Tricuspid stenosis diagnostic study of choice: Difference between revisions

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[[File:Normal echocardiographic appearance of tricuspid valve.jpg|center|thumb|709x709px|Normal echocardiographic appearance of tricuspid valve (''arrow'') and wave pattern. Case courtesy by Soham Shah et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028338/|title=Multimodal imaging of the tricuspid valve: normal appearance and pathological entities|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
[[File:Normal echocardiographic appearance of tricuspid valve.jpg|center|thumb|709x709px|Normal echocardiographic appearance of tricuspid valve (''arrow'') and wave pattern. Case courtesy by Soham Shah et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028338/|title=Multimodal imaging of the tricuspid valve: normal appearance and pathological entities|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
[[File:Tricuspid stenosis in echocardiography.jpg|alt=Tricuspid stenosis in echocardiography|center|thumb|709x709px|Tricuspid stenosis in echocardiography. 2D and color Doppler images in a patient with antiphospholipid antibody syndrome shows thickening of the valve leaflets (''arrow'') and continuous-wave Doppler with a mean pressure gradient of 11 mmHg, which is consistent with severe tricuspid stenosis. Case courtesy by Soham Shah et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028338/|title=Multimodal imaging of the tricuspid valve: normal appearance and pathological entities|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]<br />
[[File:Tricuspid stenosis in echocardiography.jpg|alt=Tricuspid stenosis in echocardiography|center|thumb|709x709px|Tricuspid stenosis in echocardiography. 2D and color Doppler images in a patient with antiphospholipid antibody syndrome shows thickening of the valve leaflets (''arrow'') and continuous-wave Doppler with a mean pressure gradient of 11 mmHg, which is consistent with severe tricuspid stenosis. Case courtesy by Soham Shah et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028338/|title=Multimodal imaging of the tricuspid valve: normal appearance and pathological entities|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
 
=== Staging of Tricuspid stenosis ===
 
* Based on the valve anatomy, hemodynamics, and consequences tricuspid stenosis can be staged into the following:<ref name="NishimuraOtto2014">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Guyton|first6=Robert A.|last7=O’Gara|first7=Patrick T.|last8=Ruiz|first8=Carlos E.|last9=Skubas|first9=Nikolaos J.|last10=Sorajja|first10=Paul|last11=Sundt|first11=Thoralf M.|last12=Thomas|first12=James D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease|journal=Journal of the American College of Cardiology|volume=63|issue=22|year=2014|pages=e57–e185|issn=07351097|doi=10.1016/j.jacc.2014.02.536}}</ref><ref name="NishimuraOtto2017">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Fleisher|first6=Lee A.|last7=Jneid|first7=Hani|last8=Mack|first8=Michael J.|last9=McLeod|first9=Christopher J.|last10=O’Gara|first10=Patrick T.|last11=Rigolin|first11=Vera H.|last12=Sundt|first12=Thoralf M.|last13=Thompson|first13=Annemarie|title=2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines|journal=Circulation|volume=135|issue=25|year=2017|issn=0009-7322|doi=10.1161/CIR.0000000000000503}}</ref><ref name="NishimuraOtto20142">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Guyton|first6=Robert A.|last7=O'Gara|first7=Patrick T.|last8=Ruiz|first8=Carlos E.|last9=Skubas|first9=Nikolaos J.|last10=Sorajja|first10=Paul|last11=Sundt|first11=Thoralf M.|last12=Thomas|first12=James D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary|journal=Journal of the American College of Cardiology|volume=63|issue=22|year=2014|pages=2438–2488|issn=07351097|doi=10.1016/j.jacc.2014.02.537}}</ref><ref name="NishimuraOtto20144">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Guyton|first6=Robert A.|last7=O’Gara|first7=Patrick T.|last8=Ruiz|first8=Carlos E.|last9=Skubas|first9=Nikolaos J.|last10=Sorajja|first10=Paul|last11=Sundt|first11=Thoralf M.|last12=Thomas|first12=James D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary|journal=Circulation|volume=129|issue=23|year=2014|pages=2440–2492|issn=0009-7322|doi=10.1161/CIR.0000000000000029}}</ref><ref name="NishimuraOtto20143">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Guyton|first6=Robert A.|last7=O’Gara|first7=Patrick T.|last8=Ruiz|first8=Carlos E.|last9=Skubas|first9=Nikolaos J.|last10=Sorajja|first10=Paul|last11=Sundt|first11=Thoralf M.|last12=Thomas|first12=James D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease|journal=Circulation|volume=129|issue=23|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000031}}</ref>
 
