The CardioPhiles

TV

PLAX - ant & post leaflets; may calculate true ant-post diam.

PSAX: planimetry, ant - closest to transducer, post - inf & lat to RV, septal -medial,close to septum

4-ch: ant & septal

Etiology Secondary, or functional TR  :  

* dilatation of the right ventricle 

* dilatation the tricuspid annulus 

- TR is a complication of    

     RV failure of any cause   

     RV hypertension secondary to any form of cardiac or pulmonary vascular disease, most commonly mitral valve disease.   

Systolic RV pressure > 55 mm Hg will cause functional TR

TR can also occur secondary to 

     RV infarction

     Congenital HD (e.g., PS and Pulom HTN, Eisenmenger synd)

     Primary pulmonary HTN

     Cor pulmonale (rarely)

     dilatation of the annulus:  Marfan syndrome

Primary TR: Disease affecting the TV apparatus directly:

Ebstein anomaly, 

Aneurysm of the ventricular septum

Transposition of the great arteries 

Isolated congenital lesion

Rheumatic fever  (MV and often AV involvement coexists)

Carcinoid synd TR or the combination of TR and TS is an important feature

Prolapse of TV: in ~ 20% of all pts with MVP; may also be associated with ASD

Penetrating and nonpenetrating trauma

Dilated CMP 

Infective endocarditis esp. staphylococcal endocarditis in narcotics addicts

Cardiac tumors (particularly RA myxoma) 

Transvenous pacemaker leads

SLE

 

PV

Pulomonic Stenosis http://www.emedicine.com/med/topic1965.htm

2D Morphology

Valve morphology - graded based on the degree of immobility and thickness of the leaflets 0 = normal, 1 = mildly abnormal, 2 = moderately abnormal, and 3 = severely abnormal 

Pts with moderate or severe immobility to the PV leaflets may warrant closer f/u. In our limited subset, all subjects with a score of >or= to 4 underwent an interventional procedure. Rowland D et a. AJC 1997;79(3):334-9

Doppler

Valvular PS --> diagnosed when there was either abnormal appearance or movement of the valve leaflets and a peak velocity in the main PA measuring >= 1.6 m/s 

Severity of transvalvular gradients: trivial (gradients<=20), Mild 21-40, mod 41-70, Severe (gradients >70 mm Hg)  Rowland D et a. AJC 1997;79(3):334-9

PS Management guidelines

AHA guidelines

Under the algorithm for mild PS (defined as an estimated gradient <40 mm Hg), it is  recommended that any patient aged <4 years at the initial evaluation by a pediatric cardiologist be reevaluated in 6-12 mo (adequate in most cases with the potential exception of the newborn infant)

The Second Natural History Study of Congenital Heart Defects concluded that pts with initial gradients <= 25 mm Hg did not experience an increase in obstruction.  Rowland D et a. AJC 1997;79(3):334-9