Week 4 TS and TR Flashcards
What 2 TV leaflets do you see in each of the following views:
LAX - RVIT
SAX
SC SAX
4ch
SC 4ch
RVIT - Ant and Post
all the other views - Ant and Sep
What are the names of the TV leaflets?
Ant
Post
Septal
TS hemodynamics
TS = incr RA press
RA dilates
Decr venous return to heart
= systemic venous congestion (jugular venous distension, peripheral edema, ascites)
TS signs and symptoms
Fatigue bc low CO
Abd discomfort bc venous congestion
Arrythmias bc large RA
if MS too (rheumatic), then dyspnea
TS etiology
Rheumatic fever
Carcinoid TV disease
Cor Triatriatum Dexter
Mass/endocarditis
Congenital (rare)
How does rheumatic fever cause TS?
Streptococcus infection
untreated strep throat becomes rheumatic fever
years later autoimmune system response causes valve disease
thickened (bright), stiff leaflets
How do carcinoid tumors cause TS?
Tumor in GI tract (carcinoid tumor)
Metastasizes in liver
Metastases produces substances that harm heart (deposit fibrous tissue on endocardium)
= thickened leaflets that don’t move
= carcinoid TV disease
What is Cor Triatiatum Dexter
Cor Triatriatum = thin membrane
Dexter = Right side
membrane across RA that mimis TS
Role of Sonography in TS
- Determine etiology - rheumatic?
- Assess RA and RV size
- Estimate severity of TS
- CW of TV inflow; trace to get mean gradient (can also measure PHT)
- continuity eqn (not routine in BC) - Assess for associated findings
- TR
- IVC dil
- AoV and MV involved if rheumatic (pulm press?)
What is the one extra step in an echo if you have patient with TS? What do you measure?
CW through TV inflow
- trace to get mean gradient
- line to get PHT (not routine in BC)
Continuity eqn for TV is not routine in BC….if you have a patient with TS and you wanted to do the continuity eqn, how would you do it?
SV(TV) = SV (LVOT)
What are the associate findings for TS?
TR
IVC dil (bc high RA press)
if rheumatic… AoV and MV involved
if MV involved… high pulm press
What are the treatment options for TS?
Meds - symptoms
Percutaneous - balloon dilatation
Surgical - valve replacement
Organic vs. functional cause of valve disease
Organic = primary = smt wrong with valve
Functional = secondary = smt wrong with heart (dilated)
What are some functional causes of TR?
chronic A-fib
ASD
Dilated cardiomyopathy
Pulm HT
RV infarction
**these all cause RA/RV dilation and therefore cause TR
What are some organic causes of TR?
Carcinoid TV disease
Endocarditis (vegetation)
Ebstein’s Anomaly
Atrioventricular Septal Defect
Rheumatic fever
RV infarct / trauma (eg. ruptured pap)
Iatrogenic
Ebstein’s Anomaly
one or both of TV leaflets insert more inferiorly than normal
Atrioventricular septal defect
instead of the MV and TV, there is one valve with 5 leaflets that crosses the entire heart
also have ASD and VSD
Iatrogenic
Caused by medical treatment (doctor caused it)
eg. pacemaker wire usually causes TR
Hemodynamic consequences of TR
significant TR = incr blood in RA
= RA dilates and normal RAP (no symptoms)
Over time…
Decr RA compliance and incr RAP
Incr RA press and venous press
Diastolic vol overload = Incr RV vol and press
Right heart failure
Symptoms of severe TR?
**blood / fluid stuck in body
pulsatile, tender liver
peripheral edema
ascites
cyanosis
SOB
fatigue
Role of echo in TR
Assess the amount of TR
Visual - colour: mild, mod, severe TR?
*only thing we do in BC
you can also look at:
- Regurgitant area
- Jet contour/intensity from CW trace
- Hepatic vein flow
- Tricuspid inflow vel
How would you determine the regurgitant area for TR?
Colour on
take cine of largest TR jet
freeze and trace entire TR jet
If you did a CW of TR…. what would you expect the trace to look like for mild TR vs severe TR
mild TR - parabolic shape and less bright (dense)
severe TR
- more triangular shape with early peaking
bc high RA press but PG equalizes fast
- brighter (more dense)
bc more RBCs
Hepatic vein flow
how to you measure it?
normal vs significant TR?
SC - PW at hepatic vein
Normal = S and D below the baseline and A above baseline
*opposite to pulm vein (bc of angle of doppler)
significant TR = S wave reversal
If severe TR, how would tricuspid inflow change?
Increase peak E velocity
Treatment for TR
Meds
Percutaneous
- valve replacement
- valve repair (new): “tampon” on a wire act as plug
Surgical
- prosthetic or mechanical valve replacement
