Imaging

Tricuspid Stenosis

Preliminary Diagnosis: Tricuspid stenosis

I. What imaging technique is first-line for this diagnosis?

Echocardiography (transesophageal offers better resolution compared with transthoracic)

II. Describe the advantages and disadvantages of this technique for diagnosis of tricuspid stenosis.

Advantages

  • Highly portable, fast, and relatively inexpensive imaging modality.

  • Does not expose patients to ionizing radiation.

  • Offers exquisite visualization of turbulent flow across the valve and details high pressure gradients seen in patients with tricuspid stenosis.

Disadvantages

  • Highly operator-dependent.

  • Cannot be used for intervention.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to echocardiography exist.

IV. What alternative imaging techniques are available?

  • Cardiac CT

  • Cardiac MR

  • Conventional cardiac angiography.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tricuspid stenosis.

Cardiac CT

Advantages

  • Offers exquisite detail of the surrounding soft tissues, osseous structures, and vascular structures.

  • CT imaging is more sensitive and specific in evaluating for calcification of the leaflets than other imaging modalities

Disadvantages

  • Does not offer dynamic imaging capability

  • Exposes patients to ionizing radiation

Cardiac MR

Advantages

  • Does not expose patients to ionizing radiation.

  • May help obtain cine images which help detect abnormal jet flow, helping to make a diagnosis of tricuspid stenosis.

Disadvantages

  • Expensive

  • Time-consuming

  • Must be cardiac gated

  • May be subject to motion artifact and flow artifact from inadequate gating

Conventional cardiac angiography

Advantages

  • Useful in diagnosis and treatment of patients with tricuspid stenosis

  • Offers exquisite dynamic imaging capability and delivers highly specific information on valvular flow.

Disadvantages

  • Less exquisite in detailing the anatomy of the surrounding soft tissues, vascular structures, and osseous structures

  • Exposes patients to large amounts of ionizing radiation.

  • Highly invasive and is associated with more morbidity and mortality compared with companion non-invasive imaging techniques.

VI. What are the contraindications for the alternative imaging techniques?

Cardiac CT

May not be performed in pregnant patients.

Cardiac MR

Contraindicated in patients with non-MR compatible hardware.

Conventional cardiac angiography

Contraindicated in patients who are in a severe hypocoaguable state. Non-iodine-based contrast agents such as CO2 may have to be used in patients with a contrast allergy.

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