Diagnosis of tricuspid regurgitation by contrast echocardiography.

Abstract

Patients (62) underwent M-mode and 2-dimensional echocardiographic studies that included imaging of the inferior vena cava (IVC) during upper extremity contrast injections. Group 1 consisted of 10 patients wth clinical tricuspid regurgitation (TR). Group 2 consisted of 40 patients without definite clinical signs of TR but with conditions commonly associated with TR (e.g., mitral valve disease, pulmonary hypertension, former tricuspid valve surgery). Group 3 consisted of 12 normal subjects. The IVC could be imaged by 2-dimensional echocardiography followed by M-mode in all subjects. M-mode IVC measurements in the absence of contrast were not sufficient to reliably separate TR patients from non-TR patients. IVC contrast was imaged, frequently during deep inspiration, in all group 1 patients, 36 group 2 patients and 3 group 3 normal subjects. Three patterns of contrast appearance in the IVC were observed: v-wave synchronous patterns in all but 2 patients with TR and a-wave synchronous or random patterns in patients without TR. The presence of TR was independently assessed during angiography or surgery in 26 patients. There were 2 false-negative echo studies as judged by intraoperative palpation of a thrill on the right atrium. There were no false-positive v-wave synchronous studies. M-mode echocardiography was superior to 2-dimensional echocardiography in detection of the appearance of contrast in the IVC and ease of pattern interpretation. Recognition of false-positive (a-wave synchronous or random) and false-negative patterns (insufficient central contrast, excessively inferior transducer position) improves the diagnostic accuracy of contrast IVC echocardiography, which is a sensitive and specific method for diagnosing TR.