TV Disease & Congenital Defects

What is the most common cause of tricuspid stenosis?

Rheumatic disease

What is rheumatic tricuspid stenosis?

Narrowing of TV that is characterized by thickening of leaflet tips and restricted mobility with diastolic doming due to inflammation

What is carcinoid tricuspid stenosis?

Narrowing of TV that is characterized as entire leaflet thickening due to carcinoid tumor in GI tract or pancreas

What are symptoms of tricuspid stenosis?

1. Dyspnea or SOB

2. Palpitations

3. IJV distension due to backup of blood flow in SVC

What is the sonographic appearance of tricuspid stenosis?

1. Increased PHT

2. Mean gradient > 2 mmHg

3. TVA < 1 cm²

4. RA and IVC dilation

5. Decreased RV size

6. Increased E wave velocity > 1 m/sec

Identify this image.

Tricuspid stenosis

How is vena contracta performed for TR?

1. Performed in PLAX or PSAX

2. Zoom on valve

3. DECREASE COLOR SCALE TO 50-60 cm/sec

4. Measure smallest jet diameter

How is PISA performed for TR?

1. Performed in A4C

2. Zoom on valve

3. DECREASE COLOR BASELINE 30-40 cm/sec (aliasing velocity)

4. Measure color shell above leaflet tips

What is the most common form of physiologic regurgitation?

TR

What is primary or degenerative TR?

TR due to defect in valve or apparatus

What is the most common cause of primary TR?

Myxomatous degeneration

What is the sonographic appearance of primary or degenerative TR?

1. Eccentric color jet

2. Associations: Congenital anomalies, TVP, leaflet thickening, endocarditis

What is secondary or functional TR?

TR due to complication of another abnormality

What is the most common cause of secondary or functional TR?

Pulmonary HTN

What is the sonographic appearance of secondary or functional TR?

1. Central color jet

2. Associations: Dilated RA or RV, CHF, pulmonary HTN, AFIB

What is the sonographic appearance of severe TR?

1. Jet area: > 10 cm²

2. Vena contracta: > 0.7 cm

3. PISA: > 0.9 cm

4. Systolic flow reversal in HV

5. Dilated RA and IVC

6. Triangular spectral contour

   * Increased severity upon inspiration

Identify this image.

TR

Identify this image.

Abnormal HV flow due to severe TR

What is tricuspid valve prolapse (TVP)?

When anterior or septal TV leaflet is displaced into RA during systole

What congenital conditions are associated with TVP?

1. Marfan syndrome

2. Ostium secundum defect

3. Ebstein anomaly

Identify this image.

TVP

What is a flail tricuspid leaflet?

When TV leaflet is dyskinetic due to ruptured papillary muscle or chest trauma

What is tricuspid atresia?

Absence of TV

What is the sonographic appearance of tricuspid atresia?

1. Echogenic plate-like structure between RA and RV

2. Small RV

3. Dilated RA

4. VSD and PFO present