Tricuspid Regurgitation

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.