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
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Highly portable, fast, and relatively inexpensive imaging modality.
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Does not expose patients to ionizing radiation.
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Offers exquisite visualization of turbulent flow across the valve and details high pressure gradients seen in patients with tricuspid stenosis.
Disadvantages
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Highly operator-dependent.
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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?
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Cardiac CT
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Cardiac MR
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Conventional cardiac angiography.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tricuspid stenosis.
Cardiac CT
Advantages
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Offers exquisite detail of the surrounding soft tissues, osseous structures, and vascular structures.
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CT imaging is more sensitive and specific in evaluating for calcification of the leaflets than other imaging modalities
Disadvantages
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Does not offer dynamic imaging capability
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Exposes patients to ionizing radiation
Cardiac MR
Advantages
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Does not expose patients to ionizing radiation.
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May help obtain cine images which help detect abnormal jet flow, helping to make a diagnosis of tricuspid stenosis.
Disadvantages
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Expensive
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Time-consuming
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Must be cardiac gated
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May be subject to motion artifact and flow artifact from inadequate gating
Conventional cardiac angiography
Advantages
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Useful in diagnosis and treatment of patients with tricuspid stenosis
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Offers exquisite dynamic imaging capability and delivers highly specific information on valvular flow.
Disadvantages
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Less exquisite in detailing the anatomy of the surrounding soft tissues, vascular structures, and osseous structures
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Exposes patients to large amounts of ionizing radiation.
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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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