Tricuspid regurgitation stages: Difference between revisions

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==Stages==
==Stages==
{|
{|
| Stage || Definition || Anatomy of the valve || Hemodynamics of the valve || Hemodynamic changes || Symptoms
| '''Stage''' || '''Definition''' || '''Anatomy of the valve''' || '''Hemodynamics of the valve''' || '''Hemodynamic changes''' || '''Symptoms'''
|-
|-
| A || At risk || Primary TR <br>
| A || At risk || ''Primary''<br>
* Mild rheumatic change
* Mild [[rheumatic]] change
* Mild prolapse
* Mild prolapse
* Findings related to other conditions (IE, carcinoid, radiation)
* Findings related to other conditions ([[IE]], [[carcinoid]], [[radiation]])
* Presnece of an intra-annular RV pacemaker or ICD lead
* Presence of an intra-annular RV [[pacemaker]] or [[ICD]] lead
* Cardiac transplant (biopsy related)
* Cardiac [[transplant]] (biopsy related)
Secondary TR <br>
''Secondary'' <br>
* No abnomrla findings
* No abnormal findings
* Beginning of annular dilation
* Beginning of annular dilation
| Absent
| Absent
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| Absent
| Absent
|-
|-
| B || Progressive || Primary
| B || Progressive || ''Primary''
* Progressive leaflet deterioration/destruction
* Progressive leaflet deterioration/destruction
* Moderate-to-severe prolapse and limited chordal rupture
* Moderate-to-severe prolapse and limited chordal rupture
Secondary
''Secondary''
* Beginning of annular dilation
* Beginning of annular dilation
* Moderate leaflet tethering  
* Moderate leaflet tethering  
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* Undefined width of vena contracta
* Undefined width of vena contracta
* Soft and parabolic CW jet density and contour
* Soft and parabolic CW jet density and contour
* Systolic dominance of hepatic vein flow
* [[Systolic]] dominance of [[hepatic vein]] flow
Moderate TR
Moderate TR
* Central jet area 5–10 cm2
* Central jet area 5–10 cm2
* Undefined width of vena contracta width but <0.70 cm
* Undefined width of vena contracta width but <0.70 cm
* Dense, variable CW jet density and contour
* Dense, variable CW jet density and contour
* Systolic blunting of hepatic vein flow
* [[Systolic]] blunting of hepatic vein flow
| Mild TR
| Mild TR
* Normal size of RV/RA/IVC
* Normal size of RV/RA/IVC
Moderate TR
Moderate TR
* Absence of RV enlargement
* Absence of RV enlargement
* Absent or mild RA enlargement
* Absent or mild [[RA]] enlargement
* Absent or mild IVC enlargement with normal respirophasic variation
* Absent or mild [[IVC]] enlargement with normal respirophasic variation
* Normal RA pressure
* Normal RA pressure
| None
| None
|-
|-
| C || Asymptomatic severe || Primary
| C || Asymptomatic severe || ''Primary''
* Flail or grossly distorted leaflets
* Flail or grossly distorted leaflets
Secondary
''Secondary''
* Severe annular dilation (>40 mm or 21 mm/m2)
* Severe annular dilation (>40 mm or 21 mm/m2)
* Marked leaflet tethering
* Marked leaflet tethering
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* Vena contracta width >0.7 cm
* Vena contracta width >0.7 cm
* Dense, triangular CW jet density and contour with early peak
* Dense, triangular CW jet density and contour with early peak
* Systolic reversal in hepatic vein flow
* [[Systolic]] reversal in hepatic vein flow
|* Dilated RV/RA/IVC and decreased IVC respirophasic variation
|* Dilated RV/RA/IVC and decreased [[IVC]] respirophasic variation
* Increased RA pressure with “c-V” wave
* Increased RA pressure with “c-V” wave
* Possible diastolic interventricular septal flattening
* Possible diastolic interventricular [[septal]] flattening
| None
| None
|-
|-
| D || Symptomatic severe || Primary
| D || Symptomatic severe || ''Primary''
* Flail or grossly distorted leaflets
* Flail or grossly distorted leaflets
Secondary
''Secondary''
* Severe annular dilation (>40 mm or 21 mm/m2)
* Severe annular dilation (>40 mm or 21 mm/m2)
* Marked leaflet tethering
* Marked leaflet tethering
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* Dense, triangular CW jet density and contour with early peak
* Dense, triangular CW jet density and contour with early peak
* Systolic reversal in hepatic vein flow
* Systolic reversal in hepatic vein flow
|* Dilated RV/RA/IVC and decreased IVC respirophasic variation
|* Dilated RV/RA/IVC and decreased [[IVC]] respirophasic variation
* Increased RA pressure with “c-V” wave
* Increased RA pressure with “c-V” wave
* Possible diastolic interventricular septal flattening
* Possible diastolic interventricular septal flattening
| Presence of symptoms (fatigue, dyspnea, anorexia, edema, abdominal distention, palpitations)
| Presence of symptoms ([[atigue]], [[dyspnea]], [[anorexia]], [[edema]], [[abdominal distention]], [[palpitations]])
|-
|-
|}
|}

Revision as of 13:58, 12 September 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Stages

Stage Definition Anatomy of the valve Hemodynamics of the valve Hemodynamic changes Symptoms
A At risk Primary

Secondary

  • No abnormal findings
  • Beginning of annular dilation
Absent Absent Absent
B Progressive Primary
  • Progressive leaflet deterioration/destruction
  • Moderate-to-severe prolapse and limited chordal rupture

Secondary

  • Beginning of annular dilation
  • Moderate leaflet tethering
Mild TR
  • Central jet area <5.0 cm2
  • Undefined width of vena contracta
  • Soft and parabolic CW jet density and contour
  • Systolic dominance of hepatic vein flow

Moderate TR

  • Central jet area 5–10 cm2
  • Undefined width of vena contracta width but <0.70 cm
  • Dense, variable CW jet density and contour
  • Systolic blunting of hepatic vein flow
Mild TR
  • Normal size of RV/RA/IVC

Moderate TR

  • Absence of RV enlargement
  • Absent or mild RA enlargement
  • Absent or mild IVC enlargement with normal respirophasic variation
  • Normal RA pressure
None
C Asymptomatic severe Primary
  • Flail or grossly distorted leaflets

Secondary

  • Severe annular dilation (>40 mm or 21 mm/m2)
  • Marked leaflet tethering
* Central jet area >10.0 cm2
  • Vena contracta width >0.7 cm
  • Dense, triangular CW jet density and contour with early peak
  • Systolic reversal in hepatic vein flow
* Dilated RV/RA/IVC and decreased IVC respirophasic variation
  • Increased RA pressure with “c-V” wave
  • Possible diastolic interventricular septal flattening
None
D Symptomatic severe Primary
  • Flail or grossly distorted leaflets

Secondary

  • Severe annular dilation (>40 mm or 21 mm/m2)
  • Marked leaflet tethering
* Central jet area >10.0 cm2
  • Vena contracta width >0.7 cm
  • Dense, triangular CW jet density and contour with early peak
  • Systolic reversal in hepatic vein flow
* Dilated RV/RA/IVC and decreased IVC respirophasic variation
  • Increased RA pressure with “c-V” wave
  • Possible diastolic interventricular septal flattening
Presence of symptoms (atigue, dyspnea, anorexia, edema, abdominal distention, palpitations)

References

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