Can two-dimensional echocardiography and Doppler color flow mapping identify the need for tricuspid valve repair?

Chopra, H.K.; Nanda, Navin C.; Fan, Pohoey; Kapur, Kanwal K.; Goyal, Rajendra; Daruwalla, Dinyar; Pacifico, Albert D.

doi:10.1016/0735-1097(89)90426-9

Cited by 124 publications

(66 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…TR was graded as trace, mild, moderate, and severe when the jet area occupied 10%, 10% to 20%, 20% to 33%, Ͼ33% of the right atrial area, respectively, in correlations with surgical and angiographic data. 12,18 The right atrial area was traced from the same frame as the maximal jet area. TR was defined as having improved when the regurgitation was trace or mild on the 1-year follow-up echocardiography.…”

Section: Echocardiographic Evaluationmentioning

confidence: 99%

Percutaneous Mitral Valvuloplasty Versus Surgical Treatment in Mitral Stenosis With Severe Tricuspid Regurgitation

et al. 2007

View full text Add to dashboard Cite

Background-The persistence of significant tricuspid regurgitation (TR) after percutaneous mitral valvuloplasty (PMV) is known to be an independent predictor of adverse outcome in mitral stenosis (MS). However, it remains unclear whether mitral valve (MV) surgery combined with surgical correction of TR is the better treatment option than PMV in patients with severe MS and severe functional TR. Methods and Results-We included a total of 92 consecutive patients (18 men, age 49Ϯ13 years) with severe MS and severe functional TR, who were potential candidates for PMV from 1997 to 2005, and the exclusion criteria were defined as the presence of left atrial thrombi, mitral regurgitation Նgrade 3, echo score Ͼ10, and left ventricular ejection fraction (EF) Ͻ35%. PMV was performed on 48 patients (PMV group), and MV surgery combined with tricuspid valve (TV) repair was performed on 44 patients (TVP group). The clinical events were defined as death, repeat surgical or percutaneous intervention, and readmission because of heart failure. There were no significant differences between the 2 groups in terms of gender, baseline EF, and baseline severity of pulmonary hypertension, but patients in the TVP group were older and had a higher echo score and a higher incidence of atrial fibrillation than those in the PMV group. During follow-up of 57Ϯ35 months, 2 deaths occurred in the TVP group, and there were 2 deaths, 7 cases of heart failure requiring surgical intervention in the PMV group. The difference of event rates between the 2 groups showed borderline significance (Pϭ0.05), but no difference in mortality was observed. The estimated actuarial 7-year event-free survival rate was 77Ϯ8% in the PMV group and 95Ϯ3% in the TVP group. Severe TR was improved to mild or absent TR in 43 (98%) patients in the TVP group, and this was significantly higher than in the PMV group (22/48, 46%; PϽ0.001).In the TVP group, the right ventricle (RV) size was significantly decreased in 18 (90%) patients among 20 patients with preoperative significant RV enlargement. On stepwise multivariate logistic regression analysis, TVP group and baseline sinus rhythm were independent predictors for improvement of TR (PϽ0.001). Conclusions-TV repair combined with MV surgery was related to better clinical outcomes than PMV alone, and we recommend that this surgical option should be considered preferentially in severe MS with severe functional TR, especially if atrial fibrillation or enlarged RV is associated.

show abstract

Section: Echocardiographic Evaluationmentioning

confidence: 99%

Percutaneous Mitral Valvuloplasty Versus Surgical Treatment in Mitral Stenosis With Severe Tricuspid Regurgitation

et al. 2007

View full text Add to dashboard Cite

show abstract

“…A quantitative assessment of tricuspid regurgitation may be possible by means of the flow convergence method [18] , which cannot be obtained by the jet parameters used in this study. However, if one accepts semiquantification of tricuspid regurgitation adequate in the clinical setting [2,3] , there is no crucial advantage of one of the methods over the others investigated in our study. The rank correlation coefficients between the PISA radii and the angiographic grade were similar to those between the jet parameters and the angiographic grade.…”

