# Echocardiography in the Diagnosis and Management of Tricuspid Atresia
###### Abstract  
This review focuses on the utility of echocardiographic studies in the diagnosis of tricuspid atresia (TA) and in its management. Tricuspid atresia is a cyanotic congenital heart defect (CHD) accounting for nearly 1.5% of all CHDs. It is generally classified according to the morphology of the atretic tricuspid valve and associated heart defects. Following the description of the anatomic features of TA, echocardiographic features characteristic for TA were illustrated. Subsequent to a review of palliative and corrective procedures to treat TA, echocardiographic evaluation at each stage of Fontan was detailed. The role of echocardiography in the assessment of cardiac defects responsible for interstage mortality was also addressed. It was concluded that echo-Doppler studies are useful in the diagnosis and management of TA. e chocardiography; Doppler; tricuspid atresia; patent foramen ovale; ventricular septal defect; pulmonary stenosis; transposition of the great arteries; coarctation of the aorta; Blalock-Taussig shunt; pulmonary artery banding; bidirectional Glenn; Fontan; interstage mortality +
Footnote †: journal: Applied Sciences  
**Citation:** [PERSON] Echocardiography in the Diagnosis and Management of Tricuspid Atresia. _Appl. Sci._**2021**, _11_, 94/22. [[https://doi.org/10.3390/app11209472](https://doi.org/10.3390/app11209472)]([https://doi.org/10.3390/app11209472](https://doi.org/10.3390/app11209472))  
Academic Editor: [PERSON]  
Received: 4 September 2021  
Accepted: 8 October 2021  
Published: 12 October 2021  
**Publicher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. **Published:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The right atrium (RA) is enlarged and the atretic tricuspid valve is seen as a dimple or a localized fibrous thickening in the floor of the right atrium at the anticipated site of the tricuspid valve [10]. An inter-atrial defect is necessary for survival and is typically a stretched patent foramen oval (PFO). However, occasionally, an ostium secundum atrial septal defect (ASD) or an ostium primary ASD may be present, facilitating right to left shunt. The left atrium (LA) is enlarged, especially when the pulmonary blood flow is increased. The mitral  
Figure 1: Diagrammatic portrayal of anatomic types of tricuspid atresia based on the morphology of the atretic tricuspid valve. (**A**) muscular type, (**B**) membranous type, (**C**) valvular type, (**D**) Ebstein’s type, (**E**) atrioventricular canal type, and (**F**) unguarded valve with muscular shelf. The prevalence of each type is shown under each diagram. For the sake of simplicity, the great vessels are not shown. Also note that no ventricular septal defects are shown. LA, left atrium; LV, left ventricle; RA, right atrium; RV right ventricle. Modified from [PERSON], [PERSON]. _Neonatology Today_ 2012;7(5):1–12 [11]. Figure 2: Classification of Tricuspid Atresia. Reproduced from [12]. valve is usually bicuspid and, morphologically, a mitral valve. However, its orifice is large and occasionally incompetent. The left ventricle (LV) is evidently a morphological LV, but it is enlarged and hypertrophied. The right ventricle (RV) is hypoplastic and is not sufficiently large in size to support pulmonary circulation in most patients. The ventricular septum is intact in a rare patient, but, usually, a ventricular septal defect (VSD) is present; this may be large or small, or multiple VSDs may be seen. The VSD may be: concurrent or perimembranous, located inferior to the septal band; a conal septal malalignment type, located in between the anterosuperior and posteroinferor limbs of the septal band; muscular, located inferiorly in the muscular septum; or, rarely, of an atrioventricular canal type.