Tricuspid stenosis echocardiography: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Tricuspid stenosis}} | {{Tricuspid stenosis}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{Rim}} | ||
==Overview== | ==Overview== | ||
[[Transthoracic echocardiography]] ([[TTE]]) should be performed | [[Transthoracic echocardiography]] ([[TTE]]) should be performed among patients with suspected tricuspid stenosis (TS) to confirm the diagnosis, determine the etiology, and establish the baseline severity. TTE commonly reveals other findings such as [[tricuspid regurgitation]] and/or [[mitral stenosis]]. TS is mainly characterized by an elevated transvalvular gradient.<ref name="pmid19065003">{{cite journal| author=Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP et al.| title=Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. | journal=Eur J Echocardiogr | year= 2009 | volume= 10 | issue= 1 | pages= 1-25 | pmid=19065003 | doi=10.1093/ejechocard/jen303 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19065003 }} </ref> | ||
==Echocardiography== | ==Echocardiography== | ||
=== | TTE is performed among patients with suspected TS to confirm the diagnosis and to determine the anatomic and hemodynamic characteristics of the [[tricuspid valve]]. TTE allows the evaluation of the following:<ref name="pmid19065003">{{cite journal| author=Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP et al.| title=Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. | journal=Eur J Echocardiogr | year= 2009 | volume= 10 | issue= 1 | pages= 1-25 | pmid=19065003 | doi=10.1093/ejechocard/jen303 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19065003 }} </ref> | ||
* [[Tricuspid valve]] thickening and calcification | |||
* | * Chordal thickening and calcification | ||
* | * Decreased mobility | ||
* | * Immobility of the leaflets (suggestive of [[carcinoid syndrome]]) | ||
* " | * [[Tumor]]s or [[metastatic lesions]] | ||
* Valvular vegetations (suggestive of [[infective endocarditis]]) | |||
* Right atrial ball valve [[thrombus]] | |||
[[Doppler echocardiography]] is useful to assess the severity of TS through the evaluation of the transvalvular gradient. TS is mainly characterized by an elevated transvalvular gradient.<ref name="pmid19065003">{{cite journal| author=Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP et al.| title=Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. | journal=Eur J Echocardiogr | year= 2009 | volume= 10 | issue= 1 | pages= 1-25 | pmid=19065003 | doi=10.1093/ejechocard/jen303 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19065003 }} </ref> Using continuous wave doppler across the [[tricuspid valve]], the peak gradient can be calculated using the modified [[Bernoulli equation]]. Pressure half time can be used but is not validated for TS. The assessment of the [[tricuspid valve]] area is limited by the common association of TS with [[tricuspid regurgitation]]. The coexistence of tricuspid regurgitation causes the underestimation of the tricuspid valvular area. A tricuspid valve area < 1.0 cm<sup>2</sup> is associated with increased severity of the TS. The tricuspid valve area can be calculated using the [[continuity equation]]:<ref name="pmid2591399">{{cite journal| author=Fawzy ME, Mercer EN, Dunn B, al-Amri M, Andaya W| title=Doppler echocardiography in the evaluation of tricuspid stenosis. | journal=Eur Heart J | year= 1989 | volume= 10 | issue= 11 | pages= 985-90 | pmid=2591399 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2591399 }} </ref> | |||
Tricuspid valve area = ( annulus PW Vti * Cross sectional area of the annulus) / valve CW Vti | Tricuspid valve area = ( annulus PW Vti * Cross sectional area of the annulus) / valve CW Vti | ||
=== | === Findings Associated with Increased Severity=== | ||
TTE findings that are associated with increased severity of tricuspid stenosis include: | TTE findings that are associated with increased severity of tricuspid stenosis include:<ref name="pmid19065003">{{cite journal| author=Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP et al.| title=Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. | journal=Eur J Echocardiogr | year= 2009 | volume= 10 | issue= 1 | pages= 1-25 | pmid=19065003 | doi=10.1093/ejechocard/jen303 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19065003 }} </ref> | ||
* Mean pressure gradient >5 mm Hg, | * Mean pressure gradient >5 mm Hg, | ||
* Pressure half-time >190 milliseconds | * Pressure half-time >190 milliseconds | ||
* Tricuspid valve area < 1.0 cm2 | * Tricuspid valve area < 1.0 cm2 | ||
* Enlargement of the right atrium | * Enlargement of the [[right atrium]] | ||
* Enlargement of the inferior vena cava | * Enlargement of the [[inferior vena cava]] | ||
==2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary<ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=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. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }} </ref>== | ==2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary<ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=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. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }} </ref>== | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor=" | | bgcolor="lightgreen" |<nowiki>"</nowiki>'''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. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki> | ||
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Latest revision as of 19:22, 12 December 2016
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Tricuspid stenosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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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]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
Transthoracic echocardiography (TTE) should be performed among patients with suspected tricuspid stenosis (TS) to confirm the diagnosis, determine the etiology, and establish the baseline severity. TTE commonly reveals other findings such as tricuspid regurgitation and/or mitral stenosis. TS is mainly characterized by an elevated transvalvular gradient.[1]
Echocardiography
TTE is performed among patients with suspected TS to confirm the diagnosis and to determine the anatomic and hemodynamic characteristics of the tricuspid valve. TTE allows the evaluation of the following:[1]
- Tricuspid 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)
- Right atrial ball valve thrombus
Doppler echocardiography is useful to assess the severity of TS through the evaluation of the transvalvular gradient. TS is mainly characterized by an elevated transvalvular gradient.[1] Using continuous wave doppler across the tricuspid valve, the peak gradient can be calculated using the modified Bernoulli equation. Pressure half time can be used but is not validated for TS. The assessment of the tricuspid valve area is limited by the common association of TS with tricuspid regurgitation. The coexistence of tricuspid regurgitation causes the underestimation of the tricuspid valvular area. A tricuspid valve area < 1.0 cm2 is associated with increased severity of the TS. The tricuspid valve area can be calculated using the continuity equation:[2]
Tricuspid valve area = ( annulus PW Vti * Cross sectional area of the annulus) / valve CW Vti
Findings Associated with Increased Severity
TTE findings that are associated with increased severity of tricuspid stenosis include:[1]
- 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
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary[3]
| 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
- ↑ 1.0 1.1 1.2 1.3 Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP; et al. (2009). "Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice". Eur J Echocardiogr. 10 (1): 1–25. doi:10.1093/ejechocard/jen303. PMID 19065003.
- ↑ 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.