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Tricuspid Regurgitation

Tricuspid Regurgitation. Etiology. Abnormalities of Supporting structure Leaflets. Annular Dilation. Abnormality of the supporting structure. Primary RV dilation and systolic dysfunction Pulmonary hypertension. Leaflet Abnormalities. Rheumatic heart disease Carcinoid Ebstein anomaly.

colleen-wiggins
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Tricuspid Regurgitation

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  1. Tricuspid Regurgitation

  2. Etiology Abnormalities of • Supporting structure • Leaflets

  3. Annular Dilation • Abnormality of the supporting structure. • Primary RV dilation and systolic dysfunction • Pulmonary hypertension.

  4. Leaflet Abnormalities • Rheumatic heart disease • Carcinoid • Ebstein anomaly

  5. Rheumatic Disease • TV is involved in about 20% to 30% of cases of Rheumatic Disease. • Occurring in conjunction with mitral and aortic valve involvement. • Usually mild. • Rheumatic TV regurgitation more common than stenosis.

  6. Carcinoid Heart Disease • Seen in metastatic carcinoid tumor of the liver. • Characterized by thickened, shortened and immobile TV leaflet. • Leading to regurgitation and less often stenosis. • Pulmonic valve may be also involved.

  7. Ebstein Anomaly • Congenital abnormality • One or more of the TV leaflets are displaced from the annulus towards the apex. • The septal leaflet is most often involved either in isolation or with apical displacement of the posterior and anterior leaflet.

  8. Ebstein Anomaly • Ebstein Anomaly should be suspected when the separation between the mitral and tricuspid valve plane is greater than 11 mm. • The portion of the right ventricle excluded from the pumping chamber is said to be atrialized. • Atrialization leads to RA enlargement.

  9. RV and RA Dilation • Progressive RV and RA dilation • M-mode – paradoxical septal motion • 2-D – flattened septum in diastole

  10. RV and RA Dilation Differential Diagnoses • ASD • Partial anomalous Pulmonary Venous Return • Pressure overload – Pulmonic stenosis or Pulmonary hypertension.

  11. Evaluation • Volume flow at two intracardiac sites. • Color flow mapping • Color flow Doppler

  12. Tricuspid Regurgitation Volume Flow at Two Intracardiac Sites Tricuspid Regurgitant SV = Transtricuspid SV – Transaortic SV

  13. Tricuspid Regurgitation

  14. Mitral Regurgitation RF = RVTR / SV TV

  15. Tricuspid Regurgitation

  16. Tricuspid Regurgitation Severe TR • Systolic flow reversal in IVC, SVC and MHV with a S wave of > 240 msec in duration. • Laminar tricuspid regurgitation.

  17. Tricuspid Regurgitation

  18. Tricuspid Regurgitation

  19. Mitral Regurgitation

  20. Mitral Regurgitation

  21. Tricuspid Regurgitation

  22. Tricuspid Regurgitation

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