Feasibility Study of Applying the Modified Hahn Nomenclature for Tricuspid Valve Leaflet Classification in Transthoracic Echocardiography Using the Subxiphoid Short-Axis View

Abstract

Objective

This study aims to validate the feasibility of applying an adapted version of the Hahn tricuspid valve nomenclature to classify the leaflets of the tricuspid valve in the subxiphoid short-axis view (SSAV) using transthoracic echocardiography (TTE).

Methods

Referral patients from three medical institutions underwent TTE, with the requirement that the tricuspid valve structure be clearly visible in standard views (AC4 V, PSAV, RVIT, S4CV). The tricuspid valve leaflets were classified retrospectively based on the nomenclature proposed by Hahn et al.

Results

Between June 2023 and June 2024, 600 patients' SSAV images were analyzed, with 421 cases (70.2%) successfully classified, while 179 cases (29.8%) failed to be classified. The average age of patients was 58 ± 31 years (range: 27–79 years). There were 334 males (55.7%). The mean weight was 75.7 ± 13.5 kg, and the average BMI was 23.1 ± 3.8 kg/m². Of the patients, 52.2% had mild or moderate tricuspid regurgitation (TR), 24.3% had severe TR, 22.8% had massive TR, and 2.3% had torrential TR. In the morphological classification of the tricuspid valve, type I was the most common (32.0%), followed by type IIIB (29.8%). Additionally, 179 cases (29.8%) were not successfully classified or determined.

Conclusion

SSAV, as an adjunctive imaging view in TTE for assessing the tricuspid valve, shows potential clinical value. Although there are challenges in classifying tricuspid valve leaflets, the method demonstrates certain feasibility.