ASE VS guidelines
TS
Causes: Rheumatic (with MS), Carcinoid (always with TR, severe immobility of the
leaves described as
frozen appearance), rare congenital, PM endocarditis,
PM-induced adhesions, lupus valvulitis, benign or malignant tumor obstruction.
reduced leaflet separation at peak opening, and right atrial enlargement
thickening and opened appearance of the valve. The right panel
shows a continuous-wave Doppler recording through the tricuspid
valve. Note an elevated peak diastolic velocity of 1.6 m/s and the
systolic TR recording.
Stenotic tricuspid valve obtained during diastole. Note the thickening
and
diastolic doming of the valve, and the marked enlargement of the
right atrium (RA)
. The right panel shows a CW Doppler recording through
the tricuspid valve. Note the elevated peak diastolic velocity of 2 m/s
and the systolic tricuspid regurgitation (TR) recording.
The hallmark of a stenotic valve is an increase in transvalvular velocity recorded by CWD. Peak
inflow velocity through a normal tricuspid valve rarely exceeds 0.7 m/s. Tricuspid inflow is normally
accentuated during inspiration; consequently, with TS, it is common to record peak velocities
1.0m/s that may approach 2 m/s during inspiration. As a general rule, the mean pressure gradient
derived using the
4v2 equation is lower in tricuspid than in MS, usually ranging between 2 and 10
mmHg, and averaging around
5 mmHg. Higher gradients may be seen with combined stenosis and
regurgitation. The primary consequence of TS is elevation of right atrial pressure and development
of right-sided congestion.Because of the frequent presence of TR, the transvalvular gradient is
clinically more relevant for assessment of severity and decision-making than the actual stenotic valve
area.

Because anatomical valve orifice area is difficult to measure and TR is so frequently present, the
typical CWD methods for valve area determination are not very accurate. The pressure half-time
method
(T1/2) has been applied in a manner analogous to MS. Some authors have used the same
constant of 220, while others have proposed a constant of 190 with valve area determined:
TVA = 190 / T1/2
Although validation studies with TS are less than those with MS, valve area by the T1/2 method may
be less accurate than in MS. This is probably due to differences in atrioventricular compliance
between the right and left side, and the influence of right ventricular relaxation, respiration, and TR
on the pressure half-time. However,
as a general rule, a longer T1/2 implies a greater TS
severity with values 190 frequently associated with significant (or critical) stenosis.

Should provide a robust method for determining the effective valve area as SV divided by the
tricuspid inflow VTI as recorded with CWD
.The main limitation of the method is obtaining an
accurate measurement of the inflow volume passing through the tricuspid valve. In the absence of
significant TR, one can use the SV obtained from either the left or right ventricular outflow; a valve
area of
1 cm2 is considered indicative of severe TS. However, as severity of TR increases,
valve area is progressively underestimated by this method. Nevertheless, a value 1 cm2, although it
is not accounting for the additional regurgitant volume, may still be indicative of a significant
hemodynamic burden induced by the combined lesion.
1- Mean
Equation: