Tricuspid valve

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Functional means the valve is normal but has

TR

What can you find in 2d m-mode of TR dilated:

TV Annulus IVC greater 1.7cm with lack of respiratory collapse Hepatic Vein Coronary Sinus SVC

What are leaflets in carcinoid disease look like?

TV leaflets are thick and rigid with no change in position from diastole to systole.

What are the 2D echo findings with TS?

Thickened Tricuspid Valve Leaflets with restricted motion. Diastolic doming of the Tricuspid Valve with commissural fusion. Right Atrial Dilatation. Dilated IVC, Hepatic Veins. Leftward protrusion of the Interatrial Septum. Pulmonary Hypertension due to coexisting MV disease.

M-mode echocardiography of TS

Thickened leaflets Decreased E-F slope of the anterior TV leaflet. Anterior motion of the Posterior TV leaflet. IN RVIT Mode

Tricuspid is larger and thinner than Mitral valve?

True

What are differential diagnosis of dilated RV with paradoxical Septal Motion that causes RV volume overload:

ASD Partial Anomalous Pulmonary Venous return Pressure overload due to Pulmonic Valve Disease Pulmonary Hypertension due either to left-sided heart disease or intrinsic lung disease D-shaped LV will be throughout Systole and Diastole (pressure overload)

What are 2D and M-Mode echo evaluation of TR

Anatomic basis for the presence of Tricuspid Regurgitation Right Atrial Dilatation Right Ventricular Dilatation Right Ventricular Volume overload pattern Globular Right Ventricle which may form the cardiac Apex Dilated M-Mode: RV volume Overload Pattern

Which Leaflets is most common followed by Septal and Posterior Leaflet Prolapse?

Anterior Leaflet Prolapse

What is the second most common disease for TS?

Carcinoid disease

Secondary TS

Due to a RA clot or tumor dropping down into the TV during diastole Vegetations Systemic Lupus Erythematosus Prosthetic Valve Dysfucntion Intracardiac wires/ pacemakers that obstruct the TV flow

The pressure Half Time is obtained by measuring the Deceleration Slope from _to_ on the peak TS waveforms.

E-F

Anatomic basis for the presence of TR

Ebstein's Anomaly Carcinoid TV Vegetation Ruptured Chordae Tendinae

Murmur of Tricuspid Regurgitation

Holosystolic murmur Increases in intensity with inspiration

What is RAP indicated by?

IVC

What does decreased E-F slope of Tricuspid Inflow Doppler tracing tell you?

Indicates increased deceleration time and an increased pressure half-time

What TV prolapse associated with?

MVP

Where is TV Prolapse common in?

Marfan's syndrome, Secundum ASD, and Ebstein's Anomaly

Which typically valves are associated with heart disease prior to the TV?

Mitral and Aortic Valve

What equals RVSP?

PAP ( pulmonary artery pressure)

How do you measure area of TV?

Pressure Half Time (PHT)

What is most common functional cause of TR due to left heart failure?

Pulmonary Hypertension

other causes of functionally TR

Pulmonary hypertension Mitral stenosis Mitral Regurgitation LV systolic/diastolic dysfunction Congenital lesions RV infarction RT Heart Pathology Constrictive Pericarditis

What is RV volume Overload Pattern:

RV Dilatation D-shpaed LV during ventricualr diastole (volume overload) Paradoxial Septal motion which is an abnormal septal motion characterized on M-mode recording by posterior motion of the septum in diastole which is volume overload and anterior motion of the septum

Which views do we see TR severity in?

RVIT AP4C VIEW PSAX of aortic view

carcinoid DIsease in RVIT

RVIT in systole showing thickened, immobile and retracted Anterior and Posterior Leaflets of TV

Anatomic casue of TR (primary, abnormal TV apparatus)

Rheumatic Heart Disease Infective Endocarditis latrogenic (pace wire, prosthetic valve) Ebstein's anomaly Marfan's Syndrome Carcinoid Heart disease Trauma Cardiac Transplantation TV Prolapse Systemic Lupus Erythematous (SLE)

What is the first affect from TR?

Right Atrial Dilatation

What equals RVSP in absence of RVOT obstruction?

