1. ADULT ECHOCARDIOGRAPHY Lesson Eight The Tricuspid Valve
Harry H. Holdorf PhD, MPA, RDMS, RVT, LRT, N.P.

2. Tricuspid Stenosis Etiology Rheumatic (most common) Congenital (rare)
Carcinoid (rare)
Prosthetic valve dysfunction
Pathophysiology
Increased RA pressure causes RA dilatation
Rheumatic TS almost always associated with MS
Carcinoid heart disease results from increased serotonin production from a carcinoid tumor (intestinal tract (40%) or appendix (25%). Serotonin induced fibrosis of the right heart endocardium causing TS/TR/PS/PR
Increased risk for endocarditis

3. Physical signs
Signs and symptoms may be masked by MS
Diastolic murmur (varies with respiration) and an opening snap
Symptoms of right heart failure (ascites, peripheral edema)
Echo
M-mode shows decreased E-F slope, multiple echoes and reduced amplitude of the E wave
Thickened tricuspid leaflets with decreased mobility
Right atrial and IVC enlargement
Tethered TV leaflet tips (doming)
In carcinoid disease, the TV leaflets are thickened an may appear fixed

4. Increased velocity and turbulence across the tricuspid valve
Doppler
Increased velocity and turbulence across the tricuspid valve
Tricuspid regurgitation may be present
Measure mean trans-valvular gradient
AHA/ACC Guidelines for Tricuspid Stenosis Severity
Mean gradient mmHg > 5

5. 2-D Tricuspid Stenosis form Rheumatic Heart Disease

7. NEXT: valvular heart disease
End Lesson Eight
NEXT: valvular heart disease