{| class="wikitable"
!Stage
! Definition
!Valve anatomy
!Valve hemodynamics
!Hemodynamic consequences
!Symptoms
|-
|C, D
|Severe TS
|Thickened, distorted, [[Calcification|calcified]] leaflets
|
*T ½ ≥190 ms 
*[[Valve]] area ≤1.0 cm2
|Right atrial / [[Inferior vena cava]] enlargement
|
*Stage C-No [[symptoms]]
*Stage D-[[Symptom|Symptoms]] variable and dependent on the severity of associated valve disease and degree of obstruction
|}
 
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 14:07, 1 April 2020

Tricuspid stenosis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Tricuspid stenosis (TS) is characterized by structural changes in the tricuspid valve. The most common cause of tricuspid stenosis (TS) is rheumatic heart disease. Echocardiography is the gold standard test for the diagnosis of tricuspid stenosis which gives tricuspid peak inflow velocity and degree of thickening of tricuspid valve leaflets.

Diagnostic Study of Choice

Study of choice

Normal echocardiographic appearance of tricuspid valve (arrow) and wave pattern. Case courtesy by Soham Shah et al[4]
Tricuspid stenosis in echocardiography
Tricuspid stenosis in echocardiography. 2D and color Doppler images in a patient with antiphospholipid antibody syndrome shows thickening of the valve leaflets (arrow) and continuous-wave Doppler with a mean pressure gradient of 11 mmHg, which is consistent with severe tricuspid stenosis. Case courtesy by Soham Shah et al[5]

Staging of Tricuspid stenosis

  • Based on the valve anatomy, hemodynamics, and consequences tricuspid stenosis can be staged into the following:[6][7][8][9][10]
Stage Definition Valve anatomy Valve hemodynamics Hemodynamic consequences Symptoms
C, D Severe TS Thickened, distorted, calcified leaflets
  • T ½ ≥190 ms 
  • Valve area ≤1.0 cm2
Right atrial / Inferior vena cava enlargement
  • Stage C-No symptoms
  • Stage D-Symptoms variable and dependent on the severity of associated valve disease and degree of obstruction


References

  1. Morgan, Jacob R.; Forker, Alan D.; Coates, J. R.; Myers, W. S. (1971). "Isolated Tricuspid Stenosis". Circulation. 44 (4): 729–732. doi:10.1161/01.CIR.44.4.729. ISSN 0009-7322.
  2. Finnegan, P; Abrams, L D (1973). "Isolated tricuspid stenosis". Heart. 35 (11): 1207–1210. doi:10.1136/hrt.35.11.1207. ISSN 1355-6037.
  3. Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Evangelista, Arturo; Griffin, Brian P.; Iung, Bernard; Otto, Catherine M.; Pellikka, Patricia A.; Quiñones, Miguel (2009). "Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice". Journal of the American Society of Echocardiography. 22 (1): 1–23. doi:10.1016/j.echo.2008.11.029. ISSN 0894-7317.
  4. "Multimodal imaging of the tricuspid valve: normal appearance and pathological entities".
  5. "Multimodal imaging of the tricuspid valve: normal appearance and pathological entities".
  6. Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease". Journal of the American College of Cardiology. 63 (22): e57–e185. doi:10.1016/j.jacc.2014.02.536. ISSN 0735-1097.
  7. Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Fleisher, Lee A.; Jneid, Hani; Mack, Michael J.; McLeod, Christopher J.; O’Gara, Patrick T.; Rigolin, Vera H.; Sundt, Thoralf M.; Thompson, Annemarie (2017). "2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Circulation. 135 (25). doi:10.1161/CIR.0000000000000503. ISSN 0009-7322.
  8. Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O'Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Journal of the American College of Cardiology. 63 (22): 2438–2488. doi:10.1016/j.jacc.2014.02.537. ISSN 0735-1097.
  9. Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Circulation. 129 (23): 2440–2492. doi:10.1161/CIR.0000000000000029. ISSN 0009-7322.
  10. Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease". Circulation. 129 (23). doi:10.1161/CIR.0000000000000031. ISSN 0009-7322.

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