Tricuspid stenosis echocardiography
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Tricuspid stenosis Microchapters |
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Tricuspid stenosis echocardiography On the Web |
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American Roentgen Ray Society Images of Tricuspid stenosis echocardiography |
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Risk calculators and risk factors for Tricuspid stenosis echocardiography |
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
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:[1]
Tricuspid valve area = ( annulus PW Vti * Cross sectional area of the annulus) / valve CW Vti
Assessment of Tricuspid Stenosis Severity with Echocardiography
The main finding of tricuspid stenosis is an elevation in transvalvular velocity. Other TTE findings of tricuspid stenosis include:
- Valve thickening and calcification
- Chordal thickening and calcification
- Decreased mobility
- Immobility of the leaflets (suggestive of carcinoid syndrome)
- Tumors or metastatic lesions
- Valvular vegetations (suggestive of infective endocarditis)
TTE findings that are associated with increased severity of tricuspid stenosis include:
- 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 | 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[2]
| 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
- ↑ Fawzy ME, Mercer EN, Dunn B, al-Amri M, Andaya W (1989). "Doppler echocardiography in the evaluation of tricuspid stenosis". Eur Heart J. 10 (11): 985–90. PMID 2591399.
- ↑ 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.