[An optimized contrast echocardiographic method for the detection and quantification of tricuspid valve...

In 47 patients the incidence and extent of tricuspid insufficiency (TI) was determined by two different contrast echocardiographic methods. In 18 patients severe mitral stenosis, in 7 patients combined mitral valve disease and in 6 patients severe mitral insufficiency were diagnosed by cardiac catheterisation. 3 patients had mitral and aortic insufficiency, one patient severe aortic stenosis and 2 patients aortic insufficiency. In 9 patients the study was performed after mitral valve replacement, in 1 patient after aortic valve replacement. 1 patient had no valvular heart disease. All patients underwent right heart catheterisation and biplane cineventriculography of the right ventricle within two days of echocardiography. Method A: Echocardiography of the inferior vena cava. Method B: Direct contrast echocardiography of the tricuspid valve in the short parasternal plane. Compared with the hemodynamic study, sensitivity of method A was 62% and specificity 89% in detection of TI. Both the sensitivity and specificity of method B were 100%. A TI grade I was diagnosed in 6 of 10 patients with method A and in 9 of 10 patients with method B, a TI grade II in 8 of 9 patients with method A and in 10 with method B. A severe TI (III) was diagnosed in only 4 of 7 patients with method A and in all 7 patients with method B. The results suggest that direct contrast echocardiography of the tricuspid valve in patients with rheumatic valve disease is a highly sensitive and specific method in detection and quantification of TI in comparison to the vena cava method.