Q. Investigation of Tricuspid stenosis by Echocardiography?

Findings are subtle. One should carefully search for organic tricuspid valve involvement in all rheumatic heart disease patients. Findings include thickened tricuspid valve leaflets with doming motion, commissural fusion and chordal thickening.

2D echo helps in determining the etiology and nature of tricuspid valve involvement. Doppler findings are very helpful. Normal velocities across tricuspid valve are less than 1m/sec with a mean gradient of less than 2 mmHg. Tricuspid stenosis is considered significant when mean gradient is > 7 mmHg or PHT is > 190 ms. It is better to measure at held expiration to avoid respiratory variation. Accurate Doppler evaluation excludes the need for cardiac catheterization.