TRANS-ESOPHAGEAL ECHOCARDIOGRAPHY VIEWS FOR TRICUSPID VALVE IMAGING
ME Four chamber view [Figure 1]
ME RV inflow – outflow view [Figure 2]
ME modified bicaval view [Figure 3]
Transgastric tricuspid valve short axis view [Figure 4].
Figure 1.
ME 4 chamber view
Figure 2.
ME RV inflow – outflow view
Figure 3.
ME modified bicaval view
Figure 4.
Transgastric tricuspid valve short axis view
TRICUSPID REGURGITATION
Functional tricuspid regurgitation (TR) can also be observed in a variety of diseases producing pulmonary hypertension and/or right ventricular (RV) dysfunction [Figure 5]
The most important characteristics of functional TR are its variability in a given patient. Two-dimensional findings of tricuspid regurgitation [Figure 6].
Figure 5.
Color Doppler showing regurgitation jet
Figure 6.
Measurement of tricuspid annulus in ME 4 chamber view
Two dimensional echocardiography
Leaflets: Thickened, prolapse, flail, non coapting.
Annulus: Tricuspid annulus [Figure 8] dilated when >36 mm septolateral dimension (4C view) or 2.1 cm/m2
Color Doppler: Turbulent retrograde flow, mosaic or red; vena contracta [Figure 7], proximal isovelocity surface area radius
Pulsed-wave: Increased E wave velocity >1 m/s, hepatic vein flow reversal
View to measure RV systolic pressure is RV inflow – outflow view and pulmonary artery systolic pressure in not an index for TR severity [Figure 9].
Figure 8.
Measurement of tricuspid annulus in ME 4 chamber view
Figure 7.
Measurement of vena contracta on color Doppler in RV inflow-outflow view
Figure 9.
Measurement of Pulmonary artery systolic pressure in RV inflow outflow view
Tricuspid regurgitation grading
| Parameter | Mild | Moderate | Severe |
|---|---|---|---|
| Distance from valve to most distal extent of jet (cm) | 1.5-3 | 3.0-4.5 | >4.5 |
| Percentage of right atrium area | ≤20 | 21-33 | ≥34 |
| Area of jet (cm2) | 2-4 | 4-10 | >10 |
| Jet area central jets (cm2)c | <5 | 5-10 | 10 |
TRICUSPID STENOSIS
Two-dimensional findings
Thickened leaflets, decreased mobility, tethered tips, right atrial enlarged, dilated inferior vena cava [Figure 10].
Figure 10.
ME 4 chamber view showing Tricuspid Stenosis
Color Doppler – turbulent flow
Continuous wave Doppler – peak E velocity >1 m/s.
Grading of tricuspid stenosis
Mean gradient < 2mm Hg – Mild stenosis
Mean gradient 2-6mm Hg – Moderate stenosis
Mean gradient >6 mm Hg – Severe stenosis.
Tricuspid stenosis on three-dimensional trans-esophageal echocardiography [Figure 11].
Figure 11.
3 dimensional echocardiography showing tricuspid stenosis
Associated Data
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