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CLINICAL SEVERITY OF TRICUSPID VALVE REGURGITATION AS GRADED BY CONTRAST ECHOCARDIOGRAPHY

English (英語)

The Kobe journal of the medical sciences

29(5)

143-160

1983-10

In order to evaluate the severity of tricuspid regurgitation (TR) by a convenient and non-invasive method, contrast echocardiograms utilizing peripheral vein injection of saline were performed in 75 patients consisting of 59 with mitral valvular disease, 12 with atrial septal defects (ASD-II), and 4 with primary pulmonary hypertension (PPH). Since previous classifications, evaluating only the flow patterns of M-mode contrast echocardiograms at the tricuspid orifice, could not provide sufficient information about TR severity, a new criterion evaluating both the regurgitant flow patterns and flow amount across the tricuspid valve, has been used to classify the severity of TR by M-mode contrast echocardiography. With this method, we were able to obtain a favorable result which not only proved to be closely related to angiocardiographic grading (p=0.91, p<0.01), but also superior to the other contrast echocardiographic methods and Doppler sonography. Based on this contrast grading, the maximum and minimum diameters of tricuspid annulus in each grade were measured from two dimensional echocardiograms. These annular measurements showed a progressive dilatation of tricuspid annulus and a progressive reduction of annular fractional shortening as TR deteriorated from mild to severe. Hemodynamic changes associated with TR included a higher pulmonary arterial pressure (PAP) in the TR group (48. 2 mmHg) than in the non-TR group (32. 6 mmHg). The PAPs in cases with sinus rhythm were significantly higher than those with atrial fibrillation (AF) in each corresponding grade of TR. Significant elevation of right atrial pressure (RAP) was observed only in severe TR (TR-III & TR-IV). In conclusion, the above results elucidate that contrast echocardiography based on the new criterion is a convenient and reliable method for evaluating the severity of TR, and that the mechanisms of TR are multifarious and associated with various factors such as PAP, cardiac rhythm, annular diameter and annular fractional shortening.

tricuspid annular diameter

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