ECHO 2013 / Right Heart Valvular Disease When to Intervene
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Transthoracic views of TV
Apical 4 chamber
Septal
Ant
Subcostal view of TV - all 3 leaflets are seen
Post
Ant
Septal
Assessing Physiology
Stenosis
Regurgitation
Assessment of tricuspid stenosis
•Key measure is mean gradient (note HR)
•Low pressure circuit
•Even mean gradients of 2-4 mmHg many be significant
•Pressure half-time validated to a limited degree (no gold standard)*
*Fawzy et al Eur Heart J 1989 10(11):985
Severe Stenosis
ASE Guidelines for the Assessment of Native Valve Stenosis :
Tricuspid Regurgitation
ASE Guidelines for Evaluation of the Severity of Native Valve Regurgitation with Two-Dimensional
and Doppler Echocardiography*
* www.Asecho.org
Beware of unrestricted TR
While you’re there…. Check RV systolic pressure
Assessing the Right Ventricle
•FAC
•TAPSE
•Dp/Dt
•DTI
•Strain