Tricuspid Valve Diseases

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Tricuspid Valve Illnesses. M.Sahebjam M.D. Echocardiologist Tehran Heart Center. The overlooked valve. Tricuspid Valve Life systems. Television annuluss. The tricuspid valve is the most apically (or caudally) set valve with the biggest opening among the four valves.

Presentation Transcript

Slide 1

Tricuspid Valve Diseases M.Sahebjam M.D. Echocardiologist Tehran Heart Center

Slide 2

The overlooked valve

Slide 3

Tricuspid Valve Anatomy

Slide 4

TV annuluss The tricuspid valve is the most apically (or caudally) put valve with the biggest opening among the four valves. The tricuspid annulus is oval-molded and when widened turns out to be more round. 20% bigger than MV annulus . Ordinary TV annulus= 3.0 3.5 cm

Slide 5

Leaflets the tricuspid valve has three particular handouts portrayed as septal, front, and back. The septal and the foremost flyers are bigger. The back flyer is littler and has all the earmarks of being of lesser practical importance since it might be imbricated without disability of valve capacity.

Slide 6

Leaflets The septal pamphlet is in quick closeness of the membranous ventricular septum, and its augmentation gives a premise to unconstrained conclusion of the perimembranous ventricular septal deformity. The foremost handout is appended to the anterolateral edge of the annulus and is regularly voluminous and cruise like in Ebstein's abnormality.

Slide 7

Papillary Muscles & Chordae There are three arrangements of little papillary muscles, each set being made out of up to three muscles. The chordae tendinae emerging from each set are embedded into two nearby pamphlets. the front set chordae embed into half of the septal and half of the foremost flyers. The average and back sets are comparatively identified with nearby valve pamphlets.

Slide 8

Etiology of Primary Tricuspid Valve Disease Congenital — Cleft valve for the most part in relationship with atrioventricular channel imperfection — Ebstein's inconsistency — Congenital tricuspid stenosis — Tricuspid atresia Rheumatic valve illness, by and large in relationship with rheumatic mitral valve malady Infective endocarditis Carcinoid coronary illness Toxic ( eg , Phen - Fen valvulopathy or methysergide valvulopathy ) Tumors ( eg , myxoma ) Iatrogenic—pacemaker lead injury Trauma—limit or infiltrating wounds Degenerative—tricuspid valve prolapse

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Etiology of Secondary or Functional Tricuspid Valve Disease Right ventricular dilatation Right ventricular hypertension Global right ventricular brokenness coming about because of cardiomyopathy , myocarditis , or longstanding right ventricular hypertension with fibrosis Segmental brokenness optional to ischemia or localized necrosis of the correct ventricle, endomyocardial fibrosis, arrhythmogenic right ventricular dysplasia

Slide 10

Clinical Presentations Pure or dominating tricuspid stenosis Pure or prevalent tricuspid disgorging Mixed

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Tricuspid valve ailment—Symptoms Fatigue Liver/gut clog Right upper quadrant distress Dyspepsia Indigestion Fluid maintenance with leg edema Ascites

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Tricuspid valve sickness ausculatory discoveries Stenosis : Low-to medium-pitch diastolic thunder with inspiratory emphasis Regurgitation : Soft, early, or holosystolic mumble Augmented with inspiratory exertion (Caravallo's sign) Prolapse : Systolic snap

Slide 13

Substantial tricuspid spewing forth may exist without the great ausculatory discoveries. Hence, clinical assessment including heart auscultation can't be utilized to prohibit tricuspid valve illness.

Slide 14

Transthoracic Views

Slide 15

Transesophageal Views

Slide 16

Transesophageal Views

Slide 20

Key Diagnostic Features Mild TR is seen in up to 60% and Moderate TR in up to 15% of sound people. Gentle or more regrettable TR in a valve with thin pamphlets, typical coaptation, and ordinary seeming supporting structures, recommends spewing forth is physiologic or practical .

Slide 21

Key Diagnostic Features In carcinoid infection, the pamphlets are thickened and withdrawn with a settled opening generally prompting to overwhelming spewing forth and less extreme stenosis. Around 30% of patients with MVP have repetition and prolapse of the tricuspid valve, prompting to TR.

Slide 22

TR & TS Severity

Slide 24

PAP in view of TR Velocity Mild expanded PAP = 2.6 - 2.9 m/s (27-33 mmhg) Moderate expanded PAP = 3.0 - 3.9 m/s (36-60 mmhg) Severe expanded PAP = 4.0 ≤ (64 mmhg ≤ )

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Tricuspid Valve Stenosis 1/The typical tricuspid inflow speed is under 0.5 to 1 m/s, with a mean inclination under 2 mm Hg. 2/The assessment of tricuspid valve stenosis with Doppler echocardiography is like the technique portrayed for mitral stenosis , in spite of the fact that the steady of 190 has been proposed of the PHT strategy . 3/Tricuspid stenosis is viewed as extreme when the mean slope is 7 mm Hg or increasingly and PHT is 190 milliseconds or more.

Slide 27

Key Diagnostic Features TS can be missed on routine TIE on the grounds that the level of flyer thickening may seem unpretentious, even with huge TS. Planimetry of the tricuspid valve opening by two-dimensional pictures is troublesome and untrustworthy. A weight half-time ~ 190 msec proposes extreme TS Valve range is less regularly utilized for deciding TS seriousness, yet a region < 1.3 to 1.5 cm2 is for the most part thought to be sufficiently huge to bring about side effects.

Slide 28

European Guideline for TV managment

Slide 29

AHA/ACC Guideline for TV managment