Tricuspid And Pulmonary Regurgitation Flashcards by Julianna Small

The eitology of TR can be divided into what 3 subgroups?

Functional (primary), organic (secondary), mechanical

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What is responsible for functional cases of TR?

Annular dilation

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What are functional causes of TR?

Atrial fibrillation, ASD, dilated cardiomyopathy, pulmonary hypertension, pulmonary regurgitation, RV dysplasia, RV CHF, RV infarction

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What are the organic causes of TR?

Carcinoid heart disease, congenital abnormalities of the TV, connective tissue disorders, iatrogenic, inefective endocarditis, myxomatous disease, radiation injury, rheumatic TV disease, RV infarction, trauma

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What are mechanical causes of TR?

Packemaker leads, implantable cardioverter defibrillator leads

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What can leads do to the tricuspid leaflets?

Perforate

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What is rheumatic TV disease characterized by? (2)

Thickened and retracted TV leaflets

Tenting and/or doming

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Doming causes an issue in which phase of the cardiac cycle and why?

Diastole, causes stenosis

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Tenting causes an issue in which phase of the cardiac cycle and why?

Systole, causes regurgitation

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What is the key difference between carcinoid and rheumatic disease?

The involvement of the MV/AV with rheumatic HD

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Why is the TV more susceptible to traumatic TV rupture?

Because the RV is more easily compressed

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What is the systolic bowing of the belly of the leaflets into the RA during systole?

Tricuspid valve prolapse

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What is Ebstein’s anomaly?

Malformation of the TV leaflets during development

Ebstein on TV = Frankenstein on TV

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What are the 4 main characteristics of Ebstein’s anomaly?

Adhesion of the septal and posterior leaflets to the underlying myocardium
Exaggerated apical displacement of the septal leaflet
Atrialization and dilation of a portion of the RV inflow tract
Small functional RV

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What is Ebstein’s anomaly associated with?

PFO, ASD, congenitally corrected transposition of the great arteries, VSD’s, hypoplastic pulmonary artery

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What may Ebstein’s lead to?

Maldevelopment of the conduction pathway from atria to ventricle

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When can Ebstein’s be diagnosed?

When the septal TV leaflet is displaced apically >20mm

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Shunt direction with Ebstein’s anomaly may be what?

Right to left (known as Eisenemnger’s syndrome)

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How will the leaflets appear with annular dilation?

Incomplete coaptation due to the stretched annulus

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What are 3 common causes of annular dilation?

Dilated cardiomyopathy, ASD’s, and pulmonary hypertension

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Chronic, severe pulmonary hypertension is associated with what?

RV and TV annular dilation

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If shunts aren’t fixed with an ASD, what can happen?

Pulmonary vascular resistance increases

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If the TR peak velocity does not reflect the severity of TR, what does it reflect?

Pressure difference between RV and RA during systole

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If a patient has pulmonary hypertension, what will you see during a sniff test?

IVC will not collapse

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If the RV is undergoing volume overload and has a D sign, what phase of the cardiac cycle would this be seen?

Systole

If the RV is undergoing pressure overload and has a D sign, what phase of the cardiac cycle would this be seen?

Systole and diastole

Clinical features of TR include what examples of right heart failure?

Increased JVP (jugular venous pulse), hepatomegaly, peripheral edema, and ascites

What are indirect signs of the severity of TR regurg using color Doppler?

Color jet area, vena contracta width, flow convergence radius

What are indirect signs of the severity of TR regurg using Spectral Doppler?

Tricuspid inflow (PW), hepatic vein profile (PW), intensity of TR signal (CW), TR jet contour (CW)

What is the coanda effect?

When the eccentric jet does not look severe (but actually is) and hugs the wall

Are PISA and vena contracta normals dependent on the valve and when can they not be used?

Nope, same same on every valve. Multiple jets

What does a hepatic vein doppler profile look like with normal TV function?

Inverted pulmonary vein

What does the hepatic vein Doppler profile look like with severe TR?

Reversed S wave

Mild TR waveforms have what kind of shape?

Parabolic

Significant TR waveforms have what kind of shape?

Triangular

The triangular shape of a significant TR waveform is known as the what?

V cut off

What does the wave look like with severe tricuspid inflow?

Dominant E wave (≥1m/s)

What does the hepatic vein look like with mild TR?

Systolic dominance

What does the hepatic vein look like with moderate TR?

Systolic blunting

What does the hepatic vein look like with severe TR?

Systolic reversal

What does the TR jet intensity look like with mild TR?

Incomplete or faint

What does TR jet intensity look like with moderate TR?

Dense

What does TR jet intensity look like with severe TR?

Dense

What does TR jet contour look like with mild TR?

Parabolic

What does TR jet contour look like with moderate TR?

Usually parabolic

What does TR jet contour look like with severe TR?

Early peaking or triangular

What are the 2 main methods used to quantify the amount of regurgitation using the PISA principle?

Regurgitant volume and EROA (Size of hole)

As flow advances closer to the hole, the area of each hemispheric shell decreases while the velocity of each shell does what?

Increases

What is considered a mild regurgitant volume?

<30

What is considered a moderate regurgitant volume?

30-44

What is considered to be a severe regurgitant volume?

≥45

What can the etiology of pulmonary regurgitation be divided into?

Functional and organic

What does organic pulmonary regurgitation refer to?

PR due to an abnormality of the cusps

Functional pulmonary regurgitation refers to what?

Causes which cause annular dilation which leads to poor cusp coaptation

What are some symptoms of severe pulmonary regurgitation?

Dyspnea, peripheral edema, fatigue, increased JVP, and liver engorgement

What is the PR jet width ratio?

Width of the PR jet compared to the RVOT diameter (PR JET WIDTH / RVOTd)

What is a severe PR PRI?

<0.77

What is PRI?

Pulmonary Regurgitation Index Ratio of the PR duration to the total duration of diastole

What are the values for PI pressure half time?

Mod PI: > 100 ms Sev: <100 ms

What are PAEDP and mPAP and when are they calculated?

Pulm art end dia pressure Mean pulm art pressure Calculated in the presence of PI

How do you calculate PAEDP?

PAEDP = 4Vpi-ed^2 + RAP Vpi-ed = End diastole (top caliper on PI slope)

How do you calculate mPAP?

mPAP = 4Vpi-endpeak-^2 + RAP Vpi-endpeak = End diastole (bottom caliper on PI slope)

Tricuspid And Pulmonary Regurgitation Flashcards

(62 cards)