Tricuspid regurgitation echocardiography: Difference between revisions

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==Overview==
==Overview==
[[Transthoracic echocardiography]] ([[TTE]]) should be performed in a patient with suspected tricuspid regurgitation 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.
[[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==
[[Transthoracic echocardiograpahy]] (TTE) is the diagnostic modality of choice to evaluate tricuspid regurgitation. TEE allows the evaluation of the following:<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= 129 | issue= 23 | pages= 2440-92 | 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>
Echocardiography is the method of choice for the non-invasive detection and evaluation of the severity and etiology of valvular regurgitation. Echocardiography allows the evaluation of the following:<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= 129 | issue= 23 | pages= 2440-92 | 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>
* [[Right ventricle]] structure and function
* [[Right ventricle]] structure and function
* [[Right atrium]] structure and function
* [[Right atrium]] structure and function
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** Tricuspid valve leaflet tethering area
** Tricuspid valve leaflet tethering area
** Tricuspid regurgitation jet velocity signal
** Tricuspid regurgitation jet velocity signal
When TTE is non diagnostic, [[transesophageal echocardiography]] ([[TEE]]) may be performed.  However, TEE is not provide an optimal way to assess the [[tricuspid valve]].<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= 129 | issue= 23 | pages= 2440-92 | 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>==
==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="LightGreen"|<nowiki>"</nowiki>'''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. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
| bgcolor="lightgreen" |<nowiki>"</nowiki>'''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. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|-
|-
|}
|}
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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.  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="lemonchiffon" |<nowiki>"</nowiki>'''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.  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
|}
|}
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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="LightGreen"|<nowiki>"</nowiki>'''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. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
| bgcolor="lightgreen" |<nowiki>"</nowiki>'''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. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])<nowiki>"</nowiki>
|}
|}


Revision as of 15:41, 13 December 2016

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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) 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 is the method of choice for the non-invasive detection and evaluation of the severity and etiology of valvular regurgitation. Echocardiography allows the evaluation of the following:[1]

  • Right ventricle structure and function
  • Right atrium structure and function
  • Inferior vena cava
  • The structure and function of the left chambers of the heart
  • The structures of the tricuspid valve and the underlying etiology of mitral regurgitation
  • Pulmonary artery pressure
  • Pressures in the heart chambers
  • The severity of the tricuspid regurgitation through the measurement of:
    • The trucuspid annular diameter in the apical 4-chamber view
    • Tricuspid valve leaflet tethering height
    • Tricuspid valve leaflet tethering area
    • Tricuspid regurgitation jet velocity signal

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

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)[2]

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 [2]

References

  1. ↑ 1.0 1.1 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.
  2. ↑ 2.0 2.1 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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