Login Here · Help · Public User
I just wanted to let you know that even though I'm looking quite old, I'm still a millenial.
So I just had a "New Year, New Me" moment and my resolution is to become a new and improved version of myself in a couple of weeks.
Don't worry, my wisdom won't change. You're still going to find the same useful information here. Stay tuned!
AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.
|Go to the COTW Archive|
The left atrium and the right atrium are enlarged. The right ventricle is enlarged. The left ventricle is mildly enlarged. The posterior mitral valve leaflet (P2) exhibits some calcification and has some restriction of the leaflet base. The mitral valve and tricuspid valve annulus are enlarged. The leaflets do not appear to be restricted except for the calcified area around the base of P2. The aortic valve exhibits an 'en face' view but appears normal. There is a chiari formation present. A small pericardial effusion is present. The pulmonary vein systolic wave is not blunted but the left atrium is so large that the systolic wave may not be affected. The hepatic vein Doppler exhibits systolic suppression from the severe tricuspid regurgitation.
The recommended therapy would be mitral and tricuspid valve repair with a ring. Since no restriction or prolapse/flail is present, the leaflets do not need to be altered. Since the etiology is not ischemic mitral regurgitation, the repair should have a high success rate.
After the repair, the tricuspid valve has a trace of regurgitation. The mitral valve post repair regurgitation is mild to moderate and the velocity of the jet is lower velocity in that there is no aliasing present.
Tricuspid annular dilation, even in the absence of regurgitation, should be repaired in the presence of mitral regurgitation. Significant tricuspid regurgitation decreases survival and increases complications. Repair of the mitral regurgitation will not reverse the amount of tricuspid regurgitation. Severe TR is a Class 1/1C recommendation for tricuspid valve repair.
The success of tricuspid valve repair for a dilated annulus should approach 80-100% in patients who have a mitral valve repair at the same time. Atrial fibrillation is a major factor in the progression of tricuspid regurgitation and if the annulus is not dilated and signficant TR is not present, then a MAZE procedure should be performed on patients undergoing mitral valve repair to prevent the long term consequences of unchecked atrial fibrillation and the progression of tricuspid regurgitation.
In patients who have severe mitral regurgitation, a dilated tricuspid valve annulus is a risk factor for the development of significant tricuspid regurgitation. A tricuspid annulus diameter > 4.0 cm will result in the development of clinically significant TR even if the TR is negligble at the time of the mitral valve repair.
The post repair regurgitation of the mitral valve was mild to moderate by jet area. However, the velocity of the jet was low so it was felt that the repair was adequate.
|Please answer the following questions correctly to obtain your CME.|
Echocardiographic assessment and clinical management of tricuspid regurgitation.
Echocardiographic-based treatment of functional tricuspid regurgitation.
Evolving indications for tricuspid valve surgery.
Tricuspid regurgitation: contemporary management of a neglected valvular lesion.
Transesophageal Doppler echocardiography of pulmonary venous flow: a new marker of mitral regurgitation severity.