SPAP (systolic pulmonary artery pressure)

Rheumatic Tricuspid Stenosis

With thickened valve leaflets and RA Enlargement in the A4C view

tricuspid murmur

a diastolic murmur that varies with respiration and has an opening snap

Ebstein's anomaly of the tricuspid valve

abnormal displacement of the septal leaflet of the tricuspid valve toward the apex of the right ventricle; the right ventricle above this leaflet becomes the "atrialized" chamber

tricuspid stenosis

abnormal narrowing of the opening of the tricuspid valve/ to obstruction o the TV that impedes diastolic blood flow traveling from the RA through the TV, into the TV

What are three leaflets of tricuspid valve?

anterior, posterior, septal

Where is annulus of Tricuspid Valve closer to?

apex of heart

Carcinoid tumor

are slow growing tumors than can arise in several places in the body, mostly GIT( Gastrointenstial tract).

What is considered stenosis in TV?

below 2cm^2

What is moderate regurgitation jet flow?

between 5 and 10 cm^2 of the RA

Where is the tricuspid valve located?

between right atrium and right ventricle

Where is Tricuspid prolapse of leaflets are at?

beyond tv Annulus

What is PHTN?

degree of Pulmonary Hypertension by the RVSP/PAP METHOD

when does volume overload happen during septal motion?

diastole

What is severe regurgitation jet flow?

fills more than 10cm^2 of an enlarged RA

What is mild MPG for TS?

less than 2mmHg

What is Severe valve area?

less then 2cm^2

What is mild jet area?

less then 5cm^2

What is TV Prolaspe associated with?

mild, late systolic TR

What is Severe Jet area?

more than 10 cm^2

What can pressure overload of the RA lead to:

peripheral edema and reduced cardiac output

What does velocity indicate?

pulmonary Hypertension is higher, you can have Mild TR with Severe Pulmonary Hypertension

what does the intensity of CW signals relative to the antegrade flow signal intensity related to?

regurgitant severity

variation with right side is due to

respiration

What is most common cause of TS?

rheumatic heart disease (90%)

What is RAP?

right atrial pressure

How much is mild regurgitation characterized by ?

small systolic to the valve closure plane )jet area of less then 5 cm^2

Severe Tricuspid Regurgitation results in ___________

systolic flow reversal in the IVC and SVC

What anatomic, primary means:

the main reason is in the Valve

How many leaflets does the tricuspid valve have?

three

Carcinoid heart disease (2 main findings)

tricuspid regurgitation, pulmonic stenosis

What do we check for TS?

we must check the other valves fro Rheumatic involvement

TR can be evaluated with color Doppler Imaging to determine the TR jet___________

width, depth and intensity

Is Hepatic flow reversal an indication of severe TR?

yes

What is Normal RVSP/PAP in degree of PHTN?

18-30 mmHg

What is formula for TVA?

190P1/2T (msec)

How many views do you need to diagnose the patient for TV prolapse?

2

What is moderate MPG for TS?

2 to 5 mmHg

What is Normal Right atrial pressure?

2-8 mmHg

Color flow doppler will demonstrate a diastolic jet which is characterized as_____

laminar aliased flow or candle flame-shaped with a mosaic center

What is RAP for IVC greater than 1.7 cm with no inspiratory collapse?

20mmHg which is severe

Mild PHTN RVSP/SPAP

30-40 mmHg

How do you estimatie Right Ventricular Systolic Pressure (RVSP)

4(v)^2+RAP

Moderate PHTN RVSP/SPAP

40-70 mmHg

What is Moderate JET area?

5 to 10cm^2

What is RAP for IVC greater than 1.7 cm and collapses greater than 50% with inspiration?

5mmHg

Normal TV orifice

7-9 cm^2

What is Normal valve area?

7-9 cm^2

how much percentage of patient have trace-to-mild TR?

93%

Severe PHTN RVSP/SPAP

> 70 mmHg

What is RAP for IVC less than 1.7 cm and collapses greater than 50% with inspiration?

15mmHg

Normal TV velocity

0.3-0.7 m/s

What is RAP for IVC greater than 1.7 cm and collapses less than 50% with inspiration?

10mmHg

Tricuspid regurgitation

Backflow of blood through incompetent tricuspid valve into RA during systole

The brighter and more filled in, the higher the_____

intensity of the TR

What is Severe MPG for TS?

greater than 6mmHg

When does pressure overload happen during septal motion?

in systole and diastole

What does Dilated Hepatic Veins with a dilated IVC suggest?

increased RAP

Doppler evaluation of TS

increased Tricuspid Valve E velocity recorded at the TV Leaflet tips (greater 1.0m/s)


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