dilated aortic root (Panels A–F). The patient was scheduled for close follow-up. !!...!!

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