Tricuspid regurgitation echocardiography

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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.[1]

Echocardiography

Echocardiography with Doppler 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:[2]

  • 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[2]

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)[3]


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 [3]

References

  1. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA; et al. (2003). "Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography". J Am Soc Echocardiogr. 16 (7): 777–802. doi:10.1016/S0894-7317(03)00335-3. PMID 12835667 PMID: 12835667 Check |pmid= value (help).
  2. 2.0 2.1 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.
  3. 3.0 3.1 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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