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
TTE is performed among patients with suspected TS to confirm the diagnosis and to determine the anatomic and hemodynamic characteristics of the tricuspid valve. TEE allows the evaluation of the following:[1]
- 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 tricuspid stenosis through the evaluation of the transvalvular gradient. TS is mainly characterized by an increased 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 triscuspid stenosis.
The assessment of the tricuspid valve area is limited by the usual association of TS with tricuspid regurgitation. The coexistence of tricuspid regurgitation causes the underestimation of the valvular ares; nevertheless, a tricuspid valve area < 1.0 cm2 is associated with increased severity. Calculation of tricuspid valve area with 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 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.