Imaging

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.

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