Echokardiografia (Trikuspidálna chlopňa)

Tricuspid valve PISA and alising velocity

Vmax TR (Peak tricuspidal regurgitation velocity)

EROA = 2π x PISAr² x Va / Vmax TR

Effective regurgitant orifice area

Efektívna plocha regurgitačného orificia.

Je najužšia časť trikuspidálneho regurgitačného prúdu

Slúži na výpočet RegVol_TR

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Echocardiography: tricuspid regurgitation severity echo

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Tricuspid valve PISA (Proximal isovelocity surface area radius)

PISAr

Proximal isovelocity surface area radius

Vzdielenosť od vena contracta po prvý aliasing flow convergence

Vena contracta je najužšia časť regurgitačného prúdu.
Flow convergenece je proximálny regurgitačný prúd ktorý sa zbieha ku orificiou a vytvára hemisféru

Slúži na výpočet EROA
A4C (so zameraním na pravú komoru)

Zoom mode (so zameraním na trikuspidálnu chlopňu)

Mid-systola (EKG: Začiatok T vlny).
Color doppler

Baseline posúvame dole. Nyquist limit: 30-40cm/s

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Va

Aliasing velocity

Manuálne nastavená hodnota na echoprístroji.
Slúži na výpočet EROA.
Nyquist limit sa nastavuje na 50-70cm/s
Pri diagnostike trikuspidálnej regurgitácie sa posúva hranica "baseline"

v smere regurgitačného prúdu na 30-40cm/s.

Ak prúd krvi od sondy (modrý) prekročí rýchlosť Va (38,5cm/s)

tak vznikne aliasing

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Apical 4 chamber (A4C). Tricuspid valve CW doppler

Vmax TR

Peak tricuspidal regurgitation velocity

Maximálna rýchlosť prúdu trikuspidálnej regurgitácie
Slúži na výpočet EROA
A4C (so zameraním na pravú komoru)
Systola (EKG: R kmit - koniec T vlny)
CW doppler

Kurzor sa umiestni medzi cípy trikuspidálnej chlopne.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid valve VCW (Vena contracta width)

VCW

Vena contracta width

Najužšia časť regurgitačného prúdu cez orificium.
Zodpovedá šírke EROA (Effective Regurgitant Orifice Area).
A4C (so zameraním na pravú komoru)

Zoom mode (so zameraním na trikuspidálnu chlopňu).

Color doppler (Nyquist limit: 50-70cm/s).

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

VTI TR (Velocity time integral of tricuspidal regurgitant jet)

RegVol_TR = EROA x VTI TR

Regurgitant volume of tricuspidal regurgitation

Regurgitačný objem trikuspidálnej regurgitácie.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

VTI TR

Velocity time integral of tricuspidal regurgitant jet

Velocity time integral trikuspidálnej regurgitácie.
Slúži na výpočet RegVol_TR
A4C (so zameraním na pravú komoru)
Systola (EKG: R kmit - koniec T vlny)
CW doppler

Kurzor sa umiestni medzi cípy trikuspidálnej chlopne.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

RegJet_{soft density}

Regurgitant jet soft density

Denzita a tvar prúdu trikuspidálnej regurgitácie.

Denzita je priamo úmerná počte erytrocytov v prúde
Čím viac erytrocytov, tým je denzita silnejšia

A4C (so zameraním na pravú komoru)
Systola (EKG: R kmit - koniec T vlny)
CW doppler
Denzita sa porovnáva s neregurgitačným prúdom
Slabá denzita regurgitačného prúdu svedčí pre miernu trikuspidálnu regurgitáciu.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RegJet_{hard density}

Regurgitant jet hard density

Denzita a tvar prúdu trikuspidálnej regurgitácie.

Denzita je priamo úmerná počte erytrocytov v prúde
Čím viac erytrocytov, tým je denzita silnejšia

A4C (so zameraním na pravú komoru)
Systola (EKG: R kmit - koniec T vlny)
CW doppler
Denzita sa porovnáva s neregurgitačným prúdom
Silná denzita regurgitačného prúdu svedčí pre závažnú trikuspidálnu regurgitáciu.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Dominant tricuspidal A wave (A wave > E wave)

Apical 4 chamber (A4C) PW doppler of tricuspid valve inflow

A wave_dominant

Dominant tricuspidal A wave (A wave > E wave)

Charakter prúdu cez trikuspidálnu chlopňu počas diastoly (E vlna, A vlna)
A4C (so zameraním na pravú komoru).
Neskorá diastola (EKG: Tesne po P vlne).
PW doppler.

Kurzor sa umiestni medzi cípy trikuspidálnej chlopne.