Section: Discussionmentioning

confidence: 79%

“…One patient had tricuspid regurgitation due to a prolapse of the septal tricuspid leaflet without any abnormality of the left heart. The remaining 70 patients suffered from: mitral valve failure (39), mitral valve prosthesis (4), aortic valve failure (12), coronary heart disease (11), atrial septal defect (3), primary pulmonary hypertension (2), dilatative cardiomyopathy, constrictive pericarditis and pulmonary valve stenosis (one patient each). Six of the 70 patients had thickened leaflets of the tricuspid valve.…”

Section: Patientsmentioning

confidence: 99%

“…However, this study did not investigate the widely used jet parameters, jet area and jet length. It is clinically significant to determine which of the (Doppler) echocardiographic methods are most suitable to measure severity of tricuspid regurgitation [2] . Therefore, our study compared the value of the radius of the proximal flow convergence region (proximal isovelocity surface area radius) with that of the jet area and jet length for the determination of the severity of tricuspid regurgitation.…”

Section: Introductionmentioning

confidence: 99%

“…Determination of the severity of tricuspid regurgitation is important since it influences the outcome of patients after mitral valvuloplasty or mitral valve surgery and determines in whom tricuspid surgery is considered necessary in the latter group [1][2][3][4][5] . Promising results were reported for the quantification of tricuspid regurgitation from studies using colour Doppler imaging of the regurgitant jet area [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of the proximal flow convergence method and the jet area method for the assessment of the severity of tricuspid regurgitation

Großmann

Stein

Kochs

et al. 1998

European Heart Journal

View full text Add to dashboard Cite

Aims To compare the value of the proximal flow convergence method and the jet area method for the determination of the severity of tricuspid regurgitation. Methods and ResultsThe proximal isovelocity surface area radius and the jet area/length were measured in 71 consecutive patients with angiographically graded (grade 0/I-III) tricuspid regurgitation. Rank correlation coefficients with the angiographic grade were 0·71 (P<0·001) for the proximal isovelocity surface area radius (aliasing border of 28 cm . s 1 ), 0·66 (P<0·001) for the jet area, and 0·63 (P<0·001) for the jet length. The proximal isovelocity surface area radius was significantly correlated with the jet area/length (correlation coefficients 0·82/0·77, P<0·001). Correct differentiation between mild to moderate (grade I-II) and severe (grade III) tricuspid regurgitation was achieved in 62 of 71 patients (87%) by means of the proximal isovelocity surface area radius, in 61 of 71 (86%) by the jet area, and in 62 of 71 (87%) by the jet length. Grade III tricuspid regurgitation was not identified in five of 21 patients (24%) by means of the proximal isovelocity surface area radius, in six of 21 (29%) by the jet area, and in seven of 21 (33%) by the jet length. ConclusionThe flow convergence method and the jet area method are of similar value for the determination of the severity of tricuspid regurgitation. Both methods differentiated mild to moderate from severe tricuspid regurgitation in most patients. However, underestimation of severe tricuspid regurgitation in 20-30% of the cases represents a serious limitation of both methods.

show abstract

Further Readilngs

2004

Handbook of Echo‐Doppler Interpretation

View full text Add to dashboard Cite

Can two-dimensional echocardiography and Doppler color flow mapping identify the need for tricuspid valve repair?

Cited by 124 publications

References 18 publications

Percutaneous Mitral Valvuloplasty Versus Surgical Treatment in Mitral Stenosis With Severe Tricuspid Regurgitation

Percutaneous Mitral Valvuloplasty Versus Surgical Treatment in Mitral Stenosis With Severe Tricuspid Regurgitation

Comparison of the proximal flow convergence method and the jet area method for the assessment of the severity of tricuspid regurgitation

Further Readilngs

Contact Info

Product

Resources

About