Echocaridographic evaluation of tricuspid valve diseases

ABSTRACT

In a trial to elucidate the role of echocardiography in evaluation of tricuspid valve [TV] diseases, sixty-four patients were studied in addition to 20 age-matched control. On clinico-echocardiographic basis, 6 groups of patients were identified. Functional tricuspid regurge [TR] secondary to rheumatic mitral and aortic lesions [51 patients], functional TR associated with atrial septal defect [ASD] [4] with cor pulmonale [4], with pulmonary stenosis [2], organic TR and tricuspid stenosis [TS] of rheumatic aetiology [1] and organic TR due to Ebstein's anomaly [2]. With M-mode study, the anterior and septal leaflets of TV were identified in 39 cases [60.9%] and Ebstein's anomaly was suggested in 2 cases [3.12%]. 2-D echocardiography revealed systolic incoaptation of TV leaflets in 55 cases [85.9%], thickened and limited movement of septal leaflet of TV [TS; in a single case [1.6%], downward displacement of TV, atrialization of RV and huge RA [Ebstein's anomaly] in 2 cases [3.1%] and RA thrombus in a single case [1.6%] using apical-4-chamber view. ASD in 4 cases [6.3%] using subcostal view. It was possible to identify the 3 leaflets in 55 cases [85.9%], the anterior leaflet was best seen in the long axis -view, the septal one in the short axis view and the posterior leaflet was seen only in the long axis view. Measurements of TV annulus, cusp separation, RA and RV dimensions were significantly higher in patients than in controls. Doppler study confirmed the presence of TR in all cases. The regurgitation jet was directed anteriorly in 43 cases [67.2%] denoting anterior leaflet affection and to the interatrial septum in 21 cases [32.8%] denoting septal leaflet affection, confirmed ASD in 4 cases [6.3%], and confirmed TS in a single case [1.6%] and PS in two cases [2.1%] through estimation of maximum pressure gradient across the valve. Moreover, the pulmonary artery systolic pressure was estimated in all cases and it was found to be higher than normal in 52 cases [81.3%] due to rheumatic valvular diseases and in 4 cases [6.3%] due to obstructive lung diseases. These results suggest that echocardiographic study gives clear information about various diseases affecting TV