Tricuspid regurgitation echocardiography

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2] Rim Halaby, M.D. [3] Fatimo Biobaku M.B.B.S [4]

Overview

Transthoracic echocardiography (TTE) is usually adequate for the evaluation of tricuspid regurgitation; to confirm the diagnosis, determine the etiology, establish the baseline severity and for the assessment of the function of the right ventricle prior to surgery. In cases of non-diagnostic transthoracic studies, transesophageal echocardiography (TEE) improves the visualization of the valvular structure and delineates the mechanism and severity of regurgitation.

Echocardiography

Echocardiography with doppler is the method of choice for the non-invasive detection and evaluation of the severity and etiology of valvular regurgitation. [1][2]Echocardiography allows the evaluation of the following:[3][4][5][6][7][8]

  • By using the modified Bernoulli equation, we can estimate pulmonary hypertension on echocardiography by measuring the right ventricle to right atrial systolic gradient from the velocity of the tricuspid regurgitation jet
Comprehensive assessment of the anatomy of functional tricuspid regurgitation by transthoracic three-dimensional echocardiography. Two-dimensional color Doppler showing severe functional tricuspid regurgitation (A). En face view of the tricuspid valve leaflets and annulus from the right atrial perspective (B). En face view of the tricuspid valve leaflets from the right ventricular perspective (C). Semi-automated quantitative analysis of tricuspid annulus size and shape, showing the relationship with the 4-chamber view plane (green line along the septal-lateral direction; D). Lateral view showing the flattening of tricuspid annulus (E). Surface rendering and quantitative analysis of tricuspid annulus and leaflets (F). A: anterior tricuspid leaflet, Ao: aorta, IVC: inferior vena cava, MV: mitral valve, P: posterior tricuspid leaflet, RVOT: right ventricular outflow tract, S: septal tricuspid leaflet. Case courtesy by Denisa Muraru[11]


https://commons.wikimedia.org/wiki/File:Severe_tricuspid_regurgitation_E00572_(CardioNetworks_ECHOpedia).jpg#/media/File:Severe_tricuspid_regurgitation_E00572_(CardioNetworks_ECHOpedia).jpg


Video demonstrating Tricuspid regurgitation on an echocardiogram

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2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary[3]

Class I
"1. TTE is indicated to evaluate severity of TR, determine etiology, measure sizes of right-sided chambers and inferior vena cava, assess RV systolic function, estimate pulmonary artery systolic pressure, and characterize any associated left-sided heart disease. (Level of Evidence: C)"
Class IIb
"1. CMR or real-time 3-dimensional echocardiography may be considered for assessment of RV systolic function and systolic and diastolic volumes in patients with severe TR (stages C and D) and suboptimal 2-dimensional echocardiograms. (Level of Evidence: C)"

==2008 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease - Evaluation of Tricuspid Valve Disease in Adolescents and Young Adults(DO NOT EDIT)[12]


Class I
"1. Doppler echocardiography is indicated for the initial evaluation of adolescent and young adult patients with TR, and serially every 1 to 3 years, depending on severity. (Level C)"

Sources

  • 2008 ACC/AHA Guidelines incorporated into the 2006 guidelines for the management of patients with valvular heart disease [12]

References

  1. Tornos Mas P, Rodríguez-Palomares JF, Antunes MJ (2015). "Secondary tricuspid valve regurgitation: a forgotten entity". Heart. 101 (22): 1840–8. doi:10.1136/heartjnl-2014-307252. PMC 4680164. PMID 26503944.
  2. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA; et al. (2003). "Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography". J Am Soc Echocardiogr. 16 (7): 777–802. doi:10.1016/S0894-7317(03)00335-3. PMID 12835667 PMID: 12835667 Check |pmid= value (help).
  3. 3.0 3.1 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 129 (23): 2440–92. doi:10.1161/CIR.0000000000000029. PMID 24589852.
  4. Chen TE, Kwon SH, Enriquez-Sarano M, Wong BF, Mankad SV (2013). "Three-dimensional color Doppler echocardiographic quantification of tricuspid regurgitation orifice area: comparison with conventional two-dimensional measures". J Am Soc Echocardiogr. 26 (10): 1143–1152. doi:10.1016/j.echo.2013.07.020. PMID 23993694.
  5. de Agustin JA, Viliani D, Vieira C, Islas F, Marcos-Alberca P, Gomez de Diego JJ; et al. (2013). "Proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography applied for tricuspid regurgitation quantification". J Am Soc Echocardiogr. 26 (9): 1063–72. doi:10.1016/j.echo.2013.06.006. PMID 23860094.
  6. Zoghbi, William A.; Adams, David; Bonow, Robert O.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A.; Hahn, Rebecca T.; Han, Yuchi; Hung, Judy; Lang, Roberto M.; Little, Stephen H.; Shah, Dipan J.; Shernan, Stanton; Thavendiranathan, Paaladinesh; Thomas, James D.; Weissman, Neil J. (2017). "Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation". Journal of the American Society of Echocardiography. 30 (4): 303–371. doi:10.1016/j.echo.2017.01.007. ISSN 0894-7317.
  7. Hahn, Rebecca T.; Thomas, James D.; Khalique, Omar K.; Cavalcante, João L.; Praz, Fabien; Zoghbi, William A. (2019). "Imaging Assessment of Tricuspid Regurgitation Severity". JACC: Cardiovascular Imaging. 12 (3): 469–490. doi:10.1016/j.jcmg.2018.07.033. ISSN 1936-878X.
  8. Hudzik B, Poloński L, Gąsior M (2016). "Lancisi sign: giant C-V waves of tricuspid regurgitation". Intern Emerg Med. 11 (8): 1139–1140. doi:10.1007/s11739-015-1384-4. PMC 5114320. PMID 26758273.
  9. Adler, Dale S. (2017). "Non-functional tricuspid valve disease". Annals of Cardiothoracic Surgery. 6 (3): 204–213. doi:10.21037/acs.2017.04.04. ISSN 2225-319X.
  10. Paranon, S.; Acar, P. (2008). "Ebstein's anomaly of the tricuspid valve: from fetus to adult". Heart. 94 (2): 237–243. doi:10.1136/hrt.2006.105262. ISSN 1355-6037.
  11. "Revisit of Functional Tricuspid Regurgitation; Current Trends in the Diagnosis and Management".
  12. 12.0 12.1 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)

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