Tricuspid Valve

Question 1

Apical 4 chamber leaflets TV

Answer 1

Anterior, septal

Question 2

Parasternal RV inflow leaflets TV

Answer 2

Septal, anterior

Question 3

Parasternal short leaflets TV

Answer 3

Posterior, septal/anterior

Question 4

Causes of tricuspid stenosis

Answer 4

Rheumatic
Congenital
Carcinoid
Impedance to flow by another structure

Question 5

Normal MG TV

Answer 5

<2 mm Hg

Question 6

Severe MG TV stenosis

Answer 6

> 5-7 mm Hg

Question 7

Severe PHT TV stenosis

Answer 7

> = 190 ms

Question 8

TV area eq using PHT

Answer 8

190/PHT

Question 9

Do not rely on PHT for TV if

Answer 9

RV myocardial disease or significant PR

Question 10

Severe anatomy TS

Answer 10

Thickened, calcified leaflets

Question 11

Severe TS hemodynamic criteria

Answer 11

MG > 5
PHT >= 190
Valve area <= 1

Question 12

Severe TS consequences

Answer 12

RA enlargement
Dilated IVC
RV normal unless other path

Question 13

TS indication for intervention

Answer 13

Severe + symptoms -> valve replacement

Don’t perform valvuloplasty b/c usually have TR

Question 14

Severe TR Vena contracta

Answer 14

> = 7 mm

Question 15

TR PISA equation for Flow

Answer 15

Flow = 2 pi * R2 * Vr * alpha/180

Question 16

Severe TR ERO

Answer 16

40

Question 17

Severe TR Rvol

Answer 17

45

Question 18

Severe TR anatomy

Answer 18

Flail or distorted leaflets

Annular dilatation

Question 19

Severe TR hemodynamics

Answer 19

Broad jet of color flow, area >= 10 cm2
Vena contracta >= 7mm
Dense dagger shaped / triangular doppler signal
Hepatic vein systolic reversal
ERO >= 40, RVOL >= 45

Question 20

Severe TR consequences

Answer 20

RA and RV enlargement

Dilated IVC

Question 21

PASP not equal to RVSP

Answer 21

Pulmonary stenosis
Severe PR
Severe TR

Question 22

Primary TR intervention indication

Answer 22

Severe + symptoms or progressive RVE / dysfunction

Question 23

Secondary TR intervention indication

Answer 23

Severe + symptoms or progressive RVE / dysfunction + can fix cause

Question 24

Severe TR + severe MR intervention

Answer 24

Fix TV with MV

Question 25

Isolated MV prolapse + TR

Answer 25

clinically silent, non-severe TR rarely progresses

Question 26

TR + PAH treatment

Answer 26

PAH therapy +/- transplant

Question 27

Device related TR characteristics

Answer 27

Perforation or flail rare
Apparatus entrapment
Adherence of leaflet to lead
Prefer TV replacement over repositioning of lead

Question 28

Gerbode defect

Answer 28

Communication between RA and LV, may encompass TV leaflets

Question 29

Rheumatic TV appearance

Answer 29

Thickening and doming of valve in diastole

Question 30

Mean PAP using PR

Answer 30

Mean = 4 (PI V max)^2 + RAP

Question 31

Diastolic PAP using PR

Answer 31

4 (PI end diastolic velocity)^2 + RAP

Question 32

Ebstein anomaly associated with

Answer 32

WPW / accessory pathways
Severe TR
Right sided HF
ASDs

Question 33

Surgery of choice for Ebstein anomaly

Answer 33

Tricuspid repair

Depends on size and functionality of RV