Tricuspid Stenosis Flashcards
What is Tricuspid Stenosis?
Obstruction of blood flow from the RA across the tricuspid valve into the RV
Etiology of the TV may have what two origins? 2
- Congenital
- Acquired
What is the frequency of Tricuspid stenosis? 2
- Rare
- Usually associated with other congenital cardiac defects
What are four examples of congenital TS? 4
- Mal- developed leaflets
- Shortened Chordae tendiae
- Annular hypoplasia
- Abnormalities of the papillary muscles
Rheumatic TS is usually concurrent with what?
MS
What does rheumatic TS usually lead to?
Dyspnea
What is the pathophysiology of TS? 4
1.TV area decrease
2. RA pressure increases
3. RAE
4. Increased pressure works its way backward into the system
What are some clinical signs of TS?
Rt and Lt CHF
What are some RT CHF symptoms? 4
- Systemic venous congestion
- Jugular venous distension (elevated jugular venous pressure)
- Ascites
- Peripheral edema
What are some LT CHF signs?
Happens with MS/ Rheumatic MS
What are some symptoms of TS? 2
- Fatigue
- Abdominal discomfort and swelling
What is the role of echo for TS? 5
- Determine Etiology
- Assess RA size
- Assess RV size and function
- Estimate severity of stenosis
- Estimate RVSP
What are some acquired TS causes? 3
- Rheumatic valve disease
- Carcinoid Heart disease
- Cor Triatriatum
Anatomic changes in rheumatic TS resemble what?
Those of MS
What are some things we see with rheumatic valve disease? 3
When the leaflets are
- Thickened
- Fibrotic
- Fused
What is the sonographic appearance of Rheumatic heart disease? 2
- Diastolic doming
- Aliasing in the RV during diastole
What is Carcinoid heart disease caused by?
A rare, malignant neuroendocrine tumor
How does the carcinoid heart tumor affect the TV?
It secretes the hormone serotonin which damages both tricuspid and pulmonary valves
What is the echogenic appearance of carcinoid heart disease?
Echogenic deposits on the endocardial surfaces and the myocardium
What does the valves look like with carcinoid heart disease?
Plaque causes the valves and chordae to become rigid, thickened, and retracted
What are some key differences between carcinoid and rheumatic?
Rheumatic always involves the MV and Carcinoid may involve the PV but never the MV
What do we use to assess for TS severity? 4
We look at
1. Mean TV pressure gradient
2. Tricuspid inflow velocity time integral (VTI)
3. TV Pressure half time
4. Tricuspid valve area (TVA)
TS will alias how in the Right sided heart?
TS will alias during diastole in the RV
How do we get a VTI measurement?
Trace the entire TV inflow waveform in CW doppler
What does tracing the CW doppler image of the TV do?
Gives us both the mean pressure gradient and the VTI measurement
What is the most important value we get from CW TV inflow?
Mean PG
What is the mean PG for TV?
Average over several beats to account for changes in venous return with respiration
What is the limitation of P1/2T?
Tachycardia
Why is tachycardia a limitation of P1/2T?
E and A waves fuse
What is the normal TVA?
6-7
What are limitations of using the continuity formula for TVA? 3
- Suboptimal alignment to the jet direction
- Improper LVOT diameter or VTI measurement
- When significant TR coexists with TS, the SV is altered, and TVA cannot be calculated.
What are some treatments for TS?
Medications and Surgical
How do we use medications to treat TS?
Diuretics/ nitrates to relieve venous congestion
What are some surgical ways to treat TS? 2
- Surgical de-bulking of tumor or vegetation
- Transvenous balloon valvuloplasty is improving
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