Dominantná A vlna svedčí pre miernu trikuspidálnu regurgitáciu.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RA major

Right atrium major axis dimension

Longitudinálna dĺžka pravej predsiene.
A4C (so zameraním na pravú komoru).
End systola (EKG: koniec T vlny).
Meria sa od stredu trikuspidálneho annulu paralelne so septom.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Right atrium (Size)
Variable	Abnormal
RA major (mm) Right atrium major axis dimension	>53
RA minor (mm) Right atrium minor axis dimension	>44
RA area (cm²) Right atrial area	>18

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

RVD1_basal

Right ventricular basal diameter at end-diastole

Maximálna šírka bázy pravej komory.
A4C (so zameraním na pravú komoru).
End-diastola (EKG: R kmit).
Meria sa tesne nad trikuspidálnym annulom.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Right ventricle (Size)
RVD1_basal Right ventricular basal diameter at end-diastole	25 - 41mm
RVD2_mid Right ventricular mid diameter at end-diastole	19 - 35mm
RVD3_long Right ventricular longitudinal diameter at end-diastole	59 - 83mm
RVOT_prox(PLAX) Right ventricular outflow tract at proximal (PLAX)	20 - 30mm
RVOT_prox(PSAX) Right ventricular outflow tract at proximal (PSAX)	21 - 35mm
RVOT_distal(PSAX) Right ventricular outflow tract at distal (PSAX)	17 - 27mm
PA_diameter Main pulmonary artery diameter	15 - 25mm
RVWT Right ventricular wall thickness	1 - 5mm

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: ASE, EACVI, ESC, CSE (2010)

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

Guidelines for the diagnosis and management of acute pulmonary embolism ESC, ERS (2019)

TV_annulus

Tricuspid valve annulus diameter

Priemer trikuspidálneho annulu.
A4C (so zameraním na pravú komoru)

Zoom mode (so zameraním na trikuspidálnu chlopňu)

End-diastola (EKG: R kmit).
Dilatovaný trikuspidálny annulus svedčí pre závažnú trikuspidálnu regurgitáciu.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Ratio regurgitant jet area and right atrium - RA area

RegJet/RA area = RegJet_area / RA area x 100

Ratio RegJet_area / RA area

Percentuálny pomer plochy jetu a plochy pravej predsiene.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RegJet_area

Regurgitation jet area

Plocha regurgitačného jetu
Slúži na výpočet RegJet/RA area
A4C (so zameraním na pravú komoru)

Zoom mode (so zameraním na trikuspidálnu chlopňu)

Systola (EKG: R kmit - koniec T vlny)
Color doppler

Nyquist limit: 50-70cm/s

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RA area

Right atrial area

Plocha pravej predsiene
Slúži na výpočet RegJet/RA area
A4C (so zameraním na pravú komoru)

Zoom mode (so zameraním na trikuspidálnu chlopňu)

End systola (EKG: koniec T vlny).
Color doppler

Nyquist limit: 50-70cm/s

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

SC window (Hepatic vein) PW doppler of hepatic vein

HV_{reversal flow}

Hepatic vein reversal flow

Reverzný prúd v hepatálnej véne počas systoly komôr
SC projekcia (so zameraním na hepatálnu vénu)
Systola (EKG: R kmit - koniec T vlny)
PW doppler

Kurzor sa umiestni do ústia hepatálnej vény

Svedčí pre závažnú trikuspidálnu regurgitáciu

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

HV_{forward flow}

Hepatic vein forward flow

Dominantný systolický prúd (nereverzný, do VCI) v hepatálnej véne počas systoly komôr
SC projekcia (so zameraním na hepatálnu vénu)
Systola (EKG: R kmit - koniec T vlny)
PW doppler

Kurzor sa umiestni do ústia hepatálnej vény

Svedčí pre miernú trikuspidálnu regurgitáciu.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RVOT diastal (Right ventricular outflow tract dimension at distal)

RVOT VTI (Velocity time integral of right ventricular outflow tract)

SV_PV = CSA_RVOT x VTI_RVOT

Stroke volume of pulmonary valve

Pulzový objem cez pulmonálnu chlopňu.
Slúži na výpočet TrVA
Je rovnaký ako pulzový objem cez trikuspidálnu chlopňu.

Ale nesmie byť prítomná trikuspidálna regurgitácia.

Vypočítate ho v menu: PuCH

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

VTI TV (Velocity time integral of tricuspid valve - inflow)

RV modified apical 4 chamber (A4C) CW doppler of tricuspid valve inflow

VTI TrV

Velocity time integral of tricuspid valve (inflow)

Velocity time integral trikuspidálneho inflow prúdu.
Slúži na výpočet TrVA
A4C (so zameraním na pravú komoru)
Diastola (EKG: Koniec T vlny - R kmit)
CW doppler

Kurzor sa umiestni na inflow prúd trikuspidálnej chlopne

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid stenosis
Variable	Abnormal
meanPG TrV* Mean pressure gradient tricuspidal valve	≥5mmHg
VTI TrV* Velocity time integral of tricuspid valve (inflow)	>60cm
PHT TrV* Pressure half time of tricuspidal valve	≥190ms
TrVA* Tricuspid valve area (continuity equation)	≤1cm²
RA major Right atrium major axis dimension	>50mm
IVC_diameter Inferior vena cava diameter	>2,1cm

* Specific findings

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

meanPG TV (Mean pressure gradient tricuspidal valve)

meanPG TrV

Mean pressure gradient tricuspidal valve

Stredný tlakový gradient na trikuspidálnej chlopni
A4C (so zameraním na pravú komoru)
Diastola (EKG: Koniec T vlny - R kmit)
CW doppler

