Optimal Echocardiographic Approach to the Evaluation of Tricuspid Regurgitation
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ECHOCARDIOGRAPHY (JM GARDIN AND AH WALLER, SECTION EDITORS)
Optimal Echocardiographic Approach to the Evaluation of Tricuspid Regurgitation T.K. Hanh Nguyen 1 & Lawrence G. Rudski 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To summarize the most recent literature on the optimal echocardiographic approach to the evaluation of tricuspid regurgitation (TR). Recent Findings Severe TR is increasingly recognized as an independent adverse prognostic marker. TR severity grading has been mainly based on qualitative and semiquantitative parameters according to the 2017 ASE guidelines, but new data emerging from 3D echocardiography and MRI will likely provide insights into more quantitative measurements of TR severity. Summary The tricuspid valve’s anatomy and physiology is complex and unique. TR can be primary or secondary to tricuspid annular dilatation. Commonly used echocardiographic parameters to define severe TR are severe valve lesions, a large color flow jet area, a vena contracta width of ≥ 7 cm, a PISA radius of ≥ 0.9 cm, a dense and triangular continuous wave Doppler jet shape, and hepatic vein systolic flow reversal. Complementary imaging modalities such as 3D echocardiography and MRI should be utilized if the 2D echocardiographic evaluation is suboptimal. Keywords Tricuspid regurgitation . Tricuspid valve . Right ventricle . Echocardiography . Regurgitation severity grading . Valvular
Introduction Tricuspid regurgitation (TR) is a common echocardiographic finding with a prevalence of 70–90% in the general population [1]. Once considered a by-product of left-sided valvular heart disease that improves upon treating the latter [2], TR is now recognized as a stand-alone entity with its own pathophysiology, natural history, and prognostic value. In fact, any TR severity that is more than mild has been shown to be an independent factor of increased morbidity and mortality [3, 4]. These findings, along with the developments in percutaneous valvular interventions lowering the risk-benefit ratio of valvular interventions, have led to an increased interest in This article is part of the Topical Collection on Echocardiography * Lawrence G. Rudski [email protected]; [email protected] T.K. Hanh Nguyen [email protected] 1
Division of Cardiology, Department of Medicine, Azrieli Heart Center, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Suite E206, Montreal, Quebec H3T 1E2, Canada
establishing accurate imaging guidelines for TR in order to ensure proper grading, follow up, and patient selection for interventions. Echocardiography remains the first line imaging modality in the evaluation of valvular heart disease. In this review, we aim to summarize recent literature on the optimal echocardiographic approach to the evaluation of TR. Tricuspid valve (TV) anatomy, TR mechanisms, grading of TR severity, effect of TR on right-sided cardiac chambers, and the added value of 3D transthoracic echocardiography (TTE) and other ima
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