Step 1: Obtain a
continuous wave doppler of the tricuspid valve. The optimal view
is the midesophageal or gastroesophageal of the long axis of the tricuspid
valve. In this view the tricuspid valve is in it's long axis
and provides the best angle to doppler the gradient's across the valve.
An alternative view is the bicaval view of the atrial septum where
the tricuspid valve is visible or the RVIO view where a good angle
can be obtained. Occasionally, a transgastric view of the tricuspid
valve may also offer a good angle of the tricuspid valve. Once
the view is obtained turn on the CWD and use the track ball to move
the CWD line to the tricuspid valve. A doppler profile of the tricuspid
valve should be displayed with high velocities in tricuspid stenosis.
If a poor or low velocity doppler wave form is displayed reposition
the view and move the CWD line thru out the valve. The CWD must be
parallel to the stenotic jet to pick up the maximal velocity and obtain
a good doppler wave form. After a good doppler wave form is obtained
look at the morphology of the waveform and note it. A profile
that has a large gradient across the valve will exhibit a "filling
in" pattern, whereas a low or normal gradient flow profile will
have a scattered filled in pattern. The amount of filling of
the flow profile is related to the amount of turbulence across the
valve. Place the trackball point at the peak of the flow profile
and note the velocity.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.
The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.