Imaging
Tricuspid Regurgitation
- Preliminary Diagnosis: Tricuspid regurgitation
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of tricuspid regurgitation.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tricuspid regurgitation.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Tricuspid regurgitation
I. What imaging technique is first-line for this diagnosis
Transthoracic 2-D echocardiography
II. Describe the advantages and disadvantages of this technique for diagnosis of tricuspid regurgitation.
Advantages
Offers exquisite anatomical and functional imaging.
Does not expose patients to ionizing radiation.
Detects pressure gradients and velocities across a diseased valve and helps guide treatment.
Disadvantages
Operator-dependent
III. What are the contraindications for the first-line imaging technique?
No specific contraindications exist.
IV. What alternative imaging techniques are available?
PA and Lateral view of the chest.
CTA
MR/MRA of the heart
Conventional cardiac catheter angiography
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tricuspid regurgitation.
PA and Lateral view of the chest
Advantages
Relatively inexpensive, portable imaging modality
Exposes patients to negligible ionizing radiation.
Disadvantages
Poor specificity in detecting and diagnosing tricuspid regurgitation.
Does not allow for adequate delineation of the surrounding anatomical structures.
CTA
Advantages
Offers exquisite detail of the anatomical structures, including vascular, soft tissue, lymphatic, and osseous structures.
Disadvantages
Exposes patients to ionizing radiation.
Does not allow for therapeutic intervention.
MR/MRA of the heart
Advantages
Does not expose patients to ionizing radiation.
Disadvantages
Expensive
Time-consuming
Offers less exquisite detail of the surrounding vascular structures than other imaging modalities
May be subject to motion and susceptibility-weighted image artifact.
Must be cardiac gated.
Conventional cardiac catheter angiography
Advantages
Offers exquisite detail of the cardiac valvular architecture and helps detect any other coexisting abnormalities
Allows the opportunity for diagnosis and therapeutic intervention simultaneously
Disadvantages
Exposes patients to greater morbidity and mortality secondary to the invasive nature of the exam.
Exposes patients to larger amounts of ionizing radiation.
VI. What are the contraindications for the alternative imaging techniques?
PA and Lateral view of the chest
No significant contraindications. Some institutions may require consent in pregnant patients.
CTA
May be contraindicated in pregnant patients.
MR/MRA of the heart
Contraindicated in patients with non-MR compatible hardware.
Conventional cardiac catheter angiography
Contraindicated in patients who are in a severe hypocoaguable state.
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