Tricuspid stenosis echocardiography

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

Overview

Transthoracic echocardiography (TTE) should be performed in a patient with suspected tricuspid stenois to confirm the diagnosis, determine the etiology, and establish the baseline severity. Echocardiography is useful for the assessment of the function of the right ventricle prior to surgery.

Echocardiography

2D-Echocardiography

2D-echocardiography is useful to identify the following:

  • Thickening of valve leaflets
  • Calcification
  • restricted mobility
  • " Doming " of the leaflets

Doppler Echocardiography

Doppler echocardiography is useful to assess the severity of tricuspid stenosis through the evaluation of the transvalvular gradient.

  • Using continuous wave doppler across the tricuspid valve in apical-4-chamber view, the peak gradient can be calculated using the modified Bernoulli equation.
  • Pressure half time can be used but is not validated for triscuspid stenosis.
  • Calculation of tricuspid valve area with the continuity equation

Tricuspid valve area = ( annulus PW Vti * Cross sectional area of the annulus) / valve CW Vti

Assessment of Tricuspid Stenosis Severity with Echocardiography

TTE findings that are associated with increased severity of tricuspid stenosis include:

  • Valve thickening and calcification
  • Chordal thickening and calcification
  • Mean pressure gradient >5 mm Hg,
  • Pressure half-time >190 milliseconds
  • Tricuspid valve area < 1.0 cm2
  • Enlargement of the right atrium
  • Enlargement of the inferior vena cava
Severity of tricuspid stenosis
Severity mild moderate severe
Tricuspid valve area - - <1
Mean Pressure Gradient <4 4-7 >7

Differential Diagnosis of a Tricuspid Mass Causing Obstruction

  • Right atrial tumor
  • Right atrial ball valve thrombus
  • Large vegetations

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary[1]

Class I
"1. TTE is indicated in patients with TS to assess the anatomy of the valve complex, evaluate severity of stenosis, and characterize any associated regurgitation and/or left-sided valve disease. (Level of Evidence: C)"

References

  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. doi:10.1161/CIR.0000000000000029. PMID 24589852.

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