Tricuspid stenosis echocardiography: Difference between revisions
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==Overview== | ==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 | [[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== | ==Echocardiography== | ||
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=== Assessment of Tricuspid Stenosis Severity with Echocardiography === | === Assessment of Tricuspid Stenosis Severity with Echocardiography === | ||
TTE findings | TTE findings of tricuspid stenosis include: | ||
* Valve thickening and calcification | * Valve thickening and calcification | ||
* Chordal 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, | * Mean pressure gradient >5 mm Hg, | ||
* Pressure half-time >190 milliseconds | * Pressure half-time >190 milliseconds | ||
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* Enlargement of the right atrium | * Enlargement of the right atrium | ||
* Enlargement of the inferior vena cava | * Enlargement of the inferior vena cava | ||
One looks for valve thickening and/or calcification, restricted mobility with diastolic doming, reduced leaflet separation at peak opening, and right atrial enlargement (Figure 11).89 In carcinoid syndrome, one sees severe immobility of the leaflets, described as a ‘frozen’ appearance (Figure 12). Echocardiography also allows for the detection of valve obstruction by atrial tumours, metastatic lesions, or giant vegetations. Three-dimensional echocardiography can provide better anatomical detail of the relation of the three leaflets to each other and assessment of the orifice area.90 Using colour flow Doppler one can appreciate narrowing of the diastolic inflow jet, higher velocities that produce mosaic colour dispersion, and associated valve regurgitation. | |||
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Revision as of 21:39, 17 September 2014
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Tricuspid stenosis Microchapters |
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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]
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
Tricuspid valve area = ( annulus PW Vti * Cross sectional area of the annulus) / valve CW Vti
Assessment of Tricuspid Stenosis Severity with Echocardiography
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
One looks for valve thickening and/or calcification, restricted mobility with diastolic doming, reduced leaflet separation at peak opening, and right atrial enlargement (Figure 11).89 In carcinoid syndrome, one sees severe immobility of the leaflets, described as a ‘frozen’ appearance (Figure 12). Echocardiography also allows for the detection of valve obstruction by atrial tumours, metastatic lesions, or giant vegetations. Three-dimensional echocardiography can provide better anatomical detail of the relation of the three leaflets to each other and assessment of the orifice area.90 Using colour flow Doppler one can appreciate narrowing of the diastolic inflow jet, higher velocities that produce mosaic colour dispersion, and associated valve regurgitation.
| 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
- ↑ 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.