cardiovascular disorders
Tricuspid Regurgitation
Diagnosis of Tricuspid Regurgitation
Echocardiography Mild tricuspid regurgitation is most often detected on Echocardiography done for other reasons. More moderate or severe TR may be suggested by history and physical examination. Confirmation is by echocardiography. Severe TRis characterized echocardiographically by≥1 of the following: 2-Dimensional failure of coaptation or flail Dense, triangular, early peaking, continuous wave Doppler of TR jet Large flow convergence zone proximal to the valve Large regurgitant jet on color Doppler (≥50% of right atrial area) Systolic flow reversal in the hepatic veins (specific for severe TR) Vena contracta width > 7 mm The vena contracta is the narrowest diameter of the fluid stream downstream of an abnormal valve orifice; it is slightly smaller than the anatomic valve orifice. When TR is moderate or severe, the peak regurgitant velocity will underestimate pulmonary pressure. Two-dimensional echocardiography detects the structural abnormalities present in primary TR. Assessing RV systolic dysfunction is challenging and is suggested on echocardiography by tricuspid annular plane systolic excursion (TAPSE)<16 mm or tricuspid annular systolic velocity<10 cm/second. Magnetic Resonance Imaging (MRI) in Cardiac Diagnosis is the preferred method for evaluating RV size and function. An ECG and chest x-ray are often done. Electrocardiography is usually normal but, in advanced cases, may show tall peaked P waves caused by right atrial enlargement, a tall R or QR wave in V1 characteristic of RV hypertrophy, or atrial fibrillation. Chest x-ray is usually normal but, in advanced cases with RV hypertrophy or RV dysfunction–induced HF, may show an enlarged superior vena cava, an enlarged right atrial or RV silhouette (behind the upper sternum in the lateral projection), or pleural effusion. Laboratory testing is not needed, but if done, may show hepatic dysfunction in patients with severe TR. Cardiac Catheterization is indicated for accurate measurement of pulmonary pressure when TR is severe and to evaluate coronary anatomy when surgery is planned. Catheterization findings include a prominent right atrial 