Research On Measurement Views Of Tricuspid Regurgitation Velocity In Different Configuration Of Right Heart By Echocardiography

Objectives To explore the feature of the different functional tricuspid regurgitation,analyse the accuracy of tricuspid regurgitation velocity measurement,get the best measurement views of tricuspid regurgitation velocity by echocardiography.Methods We selected 80 adult patients with tricuspid regurgitation examined by transthoracic echocardiography in the hospital from April to December 2015.Exclusion criteria:(1).TR was multi-beam;(2).The organic tricuspid diseases: congenital malformation,trauma,inflammation or carcinoid heart disease;(3).Arrhythmia;(4).Iatrogenic TR pacemaker,cardiac resynchronization therapy CRT/CRTD;(5).The tricuspid valve for mechanical/biological after valve replacement;(6).The transthoracic echocardiography in patients with poor image quality.Consummated the information of the patients included the sex,age,concomitant disease,etc.Patients were connected with synchronous ECG,kept the left side and quiet breathing.According to the method recommended by the American Society of echocardiography(ASE)guidelines,the right ventricular basal diameter(RVBD),right atrial diameter(RAL-RD)and the right upper and lower diameter(RAS-ID)of the right ventricle were measured in the apical four chamber of cardiac view.According to the size of right atrium(RA)and or maybe right ventricle(RV),they were divided into two groups: the normal size group and the enlargement size group.We recorded the Color Doppler and continuous Doppler dynamic images of tricuspid regurgitation in the views of parasternal long-axis of right ventricular inflow,parasternal short axis of aortic-root,apical four chamber of cardiac and parasternal four chamber of cardiac.The sampling line was respectively passing by the tricuspid orifice,measured the angle between sound beam and regurgitation,which was sound beamregurgitation angle.The sampling line was passing by the tricuspid regurgitation flow convergence area,to obtain the continuous Doppler spectrum,to measure the peak velocity of the 3 cardiac cycles;the TRVmax was taken as the tip velocity of the tricuspid regurgitation.Results(1).The TRVmax and TRVmin in different views were inconsistency,67.5% were out of the 1.96 standard deviation interval.(2).The TRVmax tended to smaller.Comparing the average value in the views of apical four chamber of cardiac and parasternal four chamber of cardiac(12°±8.1° vs 26°±10.0°),there were significant difference(P<0.05),the latter might get smaller average.(3).TR in different right heart: in the normal group,20 patients were central regurgitation and 26 patients were eccentric regurgitation;there was no frequency significant difference(P>0.05)between them.While in the right heart enlargement group,there were 26 central regurgitation and 9 eccentric regurgitation,it was significant difference(P<0.05).(4).The views of TRVmax: the eccentric TRVmax was mainly focus on the views of parasternal four chamber of cardiac and parasternal long-axis of right ventricular inflow,there were no significant difference between them(P>0.05),comparing with other views,there were significant difference(P<0.05);while the central TRVmax was parasternal four chamber of cardiac,there were significant difference comparing with other views respectively(P<0.05).(5).The average TRV of different views: the central TRV average value was maximal in the view of parasternal four chamber of cardiac comparing with others'(P<0.05).The eccentric TRV average values in the views of p parasternal long-axis of right ventricular inflow and parasternal four chamber were no significant difference(P>0.05).Conclusions Choose the best view of measuring TRV according to the different configuration of right heart,which would promote the accuracy and the inefficient.Views of parasternal four chamber of cardiac and parasternal long-axis of right ventricular inflow should be used in the normal group,and the smaller beam-sound regurgitation angle would be better.While for the right heart enlargement group,mainly the eccentric regurgitation,view of parasternal four chamber of cardiac would be used.