Q. Hemodynamic Measurements of tricuspid stenosis?

Unless one suspects it clinically and echocardiographically, and plans the hemodynamic study - diagnosis of tricuspid stenosis is easily missed at routine catheterization. Prominent ‘a' wave in right atrial pressure trace in a patient with sinus rhythm should make one suspect tricuspid stenosis. Pull back gradient especially in a patient with atrial fibrillation can easily miss the gradient. One should place two catheters simultaneously in RA and RV and measure the diastolic gradient. These small gradients can be exaggerated by exercise.