Tricuspid Valve Flashcards
Apical 4 chamber leaflets TV
Anterior, septal
Parasternal RV inflow leaflets TV
Septal, anterior
Parasternal short leaflets TV
Posterior, septal/anterior
Causes of tricuspid stenosis
Rheumatic
Congenital
Carcinoid
Impedance to flow by another structure
Normal MG TV
<2 mm Hg
Severe MG TV stenosis
> 5-7 mm Hg
Severe PHT TV stenosis
> = 190 ms
TV area eq using PHT
190/PHT
Do not rely on PHT for TV if
RV myocardial disease or significant PR
Severe anatomy TS
Thickened, calcified leaflets
Severe TS hemodynamic criteria
MG > 5
PHT >= 190
Valve area <= 1
Severe TS consequences
RA enlargement
Dilated IVC
RV normal unless other path
TS indication for intervention
Severe + symptoms -> valve replacement
Don’t perform valvuloplasty b/c usually have TR
Severe TR Vena contracta
> = 7 mm
TR PISA equation for Flow
Flow = 2 pi * R2 * Vr * alpha/180
Severe TR ERO
40
Severe TR Rvol
45
Severe TR anatomy
Flail or distorted leaflets
Annular dilatation
Severe TR hemodynamics
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
Severe TR consequences
RA and RV enlargement
Dilated IVC
PASP not equal to RVSP
Pulmonary stenosis
Severe PR
Severe TR
Primary TR intervention indication
Severe + symptoms or progressive RVE / dysfunction
Secondary TR intervention indication
Severe + symptoms or progressive RVE / dysfunction + can fix cause
Severe TR + severe MR intervention
Fix TV with MV
Isolated MV prolapse + TR
clinically silent, non-severe TR rarely progresses
TR + PAH treatment
PAH therapy +/- transplant
Device related TR characteristics
Perforation or flail rare
Apparatus entrapment
Adherence of leaflet to lead
Prefer TV replacement over repositioning of lead
Gerbode defect
Communication between RA and LV, may encompass TV leaflets
Rheumatic TV appearance
Thickening and doming of valve in diastole
Mean PAP using PR
Mean = 4 (PI V max)^2 + RAP
Diastolic PAP using PR
4 (PI end diastolic velocity)^2 + RAP
Ebstein anomaly associated with
WPW / accessory pathways
Severe TR
Right sided HF
ASDs
Surgery of choice for Ebstein anomaly
Tricuspid repair
Depends on size and functionality of RV