Clinical Echocardiography
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Introduction to echocardiography and ultrasound imaging12 Chapters
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Physics of ultrasound
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The ultrasound transducer
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Technical aspects of the ultrasound image
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Two-dimensional (2D) echocardiography
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Optimization of the ultrasound image
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M-mode (motion mode) echocardiography
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Doppler effect and Doppler echocardiography
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Pulsed Wave Doppler
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Continuous Wave Doppler (CW Doppler)
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Color Doppler
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Tissue Doppler (Tissue Velocity Imaging)
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Artifacts in ultrasound imaging
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Physics of ultrasound
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Principles of hemodynamics5 Chapters
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The echocardiographic examination3 Chapters
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Left ventricular systolic function and contractility11 Chapters
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Left Ventricular Function
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Myocardial Mechanics: Structure and Function of Myocardial Fibers
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Ventricular Pressure-Volume Relationship: Preload, Afterload, Stroke Volume, Wall Stress & Frank-Starling's law
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Assessing left ventricular systolic function
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Left ventricular mass and volume (size)
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Ejection fraction (EF): Physiology, Measurement & Clinical Evaluation
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Fractional shortening for estimation of ejection fraction
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Strain, strain rate and speckle tracking: Myocardial deformation
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Left Ventricular Segments for Echocardiography and Cardiac Imaging
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The Coronary Arteries
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Regional Myocardial Contractile Function: Wall Motion Abnormalities
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Left Ventricular Function
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Left ventricular diastolic function3 Chapters
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Cardiomyopathies6 Chapters
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Heart failure: Causes, types, diagnosis, treatments & management
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Echocardiography in cardiomyopathies: an overview
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Hypertrophic Cardiomyopathy (HCM) & Hypertrophic Obstructive Cardiomyopathy (HOCM)
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Dilated Cardiomyopathy (DCM): Definition, Types, Diagnostics & Treatment
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Arrhythmogenic Right Ventricular Cardiomyopathy / Dysplasia (ARVC, ARVD)
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Tachycardia induced cardiomyopathy
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Heart failure: Causes, types, diagnosis, treatments & management
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Valvular heart disease8 Chapters
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Miscellaneous conditions5 Chapters
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Pericardial disease2 Chapters
Tricuspid stenosis
Tricuspid valve stenosis
Tricuspid stenosis is a rare condition that may be caused by rheumatic valvular disease, congenital heart disease, Whipple’s disease, or tumors. Rheumatic disease is the most common cause, in which scenario tricuspid stenosis is virtually always accompanied by aortic or mitral disease (most commonly mitral stenosis). Simultaneous tricuspid regurgitation is also common.
Chapter content
ToggleEchocardiography
Echocardiography has replaced catheterization for the assessment of tricuspid stenosis. Yet, there is no consensus regarding grading of tricuspid stenosis severity.
Tricuspid stenosis is visually characterized by thickened leaflets, with reduced motion and potentially fused commisures. Continuous Doppler is used to assess the stenosis. Doppler recordings are made during inspiration (velocities across the valve are greater during inspiration). The following findings are indicative of tricuspid stenosis:
- Maximum flow velocity exceeds 1 m/s.
- Pressure half time (PHT) exceeds 190 ms in pronounced stenosis.
- Mean pressure gradient >5.0 mmHg suggests a clinically significant stenosis.
Tricuspid stenosis results in increased right atrial pressure, which subsequently causes right atrial dilation. Vena cava inferior may also dilate secondarily.
Principles of management
- Medical therapies do not alter disease progression. Diuretics may be used for symptom relief.
- Surgical repair or valve replacement is considered when medical therapy is insufficient, or when concomitant valvular disease (e.g mitral stenosis) requires intervention.
- Valve replacement can be performed with biological or mechanical prostheses. The former is preferred due to the lower risk of thrombosis and evidence demonstrating long-term durability (Filsoufi et al).
- Percutaneous interventions lack long-term safety and efficacy data.