Tricuspid regurgitation cardiac MRI

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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] Rim Halaby, M.D. [3]

Overview

Cardiac magnetic resonance imaging (CMR) may be beneficial when echocardiography findings are inconclusive, particularly before tricuspid valve surgery.

Cardiac MRI

• Cardiac MRI is useful in evaluating the structure and function of the right atrium and right ventricle as well as the severity of the tricuspid regurgitation, especially when echocardiography is inconclusive.
• Findings on MRI suggestive of tricuspid regurgitation include:
  • Cardiac magnetic resonance imaging (CMR) helps in giving the quantitative assessment of tricuspid regurgitant volume (TRV)
    • Severe tricuspid regurgitation if TMR is ≥30 ml, or in a separate analysis, ≥40 ml
    • Moderate or mild tricuspid regurgitation if TMR is < the above threshold.
  • Cardiac magnetic resonance imaging (CMR) helps in estimation of regurgitant fraction
  • Cardiac magnetic resonance imaging (CMR) helps in estimation of RV volumes and ejection fraction
  • Cardiac magnetic resonance imaging (CMR) helps in evaluation of associated left ventricle and mitral disease
  • Cardiac magnetic resonance imaging (CMR) helps in identification of TR jet area

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary

Class IIb

"1. CMR or real-time 3-dimensional echocardiography may be considered for assessment of RV systolic function and systolic and diastolic volumes in patients with severe TR (stages C and D) and suboptimal 2-dimensional echocardiograms. (Level of Evidence: C)"

(A) CMR four-chamber cine view. Seen here is the grossly dilated right heart, with an atrialized RV and dilated tricuspid annulus. The enlarged anterior TV leaflet is well visualized (red arrow), as is the mislaid and hypoplastic septal leaflet (yellow arrow). The LA and LV are small, owing to compression from the volume-overload right heart. LA, left atrium; LV, left ventricle; RA, right atrium. RV, right ventricle. (B) CMR short-axis cine view. The massively dilated atrial and ventricular portions of the right heart are visualized. Again the tricuspid valve septal leaflet is seen (red arrow) and the pale jet of tricuspid regurgitation is notable here in systole. Case courtesy by Gaurav Singh Gulsin et al

(a) MRI velocity-encoding magnitude (top) and phase (bottom) flow images through the main pulmonary artery at different time points during early systole. The images show a dilated pulmonary artery (PA), which appears larger than the aorta (Ao). The PA shows a negligible change in the cross-sectional area despite the flow increase with time (shown in the phase images). (b) MRI velocity-encoding magnitude (top) and phase (bottom) flow images through the tricuspid valve at end-systole showing severe tricuspid regurgitation (arrows). LV = left ventricle; RV = right ventricle. Case courtesy by El-Sayed H. Ibrahim et al