Tricuspid stenosis echocardiography and ultrasound

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Echocardiography is the gold standard test for the diagnosis of tricuspid stenosis. Findings on an echocardiography diagnostic of tricuspid stenosis include tricuspid peak inflow velocity and degree of thickening of tricuspid valve leaflets.

Echocardiography

Transthoracic echocardiography is the gold standard test for the diagnosis of tricuspid stenosis.

The following result of echocardiography is confirmatory of tricuspid stenosis:^[1]^[2]^[3]^[4]^[5]
- Peak inflow velocity:
  - During inspiration > 1 m/s
- Inflow time-velocity
  - More than 60 cm
- The degree of thickening of tricuspid valve leaflets
- Calcification of tricuspid valve leaflets
- Limited leaflet mobility of tricuspid valve leaflets
- Reduced separation of the tricuspid valve leaflet tips
- Diastolic doming of the tricuspid valve
- Echocardiography gives the degree of fusion of the commissures and chordae tendineae of the tricuspid valve

Tricuspid stenosis in echocardiography. 2D and color Doppler images in a patient with antiphospholipid antibody syndrome shows thickening of the valve leaflets (*arrow*) and continuous-wave Doppler with a mean pressure gradient of 11 mmHg, which is consistent with severe tricuspid stenosis. Case courtesy by Soham Shah et al^[6]

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[7]

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines^[7]

Class I
1.In patients with TR, TTE is indicated to evaluate the presence and severity of TR, determine the etiology, measure the sizes of the 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-LD)

References

↑ Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Evangelista, Arturo; Griffin, Brian P.; Iung, Bernard; Otto, Catherine M.; Pellikka, Patricia A.; Quiñones, Miguel (2009). “Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice”. Journal of the American Society of Echocardiography. 22 (1): 1–23. doi:10.1016/j.echo.2008.11.029. ISSN 0894-7317.
↑ Finnegan, P; Abrams, L D (1973). “Isolated tricuspid stenosis”. Heart. 35 (11): 1207–1210. doi:10.1136/hrt.35.11.1207. ISSN 1355-6037.
↑ Morgan, Jacob R.; Forker, Alan D.; Coates, J. R.; Myers, W. S. (1971). “Isolated Tricuspid Stenosis”. Circulation. 44 (4): 729–732. doi:10.1161/01.CIR.44.4.729. ISSN 0009-7322.
↑ Baumgartner, H.; Hung, J.; Bermejo, J.; Chambers, J. B.; Evangelista, A.; Griffin, B. P.; Iung, B.; Otto, C. M.; Pellikka, P. A.; Quinones, M. (2009). “Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice”. European Journal of Echocardiography. 10 (1): 1–25. doi:10.1093/ejechocard/jen303. ISSN 1525-2167.
↑ Lang, Roberto M.; Bierig, Michelle; Devereux, Richard B.; Flachskampf, Frank A.; Foster, Elyse; Pellikka, Patricia A.; Picard, Michael H.; Roman, Mary J.; Seward, James; Shanewise, Jack S.; Solomon, Scott D.; Spencer, Kirk T.; St John Sutton, Martin; Stewart, William J. (2005). “Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology”. Journal of the American Society of Echocardiography. 18 (12): 1440–1463. doi:10.1016/j.echo.2005.10.005. ISSN 0894-7317.
↑ “Multimodal imaging of the tricuspid valve: normal appearance and pathological entities”.
↑ Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F; et al. (2021). “2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”. Circulation. 143 (5): e72–e227. doi:10.1161/CIR.0000000000000923. PMID 33332150 Check |pmid= value (help).

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[BaumgartnerHung2009-1] Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Evangelista, Arturo; Griffin, Brian P.; Iung, Bernard; Otto, Catherine M.; Pellikka, Patricia A.; Quiñones, Miguel (2009). “Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice”. Journal of the American Society of Echocardiography. 22 (1): 1–23. doi:10.1016/j.echo.2008.11.029. ISSN 0894-7317.

[FinneganAbrams1973-2] Finnegan, P; Abrams, L D (1973). “Isolated tricuspid stenosis”. Heart. 35 (11): 1207–1210. doi:10.1136/hrt.35.11.1207. ISSN 1355-6037.

[MorganForker1971-3] Morgan, Jacob R.; Forker, Alan D.; Coates, J. R.; Myers, W. S. (1971). “Isolated Tricuspid Stenosis”. Circulation. 44 (4): 729–732. doi:10.1161/01.CIR.44.4.729. ISSN 0009-7322.

[BaumgartnerHung20092-4] Baumgartner, H.; Hung, J.; Bermejo, J.; Chambers, J. B.; Evangelista, A.; Griffin, B. P.; Iung, B.; Otto, C. M.; Pellikka, P. A.; Quinones, M. (2009). “Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice”. European Journal of Echocardiography. 10 (1): 1–25. doi:10.1093/ejechocard/jen303. ISSN 1525-2167.

[LangBierig2005-5] Lang, Roberto M.; Bierig, Michelle; Devereux, Richard B.; Flachskampf, Frank A.; Foster, Elyse; Pellikka, Patricia A.; Picard, Michael H.; Roman, Mary J.; Seward, James; Shanewise, Jack S.; Solomon, Scott D.; Spencer, Kirk T.; St John Sutton, Martin; Stewart, William J. (2005). “Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology”. Journal of the American Society of Echocardiography. 18 (12): 1440–1463. doi:10.1016/j.echo.2005.10.005. ISSN 0894-7317.

[6] “Multimodal imaging of the tricuspid valve: normal appearance and pathological entities”.

[pmid33332150-7] Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F; et al. (2021). “2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”. Circulation. 143 (5): e72–e227. doi:10.1161/CIR.0000000000000923. PMID 33332150 Check |pmid= value (help).

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