Kurzor sa umiestni na stenotický prúd trikuspidálnej chlopne

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid stenosis
Variable	Abnormal
meanPG TrV* Mean pressure gradient tricuspidal valve	≥5mmHg
VTI TrV* Velocity time integral of tricuspid valve (inflow)	>60cm
PHT TrV* Pressure half time of tricuspidal valve	≥190ms
TrVA* Tricuspid valve area (continuity equation)	≤1cm²
RA major Right atrium major axis dimension	>50mm
IVC_diameter Inferior vena cava diameter	>2,1cm

* Specific findings

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

PHT TV (Pressure half time of tricuspidal valve)

PHT TrV

Pressure half time of tricuspidal valve

Polčas poklesu iniciálneho tlakového gradientu
A4C (so zameraním na pravú komoru)
Diastola (EKG: Koniec T vlny - R kmit)
CW doppler

Kurzor sa umiestni na stenotický prúd trikuspidálnej chlopne

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid stenosis
Variable	Abnormal
meanPG TrV* Mean pressure gradient tricuspidal valve	≥5mmHg
VTI TrV* Velocity time integral of tricuspid valve (inflow)	>60cm
PHT TrV* Pressure half time of tricuspidal valve	≥190ms
TrVA* Tricuspid valve area (continuity equation)	≤1cm²
RA major Right atrium major axis dimension	>50mm
IVC_diameter Inferior vena cava diameter	>2,1cm

* Specific findings

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Right ventricular outflow tract dimension at distal

Velocity time integral of right ventricular outflow tract

Velocity time integral of tricuspid valve (inflow)

TrVA = SV_PV / VTI TrV

Tricuspid valve area (continuity equation)

Efektívna plocha trikuspidálnej stenózy.
TrVA je podhodnotená ak je prítomná stredná alebo závažná trikuspidálna regurgitácia.

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid stenosis
Variable	Abnormal
meanPG TrV* Mean pressure gradient tricuspidal valve	≥5mmHg
VTI TrV* Velocity time integral of tricuspid valve (inflow)	>60cm
PHT TrV* Pressure half time of tricuspidal valve	≥190ms
TrVA* Tricuspid valve area (continuity equation)	≤1cm²
RA major Right atrium major axis dimension	>50mm
IVC_diameter Inferior vena cava diameter	>2,1cm

* Specific findings

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

SC (subcostal view) long axis inferior vena cava IVC.

IVC_diameter

Inferior vena cava diameter

Maximálny priemer veny cavy inferior.
SC projekcia (so zameraním na vena cava inferior).
Koniec expíria
Meria sa najväčší priemer vena cava inferior (koniec expíria).

1-3cm od kavoatriálnej junkcie (proximálne od hepatálnej vény).

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid stenosis
Variable	Abnormal
meanPG TrV* Mean pressure gradient tricuspidal valve	≥5mmHg
VTI TrV* Velocity time integral of tricuspid valve (inflow)	>60cm
PHT TrV* Pressure half time of tricuspidal valve	≥190ms
TrVA* Tricuspid valve area (continuity equation)	≤1cm²
RA major Right atrium major axis dimension	>50mm
IVC_diameter Inferior vena cava diameter	>2,1cm

* Specific findings

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Inferior vena cava (Size)
Variable	Abnormal
IVC_diameter Inferior vena cava diameter	>2,1cm

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

Echokardiografia

Trikuspidálna chlopňa

Va

VCW

PISAr

Vmax TR

EROA

VTI TR

RegVolTR

RegJetsoft density

RegJethard density

A wavedominant

RA major

RVD1basal

TVannulus

RegJetarea

RA area

RegJet/RA area

HVreversal flow

HVforward flow

SVPV

VTI TrV

TrVA

meanPG TrV

PHT TrV

IVCdiameter

EROA = 2π x PISAr2 x Va / Vmax TR

PISAr

Va

Vmax TR

VCW

RegVolTR = EROA x VTI TR

VTI TR

RegJetsoft density

RegJethard density

A wavedominant

RA major

RVD1basal

TVannulus

RegJet/RA area = RegJetarea / RA area x 100

RegJetarea

RA area

HVreversal flow

HVforward flow

SVPV = CSARVOT x VTIRVOT

VTI TrV

meanPG TrV

PHT TrV

TrVA = SVPV / VTI TrV

IVCdiameter

RegVol_TR

RegJet_{soft density}

RegJet_{hard density}

A wave_dominant

RVD1_basal

TV_annulus

RegJet_area

HV_{reversal flow}

HV_{forward flow}

SV_PV

IVC_diameter

EROA = 2π x PISAr² x Va / Vmax TR

RegVol_TR = EROA x VTI TR

RegJet_{soft density}

RegJet_{hard density}

A wave_dominant

RVD1_basal

TV_annulus

RegJet/RA area = RegJet_area / RA area x 100

RegJet_area

HV_{reversal flow}

HV_{forward flow}

SV_PV = CSA_RVOT x VTI_RVOT

TrVA = SV_PV / VTI TrV

IVC_diameter