TR guidlines

Question 1

Mild TR

Answer 1

— Central Jet area <5 cm2

— Vena contracta width not defines

— CW jet density and contour: soft and parabolic

— Hepatic vein flow: systolic dominance

Question 2

Moderate TR

Answer 2

— Central Jet area 5-10 cm2

— Vena contracta width not defines but< 0.70 cm

— CW jet density and contour: dense, variable contou

— Hepatic vein flow: systolic blunting

Question 3

Severe TR

Answer 3

— Central Jet area >10 cm2

— Vena contracta >0.7 cm

— CW jet density and contour: dense, triangle with early contour

— Hepatic vein flow: systolic reversal

Question 4

Stage A TR

Answer 4

— At risk

— mild rheumatic change

— mild prolapse

— IE, veget, carcinoid radiation, PM, biopsy after tx

— no or trace TR

Question 5

stage B TR (primary), (Funtional)

Answer 5

— progressive leaflet deter/destruction

— mod-sev prolapse, limited chord rupture

— normal RA pressure

— mild RA IVC enl

— no RV enl

Funtional: earlu ann dil, mod leaflet tethering

Question 6

Stage C TR(primary), (Functional)

Answer 6

• Sev, Asx TR, (Prim): Flail glossy distorted leaflet
  (func) : Sev annu dil >40mm, 21mm/m2
• RV/RA/IVC dilated, elevated RA pres with c-V wave
• diastolic interventric. septal flattening maybe be pres
• Sx none, or in relation to other Lt ht or pulm disease

Question 7

Stage D(primary),(functional)

Answer 7

Sev,Sx TR, (Prim): Flail glossy distorted leaflet

(func) : Sev annu dil >40mm, 21mm/m2
- RV/RA/IVC dilated, elevated RA pres with c-V wave
- diastolic interventric. septal flattening maybe be pres
- Sx: Fatigue, palpitations,dyspnea, abd bloating, anorexia and edema

Question 8

Class I for TR

Answer 8

— TVr/TVR for Sev,Asx (C) functional + lt side valve S.

— TVr/TVR for Sev, Sx (D) functional + lt side valve S.

Question 9

Class IIa for TR

Answer 9

— TVr/TVR for Sev, Sx (D) primary TR

— TVr for mild-mod(B) progressive functional TR + left sided valve surg. + T annulus dilation (>40mm, 21mm/m2) or > 70 mm on direct intraop measurment

Question 10

Class IIb for TR

Answer 10

— TVr for mild-mod(B) progressive functional TR + left sided valve surg. + PHtn w/out TA dilation

TVr/TVR for

— Sev, Asx primary (C) TR + progressive RV dysfunctio

— Redo for Sev TR + persistent Sx due to severe TR (D) in patients who have undergone previous Lt sided valve surgery+ preserved RV function + PHTN not sev

Question 11

Stage of Severe TS

Answer 11

— C & D: sev TS

— thickened, distorted calc leaflet

— T half >190 ms

—Valve area< 1 cm2

— RA/IVC enl

Sx none or variable

Question 12

Class I for TS

Answer 12

TVr /TVR for severe TS undergoing lt sided Valve s.

TVr/TVR>perc balloon commis. for sev Sx TS

Question 13

Class IIb for TS

Answer 13

perc balloon commis might be considered for isolated Sx severe TS w/out accompanying TR